How the Experts Treat Cancer Module 4 (Gastrointestinal Stromal Tumors)

Emerging Trends and Current Surgical Management of GIST WITH CASE Presentation

Joseph Kim, MD 
Associate Professor
General Oncologic Surgery

Surgeon, Division of General Oncologic Surgery

Department of Surgery
City of Hope
Duarte, CA

Update on Targeted Therapies for the Treatment of GIST WITH CASE Presentation

Warren A. Chow, MD, FACP
Associate Professor
Medical Oncology
Department of Medical Oncology &
 Therapeutics Research
City of Hope

Duarte, CA

Release date: January 1, 2012

Expiration date: December 31, 2012

Estimated time to complete activity: 1.0 hours

Target Audience

This program has been designed for medical oncologists, radiation oncologists, gastroenterologists, and other medical professionals who treat patients with gastrointestinal cancers.

Statement of Need

GISTs are difficult to diagnose and are usually found incidentally.

Most patients diagnosed with GIST are between the ages of 50 and 80. The vast majority of GISTs are sporadic, affecting both men and women equally across all geographic and ethnic groups. GISTs have different characteristics than more common "carcinomas" of the digestive tract, and therefore, require a different type of specialized treatment. GIST represents a potentially life-threatening malignancy if the disease is not amenable to curative surgical removal or if it has metastasized. Of the new cases diagnosed each year, approximately 1,500 have already metastasized when they are initially found.

Clinical trial data in the systemic management of GISTs have been sparse owing to this cancer's innate resistance to conventional cytotoxic interventions. However, recent breakthroughs in the understanding of the malignancy’s pathogenesis and the advent of small-molecule targeted signal transduction inhibitors and anti-angiogenesis agents have changed the natural history of this disease.

In order to offer optimal patient care, including the option of clinical trial participation, the practicing healthcare professional must be well informed of these breakthroughs and subsequent advances in treatment options for GIST.


Why does it exist? Although gastrointestinal stromal tumors comprise less than 1% of all GI tumors, it is the most common form of sarcoma of the GI tract. In 2010, the National Cancer Institute estimated that there are 3,300 to 6,000 new GIST cases each year in the United States. The incidence of GIST is estimated to be 11 to 20 patients per million per year. The true incidence is not known, however, in part because many tumor have not been tested for the characteristic KIT or platelet-derived growth factor receptor alpha (PDGFRA) gene mutations. In addition, indolent GIST only a few millimeters in diameter are common in the general population and are not included in cancer registries.

Learning Objectives

At the conclusion of this educational activity, participants should be able to:

  • Compare and contrast different surgical, chemotherapy and biologic agent combinations in the treatment of rescectable, unresectable, metastatic, or recurrent GIST
  • Assess ongoing clinical trials of targeted agents in GIST
  • Apply best practice strategies in diagnostic, surgical, systemic, and targeted therapies in the management of patients with GIST
  • Evaluate the evolving therapeutic strategies in the treatment of GIST
Accreditation Statement

This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of City of Hope and Carden Jennings Publishing Co., Ltd. City of Hope is accredited by the ACCME to provide continuing medical education for physicians.

Credit Designation

City of Hope designates this enduring activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity.


The City of Hope adheres to ACCME Essential Areas, Standards for Commercial Support, and Policies regarding industry support of continuing medical education. Disclosure of the commercial relationships of everyone in a position to control content of an educational activity will be made at the activity. Speakers are also required to openly disclose discussion of any off-label, experimental, or investigational use of drugs or devices in their presentations.

The following City of Hope CME Committee members/planners have indicted they have nothing to disclose: Teresa Ball, Kathleen Blazer, MS, EdD, Sandra Bolton, RN, JD, Julianne Chun, Janet Crum, Ina Ervin, Jonathan Espenschied, MD, Karl Gaal, MD, Jo Hanson, RN, Fouad Kandeel, MD, Patricia Kassab, RN, MS, CTHQ, Lucille Leong, MD, Paul Lin, MD, Matthew Loscalzo, MSW, Mary Mendelsohn, RN, MSN, Robert Morgan, Jr., MD, Khanh Nguyen, MD, Anna Pawlowska, MD, I. Benjamin Paz, MD, Lisa Reyes, BA, Crystal Saavedra, BA, and Jeffrey Weitzel, MD.

The following CME Committee Members/planners have indicated a conflict with the following corporate organizations:

  • Ravi Bhatia, MD, discloses that he is a consultant with Novartis and Bristol Myers Squibb
  • Martin Hogan, MD, discloses that he received grant/research support from Johnson & Johnson
  • Jean Kagan, BS, discloses that she is a stock shareholder with Amgen/Zimmer

Any potential conflicts relative to the previous disclosure have been resolved.

CJP Medical Communications Disclosure

The employees of CJP Medical Communications have no financial relationships to disclose.

Faculty Disclosures

In accordance with the ACCME’s Standards for Commercial Support, all CME providers are required to disclose to the activity audience the relevant financial relationships of everyone in a position to control content of an educational activity. A relevant financial relationship is a relationship in any amount occurring in the last 12 months with a commercial interest whose products or services are discussed in the CME activity content over which the individual has control. Relationship information appears below:

  • Joseph Kim, MD, discloses that he is a member of the Speakers Bureau with Novartis and Genetech.
  • Warren A. Chow, MD, discloses that he is a member of the Speakers Bureau with Novartis and Pfizer and he will be discussing drugs that are unlabeled or used for investigational purposes including Sorafenib, Dasatinib, and 17-AAG.
Commercial Support

This activity has been developed through independent educational grants received from Novartis Pharmaceuticals Corporation and Astex Therapeutics.

Method of Participation

There are no fees for participating in this CME activity. To receive credit during the period January 1, 2012 to December 31, 2012, participants must (1) read the learning objectives and disclosure statements, (2) study the educational activity, (3) complete the posttest, and (4) complete the activity evaluation form, including the certificate information section.

The posttest can be accessed at the end of the activity. Please e-mail any questions to


The Internet was selected as the instructional format to accommodate the learning preferences of a significant portion of the target audience.


Carden Jennings Publishing and the City of Hope present this resource for educational purposes only. Participants are expected to use their own expertise and judgment while engaged in the practice of medicine. Please consult full prescribing information for any drugs or procedures discussed within this activity. The views and opinions expressed in these presentations are those of the authors and do not necessarily reflect the views of the co-sponsors, supporter, or publisher. Although great care has been taken in compiling and checking the information given in this publication to ensure accuracy, the authors, City of Hope and Carden Jennings Publishing and their servants or agents shall not be responsible or in any way liable for the continued currency of the information or for any errors, omissions, or inaccuracies in this publication, whether arising from negligence or otherwise howsoever or for any consequences arising therefrom.

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This reference may contain discussion of published and/or investigational uses of agents that are not approved by the US Food and Drug Administration. For additional information about approved uses, including approved indications, contraindications, and warnings, please refer to the prescribing information for each product, or consult the Physician’s Desk Reference.


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