위장관 간질종양의 수술 후 재발한 환자에서 발생한 Imatinib의 부작용과 효능 - 증례와 문헌고찰

Clinical Course and Side Effects of Imatinib in Recurrent Patient after Surgical Resection of GIST - A Case and Literature Review

  • 배정호 (부산대학교 의학전문대학원 내과학교실) ;
  • 김광하 (부산대학교 의학전문대학원 내과학교실) ;
  • 김동욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 이봉은 (부산대학교 의학전문대학원 내과학교실) ;
  • 송근암 (부산대학교 의학전문대학원 내과학교실)
  • Jung Ho Bae (Departments of Internal Medicine, Pusan National University School of Medicine) ;
  • Gwang Ha Kim (Departments of Internal Medicine, Pusan National University School of Medicine) ;
  • Dong Uk Kim (Departments of Internal Medicine, Pusan National University School of Medicine) ;
  • Bong Eun Lee (Departments of Internal Medicine, Pusan National University School of Medicine) ;
  • Geun Am Song (Departments of Internal Medicine, Pusan National University School of Medicine)
  • 투고 : 2013.09.04
  • 심사 : 2013.10.24
  • 발행 : 2013.11.30

초록

A 79-year-old man was diagnosed with gastrointestinal stromal tumor (GIST) of the gastric cardia. We performed proximal subtotal gastrectomy and started imatinib therapy as adjuvant treatment after surgery. Whole body skin rash with urticaria was onset on 10 days after imatinib treatment, and the patient decided to stop imatinib because of side effect. After 3 months, PET CT revealed GIST was recurred at spleen and abdominal lymph nodes, abdominal wall. The patient was then restarted on imatinib therapy. On follow-up imaging studies, the tumor almost disappeared, but both pleural effusion and pericardial effusion were found. In this paper, we describe a case of clinical course and side effects in recurred GIST after adjuvant imatinib mesylate treatment.

키워드

참고문헌

  1. Sircar K. Hewlett BR, Huizinga JD, et al. Interstitial cells of Cajal as precursors of gastrointestinal stromal tumors. Am J Surg Pathol 1999;23:377-389.
  2. Kindblom L-G, Remotti HE, Aldenborg F, et al. Gastrointes-tinal pacemaker cell tumor (GIPACT): Gastrointes tinal stromal tumors show phenotypic characteristics of interstitial cell of Cajal. Am J Pathol 1998;152:1259-1269.
  3. Hirota S, Isozaki K, Moriyama Y, et al.: Gain-of-function mutations of c-kit in human gastrointestinal stromal tumors. Science 1998;279:577-580.
  4. Heinrich MC, Corless CL, Demetri GD, et al. Kinase mutations and imatinib response in patients with metastatic gastrointestional stromal tumor. J Clin Oncol 2003;21:4342-4349.
  5. van Oosterom AT, Judson IR, Verweij J, et al. Update of phase I study of imatinib (ST1571) in advanced soft sarcomas and gastrointestinal stromal tumors: a report of the EORTC Soft Tissue and Bone Sarcoma Group. Eur J Cancer 2002;38(Suppl 5):S83-S87.
  6. Verweij J, van Oosterom A, Blay JY, et al. Imatinib mesylate (STI-571 Glivecl, GleevecTM) is an active agent for gastionintestinal stromal tumours, but does not yield reponses in-other soft-tissue sarcomas that are unselected for a molecular target: results from an EORTC Soft Tissue and Bone Sarcoma Group phase II study, Eur J Cancer 2003;39:2006-2011.
  7. (MetaGIST) GSTM-AG. Comparison of two doses of imatinib for the treatment of unresectable or metastatic gastrointestinal stromal tumors: a meta-analysis of 1,640 patients. J Clin Oncol 28(7):1247-1253.
  8. Demetri GD, von Mehren M, Blanke CD, et al. Efficacy and safety of imatinib mesylate in advanced gastrointestinal stromal tumors. N Engl J Med 2002;347:472-480.
  9. Kantarjian HM, Gies F, Gattermann et al. Nlotinib (formerly AMN107), a highly selective BCR-ABL tyrosine kinase inhibitor, is eVective in patients with Philadelphia chromosome-positive chronic myelogenous leukemia in chronic phase following imatinib resistance and intolerance. Blood 110(17715389):3540-3546.
  10. Blanke CD, Rankin C, Demetri GD, et al Phase III randomized,intergroup trial assessing imatinib mesylate at two dose levels in patients with unresectable or metastatic gastrointestinal stromal tumors expressing the kit receptor tyrosine kinase: S0033. J Clin Oncol 26(4):626-632.
  11. Verweij J, Casali PG, Zalcberg J, et al. Progression-free survival in gastrointestinal stromal tumours with high-dose imatinib: randomized trial. Lancet 364(9440):1127-1134.
  12. Judson I, Ma P, Peng B, et al. Imatinib pharmacokinetics in patients with gastrointestinal stromal tumour: a retrospective population pharmacokinetic study over time. EORTC Soft Tissue and Bone Sarcoma Group. Cancer Chemother Pharmacol 55(4):379-386.
  13. Judson IDdP E, Verweij J, Van Glabbeke M, et al. Population pharmacokinetic (PK) analysis and PK-pharmacodynamic (PD) correlations in Phase I/II trial of imatinib in gastrointestinal stromal tumours (QST) conducted by the European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group. In: ASCO Annual Meeting Chicago, vol 22. USA
  14. Dematteo RP, Gold JS, Saran L, et al. Tumor mitotic rate, size, and location independently predict recurrence after resection of primary gastrointestinal stromal tumor (GIST). Cancer 2008;112:608.
  15. Le Cesne A, Van Glabbeke M, Verweij J, et al. Absence of progression as assessed by response evaluation criteria in solid tumors predicts survival in advanced GI stromal tumors treated with imatinib mesylate: the intergroup EORTC-ISG-AGITG phase III trial. J Clin Oncol 2009;27(24):3969.