Long-Term Survival Following Multimodal Therapy with Sunitinib and Surgery for Recurrent Duodenal Gastrointestinal Stromal Tumor

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INTRODUCTION: Gastrointestinal stromal tumors (GISTs) are mesenchymal tumors often driven by KIT or PDGFRA mutations. Sunitinib, a second-line tyrosine kinase inhibitor (TKI), is effective in imatinib-resistant cases, particularly those with secondary KIT mutations in the ATP-binding domain. However, resistance to sunitinib poses challenges, and evidence supporting surgery during sunitinib treatment remains limited.

CASE PRESENTATION: A 77-year-old male presented with multiple liver and peritoneal metastases from a duodenal GIST. Initial treatment with imatinib was discontinued due to adverse effects, and sunitinib was initiated, maintaining disease stability for 7 years. Disease progression as a solitary lesion in liver segment seven was identified via imaging and diagnosed as sunitinib-resistant. A laparoscopic partial hepatectomy was performed, achieving complete resection without complications. Postoperative resumption of sunitinib has controlled all other lesions for 9 years with no recurrence.

CONCLUSIONS: This case highlights the potential of combining sunitinib with surgery to manage drug-resistant GIST. Localized surgical resection of resistant lesions, integrated with systemic therapy, may offer prolonged survival in selected patients. Further studies are needed to define the optimal role of surgery in this context.