An unrestricted educational grant for this publication was provided by Novartis Oncology.

CME test expired

November 2006 | Vol. 6, Suppl. 1
1.5 AMA PRA Category 1 Credits™

Emerging Trends in the Management of Gastrointestinal Stromal Tumors

Supplement Editor: Margaret von Mehren, MD

Table of Contents

Introduction:
Update on the Management of Gastrointestinal Stromal Tumors
Margaret von Mehren

Contributions:
The Molecular Pathogenesis of Gastrointestinal Stromal Tumors
Chi Tarn, Andrew K. Godwin

Practical Aspects of Managing Gastrointestinal Stromal Tumors
Stefan Sleijfer, Caroline Seynaeve, Erik Wiemer, Jaap Verweij

Combining Imatinib with Surgery in Gastrointestinal Stromal Tumors: Rationale and Ongoing Trials
Burton L. Eisenberg

Beyond Imatinib: Second Generation c-KIT Inhibitors for the Management of Gastrointestinal Stromal Tumors
Margaret von Mehren

Activity Goals | Back to top
Gastrointestinal (GI) stromal tumors (GISTs) are probably the most common type of mesenchymal tumor of the GI tract. Although data are not available for the incidence rates, the frequency of malignant GISTs ranges from 20% to 30% of all soft-tissue sarcomas and account for approximately 3% of all GI cancers. Gastrointestinal stromal tumors are usually defined as KIT-positive mesenchymal tumors, but approximately 5% of GISTs lack detectable KIT expression. However, molecular genetics continue to refine the molecular mechanisms involved in the pathology of GISTs. Gastrointestinal stromal tumors are highly resistant to conventional radiation therapy and traditional chemotherapeutic agents. Surgery has been the mainstay of treatment for GISTs, but > 50% of patients experience relapse within 5 years. Elucidation of the aberrant receptor tyrosine kinase model of GIST pathogenesis through mutations in c-KIT and platelet-derived growth factor–α protooncogenes led to the development of targeted therapies for GISTs. With the advent of imatinib in the treatment of metastatic GIST, 2-year patient survival has increased 3-fold from 26% to 76%, and imatinib has become the standard first-line treatment for metastatic GISTs. Most patients, however, acquire imatinib resistance and disease progression, usually after > 1 year of therapy. Currently, no effective treatment options are available for patients with unresectable imatinib-resistant GIST. Thus, novel approaches for the treatment of GISTs are needed. Several novel multitargeted treatment approaches are currently being explored for patients with GIST. The purpose of this activity is to review clinical data with irinotecan in gastric cancer and to update physicians on new therapies for GIST that has progressed on imatinib.

Learning Objectives | Back to top
Upon completion of this learning material, physicians should be able to:

• Discuss the current role of surgery and c-KIT oncogene–sensitive targeted therapies in an effort to further improve the traditional clinical outcome for patients with GIST
• Describe the molecular pathogens and the clinical role of novel oncogenes in the prognosis of patients with GIST
• Evaluate the current treatment approaches in the management of patients with GIST
• Describe the safety and efficacy of novel multitargeted receptor tyrosine kinase inhibitors in the treatment of patients with imatinib–relapsed/refractory GIST

Target Audience | Back to top
This publication is intended for medical oncologists involved in the care of patients with gastrointestinal stromal tumors. No specific skills or knowledge other than a basic training in oncology are required for successful participation in this activity.

Accreditation | Back to top
Physicians’ Education Resource is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

Physicians’ Education Resource designates this educational activity for a maximum of 1.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

This activity has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Physicians’ Education Resource and CIG Media Group. Physicians’ Education Resource is accredited by the ACCME to provide continuing medical education for physicians.

Release date: November 15, 2006

Expiration date: November 15, 2007

Burton L. Eisenberg, MD
Paid Consultant or Advisory Board – Novartis
Speaker’s Bureau – Novartis

Andrew K. Godwin, PhD
No relevant relationships to disclose

Stefan Sleijfer, MD, PhD
No relevant relationships to disclose

Caroline Seynaeve, MD, PhD
No relevant relationships to disclose

Chi Tarn, PhD
No relevant relationships to disclose

Jaap Verweij, MD, PhD
No relevant relationships to disclose

Margaret von Mehren, MD
Research Support – Novartis
Paid Consultant or Advisory Board – Novartis
Speaker’s Bureau – Novartis; Pfizer

Erik Wiemer, PhD
No relevant relationships to disclose

PER Editorial Staff

Other PER Staff
No relevant relationships to disclose

The articles in this CME activity might include discussion of investigational and/or unlabeled uses of drugs. If an article includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the article page. Please refer to the full prescribing information for each drug discussed in this newsletter for FDA-approved dosing, indications, and warnings.

Clinical Colorectal Cancer (ISSN: 1533-0028) is produced by CIG Media Group, LP, Dallas, TX. An unrestricted educational grant for this publication was provided by Novartis Oncology.

The views and opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsor or publisher. Although great care has been taken in compiling and checking the information given in this publication to ensure accuracy, the authors, Novartis Oncology, and CIG Media Group and its servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this publication, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

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©Copyright 2006 by CIG Media Group, LP. No material may be reproduced in whole or in part, in any form, without written permission from the publisher.

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Disclaimer:
While the Publisher and Editorial Board make every effort to see that no inaccurate or misleading data, opinion, or statement appears in this journal, they wish to state that the opinions or views expressed herein are those of the authors or advertisers and do not necessarily reflect the opinions or recommendations of CIG Media Group, LP. Accordingly, the Publisher, Editorial Board, and their respective employees accept no liability whatsoever for the consequences of any such inaccurate or misleading data, opinion, or statement. While every effort is made to ensure drug doses and other quantities are presented accurately, readers are advised that new methods and techniques involving drug usage described within this journal should only be followed in conjunction with the drug manufacturer’s own published literature.

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