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Optimizing the Treatment of Gastrointestinal Stromal Tumors: The Roles of Tumor Genotyping, Imatinib Blood-level Testing, and New Therapeutic Strategies

From the Portland VA Medical Center and OHSU Knight Cancer Institute, Portland, OR; Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts; Department of Internal Medicine (Cancer Research), University of Essen Medical School, Essen, Germany; Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA

Authors’ disclosures of potential conflicts of interest are found at the end of this article.

Address reprint requests to Michael Heinrich, MD, R&D-19, 3710 SW US Veterans Hospital Road, Portland, OR 97239; e-mail: heinrich{at}ohsu.edu

Overview: Gastrointestinal stromal tumors (GISTs) are the most common soft tissue sarcoma of the gastrointestinal tract. Formerly untreatable, except by surgery, the management of these tumors has been revolutionized by the use of small molecule kinase inhibitors that target the underlying pathogenetic mutant kinases found in the vast majority of cases. Recent studies have suggested that future improvements in therapy may be possible using improved diagnostic testing strategies (tumor mutation testing, imatinib blood-level testing) and development of new drugs that target aberrant signal transduction in GIST cells. In this review, we will discuss how the treatment of patients with GIST might be further optimized.