The first report of imatinib in the treatment of GIST was published in 2001 by Joensuu et al [6]. Since then, multiple studies have confirmed the usefulness of imatinib more information therapy in treating GISTs, leading to FDA approval of imatinib in the treatment of metastatic and/or unresectable GISTs [7]. Notably, Demetri et al conducted a study of 147 patients who received either 400 or 600 mg of imatinib daily. They reported a 54% radiographic response in their patient population [2]. The most common side effects of imatinib are fluid retention, diarrhea, nausea, fatigue, muscle cramps, abdominal pain, and rash. Extremity a facial edema (the latter was experienced by the patient in this case) were the most frequent adverse effects in the Demetri study.

A new approach is evolving that relies on neoadjuvant imatinib to down-stage the tumor in cases of advanced GISTs. Prior studies have described patients with inoperable or metastatic GISTs who underwent treatment with imatinib and had a dramatic response allowing surgical resection [8,9]. The median time for an objective response to imatinib is four months, but maximal response is reported to take six months or longer [10]. Response is defined as absence of progression at the time of first follow-up, generally two-three months after starting therapy. The patient in our case was believed to have achieved sufficient response to allow for an uncomplicated, successful resection of the GIST. While most patients respond to imatinib, many eventually develop resistance. Initial (primary) resistance is defined as progression of disease at the time of first follow up after start of therapy [11].

These patients are not responsive to imatinib. Late (secondary) resistance is seen in a patient who experiences disease progression after a period of response. Patients who respond should be followed with serial imaging. Ideally, resection should be performed before the development of resistance. The role of imatinib in the neoadjuvant setting is illustrated in this case. While the GIST found in this patient may not have been inoperable before imatinib treatment, the procedure may have required a multi-visceral resection. Neoadjuvant imatinib was given and after dramatic radiographic response, a simple wedge gastric resection was needed. Surgeons should consider the use of neoadjuvant imatinib therapy in patients with marginally resectable GISTs.

A response to imatinib can allow for a less extensive though still therapeutic oncologic resection. Competing Anacetrapib interests The authors declare that they have no competing interests. Authors’ contributions SA drafted the manuscript. JG reviewed an amended the manuscript. JMH reviewed and amended the manuscript. All authors read and approved the final manuscript.
Preferential expression of a cytotoxic gene in tumours is a therapeutic approach to cancer treatment.