Interactive Case Studies - Overview

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Treatment of a Patient With Metastatic Gastrointestinal Stromal Tumor

Release Date: February 5, 2009
Expiration Date: February 5, 2010

Interactive Case Study Overview

The management of gastrointestinal stromal tumor (GIST) was markedly changed several years ago by scientific and clinical evidence supporting the integration of kinase-targeted agents into the treatment armamentarium. The management of GIST continues to evolve, with new indications for and clinical trial data on kinase-targeted and other biologic agents. The utilization of molecular assessments to identify patients at high risk of recurrence and to personalize their treatment regimen is becoming an integral part of the management of patients with both resectable and advanced disease. The need for standards in patient selection is underscored by the recent approval of kinase-targeted therapy for patients with resectable KIT+ disease.

The purpose of this activity is to update physicians on current standards regarding devising treatment strategies including kinase-targeted agents based on gross and molecular disease characteristics in patients with KIT+ GIST.

Target Audience

This educational activity is intended for medical oncologists involved in the care of patients with GIST. No specific skills or knowledge other than a basic training in oncology is required for successful participation in this activity.

Learning Objectives

Upon completion of this educational activity, you should be able to:

  • Assess data from a randomized clinical trial regarding the benefit of and patient selection for adjuvant therapy for resectable GIST
  • Summarize data from randomized clinical trials evaluating the efficacy and toxicity of targeted agents in patients with advanced GIST
  • Describe the impact of KIT mutations on devising therapeutic strategies for patients with advanced/metastatic GIST

Instructions for Participation

  1. Read the following information before entering the educational activity.
  2. Complete the Pretest.
  3. Study the educational activity.
  4. Complete the Posttest.
  5. Answer the evaluation questions.
  6. After completion of the Pretest and successful completion of the Posttest and evaluation, you will receive your certificate online.

Successful completion is determined by a score of 65% or greater.

Read all of the conditions in the Activity Terms box below. You must accept the Activity Terms in order to continue:

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Charles D. Blanke, MD, FACP, FRCPC
Research Funding – Novartis Pharmaceuticals Corporation
Paid Consultant – Genentech, Inc.; Oncothyreon Inc.; Roche Pharmaceuticals; sanofi-aventis U.S.

PER Editorial Staff
Erin Grothey, MS (spouse)
Research Funding – Genentech, Inc.; sanofi-aventis U.S.
Paid Consultant – Amgen; Bayer Pharmaceuticals Corporation; Bristol-Myers Squibb Company; Genentech, Inc.; Roche Pharmaceuticals

Other PER Staff
No relevant relationships to disclose

This CME activity might include discussion of investigational and/or unlabeled uses of drugs. If the activity includes discussion of investigational and/or unlabeled uses of a drug, specific information is located on the title page. Please refer to the full prescribing information for each drug discussed in this newsletter for FDA-approved dosing, indications, and warnings.

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Banner Illustration

Activation of the c-KIT tyrosine kinase receptor requires receptor dimerization induced by the binding of stem cell factor, its ligand. Receptor dimerization results in autophosphorylation of distinct tyrosine residues present in the intracellular region of the receptor, which then bind various signaling proteins, such as Src family members and protein kinase C, to stimulate cell proliferation. The majority of gastrointestinal stromal tumors contain mutations that constitutively activate the c-KIT tyrosine kinase receptor. These mutations are frequently located in exon 11 (≈ 67%). Other activating mutations are found in exon 9 (≈ 9%), which encodes the dimerization motif, and, infrequently (≈ 1%), in exon 13 or exon 17, which code for the adenosine triphosphate binding site and activation loop motif of the kinase domain, respectively (Illustrator: Pam Curry).

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All correspondence should be directed to:
Editor, Interactive Case Study: Treatment of a Patient With Metastatic Gastrointestinal Stromal Tumor
Physicians’ Education Resource
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Suite 700
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Phone: (214) 367-3400
Fax: (214) 367-3304
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Educational Grants

An educational grant for this activity was provided by:


  1. Novartis Oncology

Charles D. Blanke, MD, FACP, FRCPC
Systemic Therapy Provincial
   Program Leader
British Columbia Cancer Agency
Head, Division of Medical Oncology
University of British Columbia
Vancouver, British Columbia, Canada