| Objective To investigate effects of 3 follow-up treatment,imatinib mesylate dose incresement, switching to sunitinib malate and symptomatic treatment,on clinical symptoms and survival time in patients of gastrointestinal stromal tumors (GIST) with conventional-dose imatinib mesylate therapy failed.Method The subjects were 40 patients of gastrointestinal stromal tumors (GIST) with conventional-dose imatinib mesylate therapy failed and positive expression of CD117,admitted the Hospital from January 2002 to December 2009. 40 patients were randomly divided into the imatinib mesylate dose incresement group (14 cases), switching to sunitinib malate group (14 cases) and symptomatic treatment group(12 patients). Therapy program was given imatinib 600mg / d, sunitinib 37.5mg / d orally, until disease progression and / or the occurrence of intolerable adverse reactions. Effects were regularly evaluated through CT and other imaging examinations, to study the changes in the incidence of drug adverse reactions. Characteristic of patients with post-treatment were followed up, compared with the efficient and survival status in 3 follow-up treatment. All data were analyzed by SPSS13.0 statistical software.Results End of follow-up in June 31, 2010, 40 cases were followed up, follow-up time were from 7 to 68 months, the median follow-up time were 26 months. There weren't cases with complete remission (CR), were 1 cases (2.5%)with partial remission (PR) , 4 cases (10%) with improved or minimal remission (MR), 19 (47.5%) cases stable disease (SD) and 16 patients (40%) with progression (PD) in 40 cases. The clinical benefit rate (PR + MR + SD) and efficient (CR + PR + MR) were 60% and 12.5%, respectively. Total of 40 cases of PR, MR, SD and PD were 2.5%, 40%, 47.5% and 40%; RR was 12.5%, CBR was 60%.Followed up over 1 year were 36 patients, survival rates in 1 year and 2 year were 67.5% and 47.3%, respectively. Compared with recent efficacy of the treatment, results show that there were statistically significance in three follow-up treatments (P <0.01), efficient and clinical benefit rate in sunitinib malate group were 28.6% and 92.9%, marked higher than the other two group. Survival analysis showed that gender, KPS scores before follow-up treatment, initial metastatic sites and density of lesions decreased or not after the initial treatment were independent prognostic factors. There were better prognosis in the patients with female, more than 70 of the follow-up KPS score before treatment, simple abdominal pelvic metastasis at initial treatment, lesions density decrease after the initial treatment. However, age, primary site, recurrence site, complete resection or not, multiple and therapy history were not prognostic factors in advanced GIST after conventional treatment failed. Drug-related adverse reactions arised in 38 patients, the most common reactions were edema (68.4%), especially common eyelid edema, fatigue (42.1%), abdominal pain (18.4%), diarrhea (34.3%), decreased white blood cell count (20.5 %), rash (23.7%), tumor hemorrhage (5%), hypothyroidism (2%), hypertension (5%), hand-foot syndrome (29%), chapped skin (26%), skin discoloration (15 %), gastrocnemius muscle cramps (23%). Reactions wereâ… ~â…¡grade mostly, relieved after dose adjustment and symptomatic treatment.Conclusion Clinical benefit rate were higher, side effects were lower and tolerance were acceptable in advanced GIST treated with Sunitinib malate. Gender, KPS scores before follow-up treatment, initial metastatic sites and density of lesions decreased or not were independent prognostic factors.
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