Role of molecular analysis in the adjuvant treatment of gastrointestinal stromal tumours: It is time to define it

Abstract

Sendur et al pointed out the attention on the importance of mutational analysis for adjuvant treatment of gastrointestinal stromal tumor (GIST) in an article published in World Journal of Gastroenterology. In particular, they suggested that the optimal dose and duration of adjuvant therapy could be defined by the mutational status of the primary disease. This comment would underline the importance of centralised laboratories, given the increasingly important role of molecular analysis in the work-flow of all GIST, and the need of retrospective analyses for subgroups population stratified for the mutational status from the available studies in the adjuvant setting, in order to define the role of mutational analysis in choosing the optimal dose and duration of adjuvant therapy.

Keywords: Gastrointestinal stromal tumours, Platelet-derived growth factor receptor alpha, KIT, Wild-type, Molecular analysis, Imatinib, Adjuvant treatment

Core tip: Sendur et al pointed out the attention on the importance of mutational analysis for adjuvant treatment of gastrointestinal stromal tumor (GIST). In particular, they suggested that the optimal dose and duration of adjuvant therapy could be defined by the mutational status of the primary disease. This topic represents a big challenge in GIST’s management by now, because even if the molecular analysis is strictly recommended in the work-flow of all GIST, its role in the adjuvant setting remains still unsettled due to the lack of prospective large clinical trials. In particular we pointed out the attention on the KIT/platelet-derived growth factor receptor alpha wild type GIST, that are extremely heterogeneous both in clinical and molecular background, making difficult their management also in the adjuvant setting. Our comment would underline the importance of centralised laboratories, given the increasingly important role of molecular analysis in the work-flow of all GIST, and the need of retrospective analyses for subgroups population stratified for the mutational status from the available studies in the adjuvant setting, in order to define the role of mutational analysis in choosing the optimal dose and duration of adjuvant therapy.