Reintroduction of Imatinib in GIST

PURPOSE: This review examines the clinical evidence showing that imatinib can be prescribed to treat recurrence or progression of gastrointestinal stromal tumors (GIST) in patients who interrupted first-line imatinib therapy in the adjuvant or advanced/metastatic setting. METHODOLOGY: A literature search was performed in PubMed, Web of Knowledge, and Google using the following keywords: rechallenge/reinitiation/reintroduction + gastrointestinal + imatinib and rechallenge/reinitiation/reintroduction + imatinib. RESULTS: The evidence indicates that the reintroduction of imatinib can benefit patients who experience GIST progression after interrupting treatment of advanced/metastatic disease, as well as patients who experience GIST recurrence after completing prescribed neoadjuvant and/or adjuvant therapy. Although reintroduction of imatinib may lead to suboptimal outcomes, as evidenced by higher rates of progressive disease compared to initial treatment, imatinib discontinuation does not appear to favor development of imatinib resistance, leaving dose escalation and third- or fourth-line imatinib treatment as viable options for patients. CONCLUSION: Results indicate that after initial start and interruption of imatinib therapy, reintroduction of imatinib therapy is efficacious and provides continued survival benefit in patients with GIST.