Gastrointestinal Stromal Tumors - Recent Progress and Upcoming Challenges in a Diverse Disease

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (15 April 2023) | Viewed by 4808

Special Issue Editor


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Guest Editor
Department of Medical Oncology, Sarcoma Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
Interests: sarcomas; personalized cancer treatment; drug resistance; sarcoma models; biomarker-based clinical trials

Special Issue Information

Dear Colleagues,

Gastrointestinal Stromal tumors were among the first solid tumors to successfully be treated with tyrosine kinase inhibitors following the identification of KIT and PDGFRA as major oncogenic drivers.

The very recent years have not only added additional drugs as salvage treatments in this subgroup of GIST but also widened the molecular spectrum of non-KIT/non-PDGFRA mutant GIST. Nonetheless, metastatic GIST cannot be cured with current KIT or PDGFRA inhibitors alone.

Our understanding of the heterogeneity of resistance is rapidly improving with the availability of plasma sequencing but further progress will need strong preclinical models to prioritize and validate novel approaches, including combinations and sequences.

This Special Issue aims to focus on the current challenges in both the most common and the rare GIST subtypes. For KIT and PDGFRA mutant GIST, this includes novel mechanisms of resistance and models to recapitulate resistance in vitro. Novel targets and novel drug approaches, tumor dormancy, microenvironment observations of unusual responses, as well as aspects of multimodal approaches involving the most recent new drugs are also of great interest. Clinical cohorts of rare subtypes that help to advise patients particularly with longer follow-up.

We look forward to receiving your contributions.

Prof. Dr. Sebastian Bauer
Guest Editor

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Keywords

  • gastrointestinal stromal tumor
  • actionable mutations
  • drug resistance
  • tumor heterogeneity
  • apoptotic resistance
  • tumor dormancy
  • prognosis
  • tumor-reductive surgery
  • complications
  • drug development

Published Papers (2 papers)

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17 pages, 3310 KiB  
Article
Plasma Sequencing for Patients with GIST—Limitations and Opportunities in an Academic Setting
by Johanna Falkenhorst, Susanne Grunewald, Dawid Krzeciesa, Thomas Herold, Julia Ketzer, Miriam Christoff, Rainer Hamacher, Karina Kostbade, Jürgen Treckmann, Johannes Köster, Farhad Farzaliyev, Benjamin Samulon Fletcher, Nils Dieckmann, Moritz Kaths, Thomas Mühlenberg, Hans-Ulrich Schildhaus and Sebastian Bauer
Cancers 2022, 14(22), 5496; https://doi.org/10.3390/cancers14225496 - 09 Nov 2022
Cited by 1 | Viewed by 1466
Abstract
Circulating tumor DNA (ctDNA) from circulating free DNA (cfDNA) in GIST is of interest for the detection of heterogeneous resistance mutations and treatment monitoring. However, methodologies for use in a local setting are not standardized and are error-prone and difficult to interpret. We [...] Read more.
Circulating tumor DNA (ctDNA) from circulating free DNA (cfDNA) in GIST is of interest for the detection of heterogeneous resistance mutations and treatment monitoring. However, methodologies for use in a local setting are not standardized and are error-prone and difficult to interpret. We established a workflow to evaluate routine tumor tissue NGS (Illumina-based next generation sequencing) panels and pipelines for ctDNA sequencing in an academic setting. Regular blood collection (Sarstedt) EDTA tubes were sufficient for direct processing whereas specialized tubes (STRECK) were better for transportation. Mutation detection rate was higher in automatically extracted (AE) than manually extracted (ME) samples. Sensitivity and specificity for specific mutation detection was higher using digital droplet (dd)PCR compared to NGS. In a retrospective analysis of NGS and clinical data (133 samples from 38 patients), cfDNA concentration correlated with tumor load and mutation detection. A clinical routine pipeline and a novel research pipeline yielded different results, but known and resistance-mediating mutations were detected by both and correlated with the resistance spectrum of TKIs used. In conclusion, NGS routine panel analysis was not sensitive and specific enough to replace solid biopsies in GIST. However, more precise methods (hybridization capture NGS, ddPCR) may comprise important research tools to investigate resistance. Future clinical trials need to compare methodology and protocols. Full article
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42 pages, 1498 KiB  
Systematic Review
Health-Related Quality of Life and Side Effects in Gastrointestinal Stromal Tumor (GIST) Patients Treated with Tyrosine Kinase Inhibitors: A Systematic Review of the Literature
by Deborah van de Wal, Mai Elie, Axel Le Cesne, Elena Fumagalli, Dide den Hollander, Robin L. Jones, Gloria Marquina, Neeltje Steeghs, Winette T. A. van der Graaf and Olga Husson
Cancers 2022, 14(7), 1832; https://doi.org/10.3390/cancers14071832 - 05 Apr 2022
Cited by 16 | Viewed by 2913
Abstract
Background: The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of gastrointestinal stromal tumors (GISTs), resulting in a substantial gain in median overall survival. Subsequently, health-related quality of life (HRQoL) has become more relevant. Here, we systematically review the available literature [...] Read more.
Background: The introduction of tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of gastrointestinal stromal tumors (GISTs), resulting in a substantial gain in median overall survival. Subsequently, health-related quality of life (HRQoL) has become more relevant. Here, we systematically review the available literature on HRQoL issues and side effects of different TKIs registered for the treatment of GIST. Methods: A search through five databases was performed. Full reports in English describing HRQoL outcomes and/or side effects in GIST patients on TKI therapy were included. Results: A total of 104 papers were included; 13 studies addressed HRQoL, and 96 studies investigated adverse events. HRQoL in patients treated with imatinib, regorafenib, and ripretinib remained stable, whereas most sunitinib-treated patients reported a decrease in HRQoL. Severe fatigue and fear of recurrence or progression were specifically assessed as HRQoL issues and had a negative impact on overall HRQoL as well as psychological and physical well-being. The majority of studies focused on physician-reported side effects. Nearly all GIST patients treated with a TKI experienced at least one adverse event, mostly mild to moderate. Conclusions: Despite the fact that almost all patients treated with a TKI experienced side effects, this did not seem to affect overall HRQoL during TKI therapy. In daily practice, it are the side effects that hamper a patient’s HRQoL resulting in treatment adjustments, suggesting that the reported side effects were underestimated by physicians, or the measures used to assess HRQoL do not capture all relevant issues that determine a GIST patient’s HRQoL. Full article
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