Most GIST patients will only have a single tumor at the time of diagnosis. A significant minority however, will already have metastases at the time of diagnosis. Initial treatment will be dependent on several factors including:
- Whether a patient has metastases or not
- The expected difficulty of the surgery
- The size of the primary tumor
- The general health of the patient
Surgery is used at three main times to treat GIST. It is most commonly used as the initial treatment after a patient is diagnosed, especially if the patient has only one tumor that can be removed fairly easily (primary surgery). If the patient has a single tumor but surgery appears to be more difficult, they may be given Glivec before surgery in order to try to shrink the tumor making surgery easier (neoadjuvant Glivec). And in some cases, surgery will be used for metastatic disease either before or during treatment with Glivec.
Glivec is different from traditional chemotherapy in that it is very selective. Traditional chemotherapy kills all cells that are dividing quickly. This is what causes so many of the side effects of traditional chemotherapy. In addition to the cancer cells, this type of chemotherapy also kills many of the body’s normal cells. Glivec is much more selective and as a result has fewer side effects.
Sutent is a pill that is taken once daily. The usual dosage is 50 mg per day. It is given daily for four weeks, before a two week rest period. This cycle is then repeated as long as the patient continues to show benefit.