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KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours

Identifieur interne : 009E40 ( Main/Exploration ); précédent : 009E39; suivant : 009E41

KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours

Auteurs : Maria Debiec-Rychter [Belgique] ; Raf Sciot [Belgique] ; Axel Le Cesne [France] ; Marcus Schlemmer [Allemagne] ; Peter Hohenberger [Allemagne] ; Allan T. Van Oosterom [Belgique] ; Jean-Yves Blay [France] ; Serge Leyuraz [Suisse] ; Michel Stul [Belgique] ; Paolo G. Casali [Italie] ; John Zalcberg [Australie] ; Jaap Verweij ; Martine Van Glabbeke [Belgique] ; Anne Hagemeijer [Belgique] ; Ian Judson [Royaume-Uni]

Source :

RBID : Pascal:06-0282946

Descripteurs français

English descriptors

Abstract

A recent randomized EORTC phase III trial, comparing two doses of imatinib in patients with advanced gastrointestinal stromal tumours (GISTs), reported dose dependency for progression-free survival. The current analysis of that study aimed to assess if tumour mutational status correlates with clinical response to imatinib. Pre-treatment samples of GISTs from 377 patients enrolled in phase III study were analyzed for mutations of KIT or PDGFRA by combination of D-HPLC and direct sequencing of tumour genomic DNA. Mutation types were correlated with patients' survival data. The presence of exon 9-activating mutations in KIT was the strongest adverse prognostic factor for response to imatinib, increasing the relative risk of progression by 171% (P < 0.0001) and the relative risk of death by 190% (P < 0.0001) when compared with KIT exon 11 mutants. Similarly, the relative risk of progression was increased by 108% (P < 0.0001) and the relative risk of death by 76% (P=0.028) in patients without detectable KIT or PDGFRA mutations. In patients whose tumours expressed an exon 9 KIT oncoprotein, treatment with the high-dose regimen resulted in a significantly superior progression-free survival (P= 0.0013), with a reduction of the relative risk of 61%. We conclude that tumour genotype is of major prognostic significance for progression-free survival and overall survival in patients treated with imatinib for advanced GISTs. Our findings suggest the need for differential treatment of patients with GISTs, with KIT exon 9 mutant patients benefiting the most from the 800 mg daily dose of the drug.


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Le document en format XML

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<name sortKey="Van Glabbeke, Martine" sort="Van Glabbeke, Martine" uniqKey="Van Glabbeke M" first="Martine" last="Van Glabbeke">Martine Van Glabbeke</name>
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<name sortKey="Hagemeijer, Anne" sort="Hagemeijer, Anne" uniqKey="Hagemeijer A" first="Anne" last="Hagemeijer">Anne Hagemeijer</name>
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<s1>Department of Human Genetics, University of Leuuen and University Hospital Gasthuisberg, O&N Gasthuisberg, Herestraat 49</s1>
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<name sortKey="Judson, Ian" sort="Judson, Ian" uniqKey="Judson I" first="Ian" last="Judson">Ian Judson</name>
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<s1>Royal Marsden Hospital</s1>
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<title xml:lang="en" level="a">KIT mutations and dose selection for imatinib in patients with advanced gastrointestinal stromal tumours</title>
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<name sortKey="Debiec Rychter, Maria" sort="Debiec Rychter, Maria" uniqKey="Debiec Rychter M" first="Maria" last="Debiec-Rychter">Maria Debiec-Rychter</name>
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<s1>Department of Human Genetics, University of Leuuen and University Hospital Gasthuisberg, O&N Gasthuisberg, Herestraat 49</s1>
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<s3>BEL</s3>
<sZ>1 aut.</sZ>
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<sZ>14 aut.</sZ>
</inist:fA14>
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<name sortKey="Sciot, Raf" sort="Sciot, Raf" uniqKey="Sciot R" first="Raf" last="Sciot">Raf Sciot</name>
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<s1>Department of Pathology, University of Leuuen and University Hospital Gasthuisberg, Herestraat 49</s1>
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<region type="province" nuts="2">Province du Brabant flamand</region>
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<name sortKey="Le Cesne, Axel" sort="Le Cesne, Axel" uniqKey="Le Cesne A" first="Axel" last="Le Cesne">Axel Le Cesne</name>
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<s1>Institut Gustave Roussy</s1>
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<sZ>3 aut.</sZ>
</inist:fA14>
<country>France</country>
<wicri:noRegion>Villejuif</wicri:noRegion>
<wicri:noRegion>Institut Gustave Roussy</wicri:noRegion>
<wicri:noRegion>Institut Gustave Roussy</wicri:noRegion>
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<name sortKey="Schlemmer, Marcus" sort="Schlemmer, Marcus" uniqKey="Schlemmer M" first="Marcus" last="Schlemmer">Marcus Schlemmer</name>
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<s1>Department of Medical Oncology, Klinikum Grosshadern</s1>
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<sZ>4 aut.</sZ>
</inist:fA14>
<country>Allemagne</country>
<placeName>
<region type="land" nuts="1">Bavière</region>
<region type="district" nuts="2">District de Haute-Bavière</region>
<settlement type="city">Munich</settlement>
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<inist:fA14 i1="05">
<s1>GSF - National Research Center for Environment and Health</s1>
<s2>Neuherberg</s2>
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</inist:fA14>
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<wicri:noRegion>Neuherberg</wicri:noRegion>
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<name sortKey="Hohenberger, Peter" sort="Hohenberger, Peter" uniqKey="Hohenberger P" first="Peter" last="Hohenberger">Peter Hohenberger</name>
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<name sortKey="Blay, Jean Yves" sort="Blay, Jean Yves" uniqKey="Blay J" first="Jean-Yves" last="Blay">Jean-Yves Blay</name>
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<region type="region">Auvergne-Rhône-Alpes</region>
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</placeName>
</affiliation>
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<name sortKey="Leyuraz, Serge" sort="Leyuraz, Serge" uniqKey="Leyuraz S" first="Serge" last="Leyuraz">Serge Leyuraz</name>
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<s1>CHU Vaudois</s1>
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<country>Suisse</country>
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<settlement type="city">Lausanne</settlement>
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<name sortKey="Stul, Michel" sort="Stul, Michel" uniqKey="Stul M" first="Michel" last="Stul">Michel Stul</name>
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<inist:fA14 i1="01">
<s1>Department of Human Genetics, University of Leuuen and University Hospital Gasthuisberg, O&N Gasthuisberg, Herestraat 49</s1>
<s2>3000 Leuven</s2>
<s3>BEL</s3>
<sZ>1 aut.</sZ>
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<settlement type="city">Louvain</settlement>
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<name sortKey="Casali, Paolo G" sort="Casali, Paolo G" uniqKey="Casali P" first="Paolo G." last="Casali">Paolo G. Casali</name>
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<s1>Instituto Nazionale Tumori</s1>
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<s3>ITA</s3>
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</inist:fA14>
<country>Italie</country>
<wicri:noRegion>Instituto Nazionale Tumori</wicri:noRegion>
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<name sortKey="Zalcberg, John" sort="Zalcberg, John" uniqKey="Zalcberg J" first="John" last="Zalcberg">John Zalcberg</name>
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<inist:fA14 i1="11">
<s1>Peter MacCallum Cancer Centre</s1>
<s2>Melbourne</s2>
<s3>AUS</s3>
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</inist:fA14>
<country>Australie</country>
<placeName>
<settlement type="city">Melbourne</settlement>
<region type="état">Victoria (État)</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Verweij, Jaap" sort="Verweij, Jaap" uniqKey="Verweij J" first="Jaap" last="Verweij">Jaap Verweij</name>
</author>
<author>
<name sortKey="Van Glabbeke, Martine" sort="Van Glabbeke, Martine" uniqKey="Van Glabbeke M" first="Martine" last="Van Glabbeke">Martine Van Glabbeke</name>
<affiliation wicri:level="3">
<inist:fA14 i1="12">
<s1>EORTC Data Center</s1>
<s2>Brussels</s2>
<s3>BEL</s3>
<sZ>13 aut.</sZ>
</inist:fA14>
<country>Belgique</country>
<placeName>
<settlement type="city">Bruxelles</settlement>
<region nuts="2">Région de Bruxelles-Capitale</region>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Hagemeijer, Anne" sort="Hagemeijer, Anne" uniqKey="Hagemeijer A" first="Anne" last="Hagemeijer">Anne Hagemeijer</name>
<affiliation wicri:level="3">
<inist:fA14 i1="01">
<s1>Department of Human Genetics, University of Leuuen and University Hospital Gasthuisberg, O&N Gasthuisberg, Herestraat 49</s1>
<s2>3000 Leuven</s2>
<s3>BEL</s3>
<sZ>1 aut.</sZ>
<sZ>9 aut.</sZ>
<sZ>14 aut.</sZ>
</inist:fA14>
<country>Belgique</country>
<placeName>
<region type="province" nuts="2">Province du Brabant flamand</region>
<settlement type="city">Louvain</settlement>
</placeName>
</affiliation>
</author>
<author>
<name sortKey="Judson, Ian" sort="Judson, Ian" uniqKey="Judson I" first="Ian" last="Judson">Ian Judson</name>
<affiliation wicri:level="3">
<inist:fA14 i1="13">
<s1>Royal Marsden Hospital</s1>
<s2>London</s2>
<s3>GBR</s3>
<sZ>15 aut.</sZ>
</inist:fA14>
<country>Royaume-Uni</country>
<placeName>
<settlement type="city">Londres</settlement>
<region type="country">Angleterre</region>
<region type="région" nuts="1">Grand Londres</region>
</placeName>
</affiliation>
</author>
</analytic>
<series>
<title level="j" type="main">European journal of cancer : (1990)</title>
<title level="j" type="abbreviated">Eur. j. cancer : (1990)</title>
<idno type="ISSN">0959-8049</idno>
<imprint>
<date when="2006">2006</date>
</imprint>
</series>
</biblStruct>
</sourceDesc>
<seriesStmt>
<title level="j" type="main">European journal of cancer : (1990)</title>
<title level="j" type="abbreviated">Eur. j. cancer : (1990)</title>
<idno type="ISSN">0959-8049</idno>
</seriesStmt>
</fileDesc>
<profileDesc>
<textClass>
<keywords scheme="KwdEn" xml:lang="en">
<term>Advanced stage</term>
<term>Antineoplastic agent</term>
<term>Cancerology</term>
<term>Dose</term>
<term>Enzyme inhibitor</term>
<term>Gastrointestinal stromal tumor</term>
<term>Human</term>
<term>Imatinib</term>
<term>Mutation</term>
<term>Pharmacology</term>
<term>Protein-tyrosine kinase</term>
<term>Selection</term>
<term>kit Gene</term>
</keywords>
<keywords scheme="Pascal" xml:lang="fr">
<term>Imatinib</term>
<term>Mutation</term>
<term>Gène kit</term>
<term>Dose</term>
<term>Sélection</term>
<term>Protein-tyrosine kinase</term>
<term>Inhibiteur enzyme</term>
<term>Homme</term>
<term>Stade avancé</term>
<term>Cancérologie</term>
<term>Pharmacologie</term>
<term>Anticancéreux</term>
<term>Tumeur stromale gastrointestinale</term>
</keywords>
<keywords scheme="Wicri" type="topic" xml:lang="fr">
<term>Homme</term>
<term>Pharmacologie</term>
</keywords>
</textClass>
</profileDesc>
</teiHeader>
<front>
<div type="abstract" xml:lang="en">A recent randomized EORTC phase III trial, comparing two doses of imatinib in patients with advanced gastrointestinal stromal tumours (GISTs), reported dose dependency for progression-free survival. The current analysis of that study aimed to assess if tumour mutational status correlates with clinical response to imatinib. Pre-treatment samples of GISTs from 377 patients enrolled in phase III study were analyzed for mutations of KIT or PDGFRA by combination of D-HPLC and direct sequencing of tumour genomic DNA. Mutation types were correlated with patients' survival data. The presence of exon 9-activating mutations in KIT was the strongest adverse prognostic factor for response to imatinib, increasing the relative risk of progression by 171% (P < 0.0001) and the relative risk of death by 190% (P < 0.0001) when compared with KIT exon 11 mutants. Similarly, the relative risk of progression was increased by 108% (P < 0.0001) and the relative risk of death by 76% (P=0.028) in patients without detectable KIT or PDGFRA mutations. In patients whose tumours expressed an exon 9 KIT oncoprotein, treatment with the high-dose regimen resulted in a significantly superior progression-free survival (P= 0.0013), with a reduction of the relative risk of 61%. We conclude that tumour genotype is of major prognostic significance for progression-free survival and overall survival in patients treated with imatinib for advanced GISTs. Our findings suggest the need for differential treatment of patients with GISTs, with KIT exon 9 mutant patients benefiting the most from the 800 mg daily dose of the drug.</div>
</front>
</TEI>
<affiliations>
<list>
<country>
<li>Allemagne</li>
<li>Australie</li>
<li>Belgique</li>
<li>France</li>
<li>Italie</li>
<li>Royaume-Uni</li>
<li>Suisse</li>
</country>
<region>
<li>Angleterre</li>
<li>Auvergne-Rhône-Alpes</li>
<li>Bavière</li>
<li>Berlin</li>
<li>Canton de Vaud</li>
<li>District de Haute-Bavière</li>
<li>Grand Londres</li>
<li>Province du Brabant flamand</li>
<li>Rhône-Alpes</li>
<li>Région de Bruxelles-Capitale</li>
<li>Victoria (État)</li>
</region>
<settlement>
<li>Berlin</li>
<li>Bruxelles</li>
<li>Lausanne</li>
<li>Londres</li>
<li>Louvain</li>
<li>Lyon</li>
<li>Melbourne</li>
<li>Munich</li>
</settlement>
</list>
<tree>
<noCountry>
<name sortKey="Verweij, Jaap" sort="Verweij, Jaap" uniqKey="Verweij J" first="Jaap" last="Verweij">Jaap Verweij</name>
</noCountry>
<country name="Belgique">
<region name="Province du Brabant flamand">
<name sortKey="Debiec Rychter, Maria" sort="Debiec Rychter, Maria" uniqKey="Debiec Rychter M" first="Maria" last="Debiec-Rychter">Maria Debiec-Rychter</name>
</region>
<name sortKey="Hagemeijer, Anne" sort="Hagemeijer, Anne" uniqKey="Hagemeijer A" first="Anne" last="Hagemeijer">Anne Hagemeijer</name>
<name sortKey="Sciot, Raf" sort="Sciot, Raf" uniqKey="Sciot R" first="Raf" last="Sciot">Raf Sciot</name>
<name sortKey="Stul, Michel" sort="Stul, Michel" uniqKey="Stul M" first="Michel" last="Stul">Michel Stul</name>
<name sortKey="Van Glabbeke, Martine" sort="Van Glabbeke, Martine" uniqKey="Van Glabbeke M" first="Martine" last="Van Glabbeke">Martine Van Glabbeke</name>
<name sortKey="Van Oosterom, Allan T" sort="Van Oosterom, Allan T" uniqKey="Van Oosterom A" first="Allan T." last="Van Oosterom">Allan T. Van Oosterom</name>
</country>
<country name="France">
<noRegion>
<name sortKey="Le Cesne, Axel" sort="Le Cesne, Axel" uniqKey="Le Cesne A" first="Axel" last="Le Cesne">Axel Le Cesne</name>
</noRegion>
<name sortKey="Blay, Jean Yves" sort="Blay, Jean Yves" uniqKey="Blay J" first="Jean-Yves" last="Blay">Jean-Yves Blay</name>
</country>
<country name="Allemagne">
<region name="Bavière">
<name sortKey="Schlemmer, Marcus" sort="Schlemmer, Marcus" uniqKey="Schlemmer M" first="Marcus" last="Schlemmer">Marcus Schlemmer</name>
</region>
<name sortKey="Hohenberger, Peter" sort="Hohenberger, Peter" uniqKey="Hohenberger P" first="Peter" last="Hohenberger">Peter Hohenberger</name>
<name sortKey="Schlemmer, Marcus" sort="Schlemmer, Marcus" uniqKey="Schlemmer M" first="Marcus" last="Schlemmer">Marcus Schlemmer</name>
</country>
<country name="Suisse">
<region name="Canton de Vaud">
<name sortKey="Leyuraz, Serge" sort="Leyuraz, Serge" uniqKey="Leyuraz S" first="Serge" last="Leyuraz">Serge Leyuraz</name>
</region>
</country>
<country name="Italie">
<noRegion>
<name sortKey="Casali, Paolo G" sort="Casali, Paolo G" uniqKey="Casali P" first="Paolo G." last="Casali">Paolo G. Casali</name>
</noRegion>
</country>
<country name="Australie">
<region name="Victoria (État)">
<name sortKey="Zalcberg, John" sort="Zalcberg, John" uniqKey="Zalcberg J" first="John" last="Zalcberg">John Zalcberg</name>
</region>
</country>
<country name="Royaume-Uni">
<region name="Angleterre">
<name sortKey="Judson, Ian" sort="Judson, Ian" uniqKey="Judson I" first="Ian" last="Judson">Ian Judson</name>
</region>
</country>
</tree>
</affiliations>
</record>

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