Ocena skuteczności i tolerancji leczenia imatynibem chorych na zaawansowane nowotwory podścieliskowe przewodu pokarmowego (GIST)

Abstract

Author(s): E Starosławska, A Chrzanowska-Kapica, A Czerepińska, M Mazurkiewicz

Introduction: Treatment with imatynib of inoperable and/or GIST metastases, as it is extremely effective and safe, constitutes a pattern example of applying medicines aimed moleculary in the therapy of solid carcinomas. The aim of the work was the evaluation of results in the tolerance of imatynib treatment of patients suffering from an advanced GIST form.

Method: We analysed 37 patients treated with imatynib in COZL in conformity with binding rules of diagnostic and therapeutic conduct. We evaluated the level of clinical response, progression-free survival (PFS), and overall survival (OS). We used the adverse effects scale according to WHO for the treatment toxicity evaluation. Subgroups of patients immune to imatynib treatment were analysed paying special attention to the presence of clinical factors known from literature, associated with the frequency of primary or secondary resistance. The evaluated the predictive value of chosen clinical parameters linked with overall survival length. The data were drawn up statistically.

Results: We obtained a response profile in accordance with literature data. We observed the highest proportion of cases with partial remission (PR), whereas the lowest with progressive disease (PD) and complete remission (CR). We did not observed statistically significant differences in overall survival between the patients with objective response to the treatment (CR+PR) and the stabilization of the disease (SD). PFS and OS medians hale not been achieved. Estimated probability of achieving 24-month PFS amounted to 0.70 (CI=95%; 22.39-39.72), and 40-month OS - 0.68 (CI= 95%; 22.6-49.2), reaching statistical significance. The probability of achieving 5-year OS, amounting to 0.57 had no traits of statistical significance. Treatment with imatynib was well tolerated. Most frequently observed adverse effects were occurring in level 1 and 2 according to WHO scale. Severe adverse effects in level 3 and 4 according to WHO concerned around 8% of all treated patients. Among patients immune to imatynib therapy, we stated the presence of clinical factors linked with frequent occurrence of both primary and secondary immunity. The analysis of chosen predictive factors showed a significant dependence between overall survival time OS and state of general fitness according to WHO.

Conclusions: our own finding of imatynib treatment in standard dose of patients suffering from advanced forms of GIST confirm a high efficacy of this therapy with a simultaneously acceptable level of adverse effects.

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