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JAMA. 2012 Mar 28;307(12):1265-72. doi: 10.1001/jama.2012.347.

One vs three years of adjuvant imatinib for operable gastrointestinal stromal tumor: a randomized trial.

Author information

  • 1Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, FIN-00029 Helsinki, Finland. heikki.joensuu@hus.fi

Abstract

CONTEXT:

Adjuvant imatinib administered for 12 months after surgery has improved recurrence-free survival (RFS) of patients with operable gastrointestinal stromal tumor (GIST) compared with placebo.

OBJECTIVE:

To investigate the role of imatinib administration duration as adjuvant treatment of patients who have a high estimated risk for GIST recurrence after surgery.

DESIGN, SETTING, AND PATIENTS:

Patients with KIT-positive GIST removed at surgery were entered between February 2004 and September 2008 to this randomized, open-label phase 3 study conducted in 24 hospitals in Finland, Germany, Norway, and Sweden. The risk of GIST recurrence was estimated using the modified National Institutes of Health Consensus Criteria.

INTERVENTION:

Imatinib, 400 mg per day, orally for either 12 months or 36 months, started within 12 weeks of surgery.

MAIN OUTCOME MEASURES:

The primary end point was RFS; the secondary end points included overall survival and treatment safety.

RESULTS:

Two hundred patients were allocated to each group. The median follow-up time after randomization was 54 months in December 2010. Diagnosis of GIST was confirmed in 382 of 397 patients (96%) in the intention-to-treat population at a central pathology review. KIT or PDGFRA mutation was detected in 333 of 366 tumors (91%) available for testing. Patients assigned for 36 months of imatinib had longer RFS compared with those assigned for 12 months (hazard ratio [HR], 0.46; 95% CI, 0.32-0.65; P < .001; 5-year RFS, 65.6% vs 47.9%, respectively) and longer overall survival (HR, 0.45; 95% CI, 0.22-0.89; P = .02; 5-year survival, 92.0% vs 81.7%). Imatinib was generally well tolerated, but 12.6% and 25.8% of patients assigned to the 12- and 36-month groups, respectively, discontinued imatinib for a reason other than GIST recurrence.

CONCLUSION:

Compared with 12 months of adjuvant imatinib, 36 months of imatinib improved RFS and overall survival of GIST patients with a high risk of GIST recurrence.

TRIAL REGISTRATION:

clinicaltrials.gov Identifier: NCT00116935.

Comment in

PMID:
22453568
[PubMed - indexed for MEDLINE]
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