Significance of monitoring imatinib plasma concentration in secondline treatment decisions for c-kit 11 gene-mutated gastrointestinal stromal tumors  

作　　者：Hai-Tao Li Yun-Yun Du Zhen Huang Jin-Jin Li Jun Zhang 

机构地区：[1]Department of Gastrointestinal Surgery,Nanchuan Hospital of Chongqing Medical University,Chongqing 408400,China [2]Department of Oncology,Nanchuan Hospital of Chongqing Medical University,Chongqing 408400,China [3]Department of Gastrointestinal Surgery,The First Affiliated Hospital of Chongqing Medical University,Chongqing 400016,China

出　　处：《World Journal of Gastrointestinal Oncology》2025年第3期81-90,共10页世界胃肠肿瘤学杂志(英文)

摘　　要：BACKGROUND For patients with advanced gastrointestinal stromal tumors(GISTs)carrying the ckit exon 11 mutation,imatinib(IM)at a standard dosage of 400 mg per day is the preferred first-line treatment.In cases where treatment with IM fails,there is an urgent need for a more precise assessment method to determine whether to switch therapies or escalate the IM dosage.This approach will enhance clinical decision-making and optimize patient outcomes.AIM To investigate IM plasma concentration’s role in second-line treatment decisions for c-kit 11-mutated advanced GISTs post-IM failure.METHODS Patients with advanced GIST harboring c-kit 11 mutation who experienced failure with IM 400 mg per day as first-line treatment at our hospital were retrospectively analyzed.Patients were categorized into a low plasma(LP)concentration group(LP group,<1100 ng/mL)and high plasma(HP)concentration group(HP group,≥1100 ng/mL).Each group was further subdivided into Group A(dose-escalation group)and Group B(drug-switch group).Baseline characteristics were compared and Kaplan-Meier curves were used to analyze the survival of patients.RESULTS Seventy-five patients were included in the analysis.For the LP group(n=28),Group A(n=14)had longer overall survival(OS)than Group B(n=14)(P=0.02).No differences were observed between the two subgroups in disease control rate(DCR),objective response rate,and progression-free survival(PFS)(P>0.05).For the HP group(n=47),Group B(n=18)had a higher DCR and longer PFS than Group A(n=29)(P=0.008 and P=0.03,respectively).No difference in OS was observed between the two subgroups(P>0.05).CONCLUSION Increasing IM dosage for c-kit 11-mutated advanced GISTs post-IM failure may prolong OS if plasma concentration is<1100 ng/mL.Switching tyrosine kinase inhibitors may improve DCR and PFS if≥1100 ng/mL.

关 键 词：Gastrointestinal stromal tumor C-kit exon 11 IMATINIB Plasma concentration Second-line treatment 

分 类 号：R73[医药卫生—肿瘤]