Cancer Res Treat.  2016 Apr;48(2):546-552. 10.4143/crt.2015.015.

Efficacy of Imatinib in Patients with Platelet-Derived Growth Factor Receptor Alpha-Mutated Gastrointestinal Stromal Tumors

Affiliations
  • 1Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. ykkang@amc.seoul.kr

Abstract

PURPOSE
The incidence of gastrointestinal stromal tumors (GISTs) harboring platelet-derived growth factor receptor alpha (PDGFRA) mutations is low, therefore further investigation of the efficacy of imatinib in this subgroup was needed.
MATERIALS AND METHODS
Patients with PDGFRA-mutant GISTs who received imatinib as primary therapy for advanced disease between January 2000 and June 2012 were identified from the GIST registry of Asan Medical Center, Seoul, Korea.
RESULTS
KIT and PDGFRA genotyping in 823 patients identified 18 patients (2%) with PDGFRA mutations who were treated with first-line imatinib. Exon 18 D842V substitution, non-D842V exon 18 mutations, and exon 12 mutations were detected in nine (50%), four (22%), and five (28%) patients, respectively. Objective response rate differed significantly between patients with the D842V mutation and those with non-D842V mutations (0% [0/5] vs. 71% [5/7], p=0.03). In all patients, median progression-free survival (PFS) and overall survival (OS) was 24.8 months (95% confidence interval [CI], 0.0 to 57.2) and 51.2 months (95% CI, 37.1 to 65.3), respectively. Significantly, poorer PFS was observed for patients with D842V-mutant GISTs than those with non-D842V PDGFRA-mutant GISTs: median 3.8 months (95% CI, 1.4 to 6.3) versus 29.5 months (95% CI, 18.3 to 40.7) (p < 0.001). Patients with the D842V mutation had poorer OS than those with non-D842V PDGFRA mutations: median 25.2 months (95% CI, 12.7 to 37.8) versus 59.8 months (95% CI, 43.0 to 76.5) (p=0.02).
CONCLUSION
Imatinib is active against non-D842V PDGFRA-mutant GISTs, whereas GISTs harboring the D842V mutation are primarily resistant to imatinib.

Keyword

Imatinib; Gastrointestinal stromal tumors; Platelet-derived growth factor receptor alpha

MeSH Terms

Chungcheongnam-do
Disease-Free Survival
Exons
Gastrointestinal Stromal Tumors
Humans
Imatinib Mesylate*
Incidence
Korea
Platelet-Derived Growth Factor*
Receptors, Platelet-Derived Growth Factor*
Seoul
Imatinib Mesylate
Platelet-Derived Growth Factor
Receptors, Platelet-Derived Growth Factor

Figure

  • Fig. 1. Progression-free survival (A) with first-line imatinib and overall survival (B) according to the type of PDGFRA mutation.

  • Fig. 2. Progression-free survival with second-line sunitinib treatment after failure of imatinib.


Reference

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