lunes, 19 de agosto de 2019

Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERC... - PubMed - NCBI

2019 Aug 3. pii: S1590-8658(19)30690-5. doi: 10.1016/j.dld.2019.07.006. [Epub ahead of print]

Gastrointestinal stromal tumours (GISTs): French Intergroup Clinical Practice Guidelines for diagnosis, treatments and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO).

Landi B1, Blay JY2, Bonvalot S3, Brasseur M4, Coindre JM5, Emile JF6, Hautefeuille V7, Honore C8, Lartigau E9, Mantion G10, Pracht M11, Le Cesne A12, Ducreux M12, Bouche O4; Thésaurus National de Cancérologie Digestive (TNCD).

Author information

1: Department of Hepatogastroenterology and Digestive Oncology, European Georges Pompidou Hospital, Paris, France. Electronic address: bruno.landi@aphp.fr.
2: Department of Medical Oncology, Léon Bérard Center, Lyon, France.
3: Department of Surgery, Curie Institute, Paris, France.
4: Department of Hepatogastroenterology and Digestive Oncology, CHU Robert Debré Hospital, Reims, France.
5: Department of Pathology, Institut Bergonié, Bordeaux, France.
6: Department of Pathology, Hôpital Ambroise-Paré, Boulogne-Billancourt, France.
7: Department of Hepatogastroenterology and Digestive Oncology, CHU Amiens Picardie, Amiens, France.
8: Department of Surgery, Gustave Roussy Cancer Campus, Villejuif, France.
9: Department of Radiotherapy, Oscar Lambret Center, Lille, France.
10: Department of Surgery, CHU Jean Minjoz, Besançon, France.
11: Department of Medical Oncology, Eugène Marquis Center, Rennes, France.
12: Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France.

Abstract

BACKGROUND:

This document is a summary of the French Intergroup guidelines regarding the management of gastrointestinal stromal tumours (GISTs) updated in December 2018.

DESIGN:

This collaborative work summarizes clinical practice recommendations (guidelines) on the management of GISTs. It is based on recent literature review, ESMO recommendations and expert opinions.

RESULTS:

The diagnosis of GIST is based on histological examination and immunohistochemistry with markers KIT and DOG-1. Each case must be discussed within a multidisciplinary team. Complete surgical resection tumour, avoiding peroperative perforation, is the potentially curative treatment of localized GISTs. The estimation of the recurrence risk is essential, or adjuvant treatment, and follow-up adaptation. Genotyping (KIT and PDGFRA) of all but very low-risk GISTs is recommended. The nature of mutation has a prognostic value and predictive influence on drug efficacy. Imatinib, a tyrosine-kinase inhibitor, is the standard adjuvant treatment after R0 resection of a GIST with a high risk of recurrence, and the first line therapy for advanced GISTs. Suninitib and regorafenib are respectively the second- and third-line standard treatments for advanced GISTs.

CONCLUSION:

Guidelines for management of GISTs are continuously evolving and need to be regularly updated. This constant progress is made possible through clinical and translational research.