对伊马替尼继发耐药的晚期胃肠道间质瘤治疗策略

论著

文章编号：1005-2208（2012）08-0648-04

对伊马替尼继发耐药的晚期胃肠道

间质瘤治疗策略探讨

王洪山a，王翠众a，侯英勇b，沈坤堂a，高晓东a，秦净a，孙益红a，秦新裕a

【摘要】目的探讨对伊马替尼继发耐药的复发和转移的晚期胃肠道间质瘤（gastrointestinal stromal tumors, GIST）的治疗策略。方法回顾性分析复旦大学附属中山医院2000—2009年对伊马替尼继发耐药的复发和转移的晚期8例GIST病人的临床资料。结果所有病人均行手术治疗，完整切除原发肿瘤后，肿瘤复发和（或）转移，口服伊马替尼治疗产生继发耐药，采取手术切除复发和转移灶（特别是耐药病灶）联合伊马替尼等靶向治疗为主的综合治疗模式，均获得较好的治疗效果。1例死亡，存活96个月；其余7例仍存活，目前存活时间65~145个月，平均98.6个月。结论伊马替尼继发耐药的复发和转移的晚期GIST，选择手术联合酪氨酸激酶抑制剂靶向治疗为主的多学科综合治疗模式，参考肿瘤的基因状态，采取个体化治疗，可取得较好的疗效。

【关键词】胃肠道间质瘤；伊马替尼；耐药；复发；转移

中图分类号：R6文献标志码：A

Treatment of advanced gastrointestinal stromal tumors acquired resistance to imatinib WANG Hong-shan*, WANG Cui-zhong,HOU Ying-yong,et al.*Department of General Surgery,Zhongshan Hospital,Fudan University, Shanghai200032,China

Corresponding author:SHEN Kun-tang,E-mail:kuntang_shen@

Abstract Objective To discuss and explore the treatment strategy for recurrent and metastatic advanced gastrointestinal stromal tumors(GIST)acquired resistance to imatinib.Methods The clinical data of8cases of recurrent and metastatic advanced GIST acquired resistance to imatinib admitted between2000and2009at Zhongshan Hospital of Fudan University were analyzed retrospectively.Results All cases were performed complete resection of primary tumors,followed by oral administration of imatinib.All cases got acquired resistance to imatinib before or after recurrence and/or metastasis.A comprehensive treatment of surgical resection combined with molecularly targeted therapy was employed with considerably effectiveness in all cases.One case died of recurrence after96months of survival time.Other7cases survived for98.6months of the mean existing survival time（65-145months）.Conclusion For recurrent and metastatic advanced GIST acquired resistance to imatinib,a multidisciplinary approach,mainly characterized by surgical resection combined with molecularly targeted therapy based on gene features,is an effective treatment strategy,which can offer a better prognosis.

Keywords gastrointestinal stromal tumors;imatinib;resistance;recurrence;metastasis

近年来，伊马替尼成为复发、转移性胃肠道间质瘤（gastrointestinal stromal tumors，GIST）治疗的一线药物，然而，对于伊马替尼继发耐药的复发和转移的晚期GIST的治疗目前仍是一个棘手的问题。回顾性分析我院2000-2009年收治的8例对伊马替尼继发耐药的复发和转移的晚期GIST病人的临床资料。报告如下。1临床资料

本组8例GIST病人，年龄29~70岁，其中胃间质瘤3例，小肠间质瘤4例，直肠间质瘤1例。首次手术均完整切除原发病灶后，肿瘤复发和（或）转移，口服伊马替尼治疗中产生继发耐药。针对复发和转移病灶（特别是耐药病灶），采取了手术切除联合伊马替尼等靶向治疗为主的综合治疗模式，参考肿瘤的基因状态，合理选择药物剂量，及时改换药物，适时手术，病人均获得了较好的治疗效果。1例死亡，存活96个月；其余7例仍存活，目前存活时间65~ 145个月，平均98.6个月。病人的具体临床资料见表1。

基金项目：国家自然科学基金青年基金资助（No.81101809）作者单位：复旦大学附属中山医院a.普外科b.病理科，上海200032

通讯作者：沈坤堂，E-mail：kuntang_shen@