Interdisciplinary treatment at the USZ
Doctors from various disciplines are involved in the treatment of gastrointestinal stromal tumors, for example oncology, surgery, pathology, anesthesiology or gastroenterology. But psycho-oncology is also playing an increasingly important role, because cancer not only affects the body, but also the mind. They all work together on an interdisciplinary basis and discuss each case individually in a tumor board.
Operation comes first
Surgery is the treatment of choice for GIST. The prerequisite is that the tumor is not yet too large, has not yet invaded surrounding tissue and has not yet metastasized. Doctors try to remove the tumor as completely as possible through surgery. Minimally invasive surgery using “keyhole surgery” is sometimes possible for small GISTs. The tumor is removed during a laparoscopy. Otherwise, doctors operate through a larger abdominal incision (laparotomy).
Sometimes they first shrink the tumor with medication to make it easier to operate on. Healthy tissue can then be better protected. This procedure is called “neoadjuvant”. Doctors call all treatments that follow an operation “adjuvant”.
Medication for GIST
After an operation, new drugs can help to reduce the risk of relapse. They can also slow down the progression of cancer in advanced gastrointestinal stromal tumors and metastases. The drugs from the group of tyrosine kinase inhibitors act specifically against certain characteristics and properties of the cancer cells. “Targeted therapy” or “targeted therapy”. Doctors call this treatment “targeted therapy”. However, they only help if a certain mutation status (KIT/PDGFRA) is detectable.
The following active ingredients are used:
- Imatinib: It acts against a special enzyme of the GIST cells, the so-called receptor tyrosine kinase. Imatinib blocks cell division by binding to the enzyme and preventing the transmission of division signals. Treatment can sometimes delay the cancer for a long time. Imatinib is recommended for patients who have undergone surgery and have a high risk of relapse. Doctors also sometimes use it before an operation to reduce the size of the tumor. Patients take the medication in tablet form. You must not interrupt or stop the therapy, otherwise the cancer will flare up again. Nevertheless, the disease progresses in some patients. One option is to first increase the dose of the medication.
- Sunitinib: The active substance is used if Imatinib is no longer sufficiently effective or patients cannot tolerate the drug. Sunitinib also attacks the receptor tyrosine kinase, but it also influences other signaling pathways in the cell. It is available in the form of tablets.
- Regorafenib: The drug can help if sunitinib is no longer sufficiently effective and the disease progresses. It is available as tablets.
Researchers are currently working on further active substances against gastrointestinal stromal tumors and their approval.
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