EIBIR 3 - Innovative solutions for diagnosis and treatment concepts for GIST patients from the MITIGATE project
EIBIR 3 - Innovative solutions for diagnosis and treatment concepts for GIST patients from the MITIGATE projectSaturday, March 4, 14:00 - 15:30 Room: L 8 Session Type: EIBIR Session Topics: Nuclear Medicine, GI Tract, Interventional Radiology Moderator: S. O. Schönberg (Mannheim/DE) Add session to my schedule In your schedule (remove)
1. To learn about current therapy options for GIST patients.
2. To understand specificity of GIST treatment.
GIST primarily affects the GI tract with the stomach being most frequently involved, followed by the small intestine, the rectum and the duodenum and oesophagus. This disease entity represents “the” role model for the efficacy of molecular-based targeted therapy, molecular imaging and minimally invasive treatment. The detection of the KIT-protooncogene in 1988 and the KIT-receptor antagonist TKI imatinib provided an effective treatment in the advanced stage of the disease. Unlike other tumours, no valid blood tumour markers exist for monitoring the course of the disease, rendering functional and molecular imaging-based approaches of high importance. Patients with completely resected primary tumour, but imatinib-resistant progressive oligometastatic disease are quite frequent. Tumour types as those with a platelet-derived growth factor receptor-alpha (PDGFRA)-D842V mutation or SDH mutant GIST, or so-called quadruple-negative GIST represents 10-15% of all GIST patients. They are insensitive to imatinib or other TKI drugs as are the huge group of patients who no longer respond to imatinib due to secondary mutations in the KIT protooncogene. Therefore, for a major group of patients with metastatic GIST no treatment alternatives currently exist as tumours are neither sensitive to large-field external irradiation nor cytotoxic chemotherapy. Thus, interventional techniques such as SIRT, RFA or radionuclide therapy such as ion is the clinical focus when treating patients who live for 10 to 15 years at very good QoL with a disease that has metastasized but is still to be controlled by various measures and interventions.
1. To learn about the current imaging approach in GIST patients.
2. To discover the novel imaging approach applied in the MITIGATE clinical study.
Gastrointestinal stromal tumour (GIST) is a rare disease and can be treated with tyrosine kinase inhibitors (TK). Resistance to TK is a common problem limiting therapeutic options and life expectancy. The MITIGATE project aims to develop new approaches to diagnose and treat patients with metastatic GIST resistant to the standard TK treatment. PET/CT is a widely used molecular imaging tool in oncology, usually investigating glucose metabolism with FDG. More specifically targeted radiopharmaceuticals are sought to better identify and characterise tumour lesions. Within the MITIGATE project, a novel 68Ga-labelled peptide, NeoBOMB1 was selected to be investigated in GIST patients within the MITIGATE clinical study. 68Ga-NeoBOMB1 binds specifically to gastrin-releasing peptide (GRP) receptors highly overexpressed on GIST tumour cells. The combination of 68Ga, an ultra-short-lived, generator-derived positron emitter, with a small bombesin peptide analogue with antagonistic receptor properties provides a unique basis for highly sensitive and specific imaging of GIST tumours. The MITIGATE study aims not only to assess safety and pharmacokinetics of this novel imaging approach, but also to provide a basis for better characterisation of GIST tumours by molecular imaging opening new therapeutic options in this rare disease. Preclinical development of 68Ga-NeoBOMB1, clinical trial design and first clinical results of PET/CT imaging in GIST patients will be presented.
1. To understand minimally invasive treatment options.
2. To learn about the MITIGATE compassionate use programme and its minimally invasive treatment options.
Several minimal invasive treatments are currently available for GIST patients. In case of multiple liver metastases, radioembolization (RE) offers a safe and effective treatment for patients with GIST liver metastases who do not show a response to TKIs. In case of oligometastatic disease, percutaneous ablations such as microwave ablation (MWA) or irreversible electroporation (IRE) can be used in lung, liver and soft tissue metastases. Besides a brief description of the methods, the use within the MITIGATE compassionate use programme will be presented. The focus will be on the combination of several minimal invasive therapeutic options.