Neoadjuvant imatinib for borderline resectable GIST.

A 36-year-old woman presented to the emergency department with black stools and syncope. Her hemoglobin was 7.0 and her red blood cells were microcytic. Upper endoscopy did not identify a clear source of bleeding, but a bulge in the third portion of the duodenum was noted. A CT scan showed a large extraintestinal mass, and follow-up esophagogastroduodenoscopy/endoscopic ultrasound with biopsy revealed a spindle cell neoplasm, consistent with gastrointestinal stromal tumor (GIST). Because of the size of the lesion and association with the superior mesenteric vein and common bile duct, she was referred to medical oncology for consideration of neoadjuvant imatinib. Neoadjuvant tyrosine kinase inhibitor therapy for GISTs is emerging as a viable treatment strategy for borderline resectable tumors, although the dose, duration, and optimal imaging modalities have not been clearly established. Recent pathologic and radiographic data have provided insight into the mechanism and kinetics of this approach. This case report presents a patient for whom surgery was facilitated using neoadjuvant imatinib.

Activity of trabectedin (ET-743, Yondelis) in metastatic uterine leiomyosarcoma.

BACKGROUND: The ongoing search for more effective agents in the treatment of uterine leiomyosarcomas is warranted because of the poor prognosis related to these tumors. CASE: A case of advanced, recurrent and refractory uterine leiomyosarcoma is presented that responded to trabectedin (ET-743) 1.2 mg/m2 intravenously over 24 h every 3 weeks after failing four prior regimens. A durable objective response lasting at least 8 months was documented. CONCLUSION: Trabectedin (ET-743) has activity in uterine leiomyosarcoma and warrants further investigation.