Cargando…

Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report

BACKGROUND: The management of unresectable or metastatic gastrointestinal stromal tumors (GISTs) has previously been difficult as they are resistant to conventional chemotherapy and radiation. The development of imatinib mesylate has made a major impact on the management of advanced GISTs. It is app...

Descripción completa

Detalles Bibliográficos
Autores principales: Hughes, Brett, Yip, Desmond, Goldstein, David, Waring, Paul, Beshay, Victoria, Chong, Guan
Formato: Texto
Lenguaje:English
Publicado: BioMed Central 2004
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524360/
https://www.ncbi.nlm.nih.gov/pubmed/15473910
http://dx.doi.org/10.1186/1471-2407-4-74
_version_ 1782121895424950272
author Hughes, Brett
Yip, Desmond
Goldstein, David
Waring, Paul
Beshay, Victoria
Chong, Guan
author_facet Hughes, Brett
Yip, Desmond
Goldstein, David
Waring, Paul
Beshay, Victoria
Chong, Guan
author_sort Hughes, Brett
collection PubMed
description BACKGROUND: The management of unresectable or metastatic gastrointestinal stromal tumors (GISTs) has previously been difficult as they are resistant to conventional chemotherapy and radiation. The development of imatinib mesylate has made a major impact on the management of advanced GISTs. It is apparent that there are sanctuary sites such as the central nervous system where imatinib does not achieve adequate concentrations. We describe the case of a man with metastatic GIST who experienced multiple cerebral relapses of disease while systemic disease progression appeared to be controlled by imatinib. CASE PRESENTATION: A 47-year-old man presented in July 1999 with a jejunal GIST with multiple hepatic metastases. The jejunal primary was resected and after unsuccessful cytoreductive chemotherapy, the liver metastases were also resected in December 1999. The patient subsequently relapsed in August 2001 with symptomatic hepatic, subcutaneous gluteal, left choroidal and right ocular metastases all confirmed on CT and PET scanning. Biopsy confirmed recurrent GIST. MRI and lumbar puncture excluded central nervous system involvement. The patient was commenced on imatinib 400 mg bd in September 2001 through a clinical trial. The symptoms improved with objective PET and CT scan response until December 2002 when the patient developed a right-sided foot drop. MRI scan showed a left parasagittal tumor which was resected and confirmed histologically to be metastatic GIST. Imatinib was ceased pre-operatively due to the trial protocol but recommenced in February 2003 on a compassionate use program. The left parasagittal metastasis recurred and required subsequent re-excision in September 2003 and January 2004. Control of the systemic GIST was temporarily lost on reduction of the dose of imatinib (due to limited drug supply) but on increasing the dose back to 800 mg per day, systemic disease was stabilized for a period of time before generalised progression occurred. CONCLUSION: This case illustrates that the brain can be a sanctuary site to treatment of GISTs with imatinib. Maintaining dosing of imatinib in the face of isolated sites of disease progression is also important, as other metastatic sites may still be sensitive.
format Text
id pubmed-524360
institution National Center for Biotechnology Information
language English
publishDate 2004
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-5243602004-10-29 Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report Hughes, Brett Yip, Desmond Goldstein, David Waring, Paul Beshay, Victoria Chong, Guan BMC Cancer Case Report BACKGROUND: The management of unresectable or metastatic gastrointestinal stromal tumors (GISTs) has previously been difficult as they are resistant to conventional chemotherapy and radiation. The development of imatinib mesylate has made a major impact on the management of advanced GISTs. It is apparent that there are sanctuary sites such as the central nervous system where imatinib does not achieve adequate concentrations. We describe the case of a man with metastatic GIST who experienced multiple cerebral relapses of disease while systemic disease progression appeared to be controlled by imatinib. CASE PRESENTATION: A 47-year-old man presented in July 1999 with a jejunal GIST with multiple hepatic metastases. The jejunal primary was resected and after unsuccessful cytoreductive chemotherapy, the liver metastases were also resected in December 1999. The patient subsequently relapsed in August 2001 with symptomatic hepatic, subcutaneous gluteal, left choroidal and right ocular metastases all confirmed on CT and PET scanning. Biopsy confirmed recurrent GIST. MRI and lumbar puncture excluded central nervous system involvement. The patient was commenced on imatinib 400 mg bd in September 2001 through a clinical trial. The symptoms improved with objective PET and CT scan response until December 2002 when the patient developed a right-sided foot drop. MRI scan showed a left parasagittal tumor which was resected and confirmed histologically to be metastatic GIST. Imatinib was ceased pre-operatively due to the trial protocol but recommenced in February 2003 on a compassionate use program. The left parasagittal metastasis recurred and required subsequent re-excision in September 2003 and January 2004. Control of the systemic GIST was temporarily lost on reduction of the dose of imatinib (due to limited drug supply) but on increasing the dose back to 800 mg per day, systemic disease was stabilized for a period of time before generalised progression occurred. CONCLUSION: This case illustrates that the brain can be a sanctuary site to treatment of GISTs with imatinib. Maintaining dosing of imatinib in the face of isolated sites of disease progression is also important, as other metastatic sites may still be sensitive. BioMed Central 2004-10-09 /pmc/articles/PMC524360/ /pubmed/15473910 http://dx.doi.org/10.1186/1471-2407-4-74 Text en Copyright © 2004 Hughes et al; licensee BioMed Central Ltd.
spellingShingle Case Report
Hughes, Brett
Yip, Desmond
Goldstein, David
Waring, Paul
Beshay, Victoria
Chong, Guan
Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title_full Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title_fullStr Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title_full_unstemmed Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title_short Cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: Case report
title_sort cerebral relapse of metastatic gastrointestinal stromal tumor during treatment with imatinib mesylate: case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC524360/
https://www.ncbi.nlm.nih.gov/pubmed/15473910
http://dx.doi.org/10.1186/1471-2407-4-74
work_keys_str_mv AT hughesbrett cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport
AT yipdesmond cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport
AT goldsteindavid cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport
AT waringpaul cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport
AT beshayvictoria cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport
AT chongguan cerebralrelapseofmetastaticgastrointestinalstromaltumorduringtreatmentwithimatinibmesylatecasereport