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A clinical and biological overview of gastrointestinal stromal tumors

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Abstract

In the last few years a body of knowledge has been generated on the molecular basis of gastrointestinal stromal tumors (GIST). These mesenchymal tumors are characterized by the expression of KIT protein and because they have an activating mutation in a class III receptor tyrosine kinase gene (KIT or PDGFRA). Several KIT-activating mutations, which are largely responsible for the development of this tumor, promote cell survival, proliferation, and migration through different pathways such as MAPK p42/44, AKT, S6K, STAT1, and STAT3. Likewise, gene-activating mutations in the gene PDGFRα which codes for the receptor tyrosine kinase, Platelet-derived growth factor receptor α have been identified in GIST lacking KIT mutations. This means that KIT and PDGFRα mutations appear to be alternative and mutually exclusive oncogenic pathways for GIST development.

These tumors may occur anywhere along the gastrointestinal tract (GI). The most frequently involved sites are stomach and small intestine. They are typically chemo- and radioresistant. The discovery of a specific inhibitor of this tyrosine kinase, imatinib mesylate, has radically changed the prognosis of patients with unresectable disease. Only 4 yr after the first patient was successfully treated with imatinib, multiple phase II and III trials have been published and, currently, imatinib mesylate is the only effective systemic treatment available of these tumors. Response rates are approximately 70–90% with acceptable toxicity. GIST are the first model of a solid tumor efficiently treated with a molecular-targeted agent. This review summarizes the clinical and biological aspects of this unique neoplasm.

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Authors and Affiliations

  1. Division of Clinical Research, National Cancer Institute, Mexico City

    Myrna Candelaria MD (Head of Clinical Research) & Jaime de la Garza

  2. Unit of Biomedical Research on Cancer, Institute of Biomedical Research, National Autonomous University of Mexico, Mexico City

    Alfonso Duenas-Gonzalez

  3. National Cancer Institute of Mexico, Mexico City

    Alfonso Duenas-Gonzalez

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  1. Myrna Candelaria MD
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  2. Jaime de la Garza
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  3. Alfonso Duenas-Gonzalez
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Correspondence to Myrna Candelaria MD.

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Candelaria, M., de la Garza, J. & Duenas-Gonzalez, A. A clinical and biological overview of gastrointestinal stromal tumors. Med Oncol 22, 1–10 (2005). https://doi.org/10.1385/MO:22:1:001

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