Surgery May Extend Survival For Patients with GIST and Liver Metastases

Among patients with gastrointestinal stromal tumors (GISTs) with liver metastases, treatment with surgery and chemotherapy has been shown to have survival benefits compared with chemotherapy alone.

Researchers, who published their findings in Gastroenterology Report, stated that among 607 patients — 380 of whom were treated with chemotherapy alone and 227 of whom also underwent surgery — the combination of surgery and chemotherapy was found to increase median cancer-specific survival (CSS) by at least 63 months and the median overall survival (OS) by at least 76 months.

“This has kind of been our general consensus, that surgery can add to survival, can improve, in conjunction with medications in the metastatic setting, and maybe validates what we what we know, and our experiences in the clinic,” Dr. Gina D’Amato told CURE®. D’Amato is a Professor of Medicine at the Sylvester Comprehensive Cancer Center at the University of Miami, in Florida.

The median CSS of the chemotherapy group was 57 months, and the median OS of those patients was 44 months, while the chemotherapy and surgery arm had median CSS and OS times of more than 120 months, researchers reported.

The benefits of surgery, researchers noted, were unaffected by the timing of the procedure.

“This study confirmed that surgical resection of GIST liver metastases during systematic treatment can improve both CSS and OS, regardless of whether surgery is performed before, after, or during systemic treatment,” researchers wrote in the study.

For the study, researchers evaluated data from the Surveillance, Epidemiology and End Results database. They noted that live metastasis occurs in approximately 11% of all patients with GIST, accounting for 65% to 67% of all GIST metastases.

“It's not surprising to me that that surgery can help,” said D’Amato. “In the past, we didn't have good treatment options, so we used the surgeons. [However], we can now tailor [the approach to surgery and] say, ‘Let's have them remove these [treatment-]resistant tumors,’ and then we can analyze that with molecular profiling.”

Study researchers also wrote that these data, “provides important clinical evidence for the necessity of surgery during the systematic treatment of resectable GIST liver metastases.”

The study findings exemplify the importance of a multidisciplinary care team of experts for patients with GIST, D’Amato added.

“GIST is rare and there are a lot of treatment options available; it's a multi-disciplinary approach to taking care of [patients with] GIST,” she said. “We need all the physicians that are experts involved and helping with the patient. For example, it's not just once someone has metastatic disease. A lot of times, we just have the medical oncologist take over and we see from this study that patients are not just needing to be treated with medication. Sometimes one drug could work, but you can have someone have resistant mutations, develop in different tumors and so they need both medical management and potentially targeted therapy, whether that be a surgeon removing it, or a radiation oncologist or an interventional radiologist. It's multi-disciplinarian, and that's the importance.”

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Reference:

“The benefit of surgery during systematic therapy for gastrointestinal stromal tumor liver metastasis: a SEER-based retrospective study” by Dr. Bozhi Hu, et al., Gastroenterology Report.