| 特集名 | 消化器癌化学療法― 新たなエビデンスを求めて | |
|---|---|---|
| 題名 | GISTに対する新たな治療戦略 | |
| 発刊年月 | 2013年 03月 | |
| 著者 | 澤木 明 | 名古屋第二赤十字病院薬物療法科・消化器内科 |
| 【 要旨 】 | GISTは消化管由来の間葉系腫瘍でもっとも頻度が高く，腫瘍化の要因はc-kitまたはPDGFRA遺伝子の変異である．このdriver mutationを選択的に阻害する薬剤で高い臨床効果が得られている．本稿では，新しい治療として補助化学療法と新薬について述べる．SSG XVIII試験では，高リスクに対する3年間のイマチニブが標準治療となった．CT検査は原則6カ月ごとで，補助化学療法後の再発にはイマチニブの再投与が勧められる．イマチニブ不応のD842V変異には補助化学療法は推奨できない．イマチニブとスニチニブ無効GISTに対するレゴラフェニブの有効性と安全性が示され，早期の臨床導入が望まれる． | |
| Theme | Perspective for Chemotherapy in Gastrointestinal Malignancy Based on Current Evidence | |
|---|---|---|
| Title | New Treatment Strategy of Gastrointestinal Stromal Tumor | |
| Author | Akira Sawaki | Department of Oncology, Japan Red Cross Nagoya Daini Hospital |
| [ Summary ] | Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract. The development of GISTs is driven by the mutated c-kit or PDGFRA gene. Discoveries in molecular pathogenesis have provided us with effective targeted therapies which selectively inhibit etiologic driver pathways, leading to dramatically improved clinical outcomes. In this review, we discuss the highlights of adjuvant chemotherapy and new agents for GIST therapy. Recently reported results of the SSG XVIII/AIO trial represent a significant change in the evidence for adjuvant therapy. Adjuvant therapy with imatinib at 400 mg/day for 3 years is a standard treatment following resection of high risk GISTs. Adjuvant therapy for other risk patients may be considered on a case-by-case basis in reference to recurrent risk. Reinitation of imatinib therapy may be proposed for patients for whom we have discontinued adjuvant imatinib therapy. Treatment is not recommended for those who are imatinib-insensitive with D842V-mutated GIST. Patients should be assessed at 6-month intervals after initation of treatment. An international phase III, randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of regorafenib. The hazard ratio for progression-free survival (PFS) and overall survival (OS) was 0.27 and 0.77, respectively. Regorafenib was well tolerated and significantly improved PFS and OS in patients with GIST after failure of prior imatinib and sunitinib treatment. |
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