Gastrointestinal Stromal Tumours (GIST) in adolescents and young adults (AYA)

Date 28 September 2019
Event ESMO 2019 Congress
Session Poster Display session 1
Topics GIST
Presenter Nikki Ijzerman
Citation Annals of Oncology (2019) 30 (suppl_5): v683-v709. 10.1093/annonc/mdz283
Authors N.S. Ijzerman1, C. Drabbe2, D. Den Hollander2, M. Mohammadi3, H. van Boven4, I.M.E. Desar2, H. Gelderblom5, D.J. Grünhagen6, A.K.L. Reyners7, R.H.J. Mathijssen8, N. Steeghs1, W.T.A. van der Graaf9
  • 1Department Of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), 1066 CX - Amsterdam/NL
  • 2Department Of Medical Oncology, Radboud University Medical Center, 6525 GA - Nijmegen/NL
  • 3Department Of Medical Oncology, Leiden University Medical Center, 2300RC - Leiden/NL
  • 4Department Of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), 1066 CX - Amsterdam/NL
  • 5Department Of Medical Oncology, Leiden University Medical Center, 2300 RC - Leiden/NL
  • 6Department Of Surgical Oncology, Erasmus MC Cancer Institute, 3015 GD - Rotterdam/NL
  • 7Department Of Medical Oncology, University of Groningen, University Medical Center Groningen, 9713GZ - Groningen/NL
  • 8Department Of Medical Oncology, Erasmus MC Cancer Institute, 3015 GD - Rotterdam/NL
  • 9Department Of Medical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek hospital (NKI-AVL), 1066CX - Amsterdam/NL

Abstract

Background

GIST in older adults and in children are well-known entities, but this is not the case for AYA patients with GIST. Typically, GIST in children (70% female) rarely show mutations in KIT or platelet-derived growth factor receptor (PDGFR) (<15%), are often Succinate Dehydrogenase (SDH) deficient, are almost always located in the stomach (90%) and have a relatively indolent course of disease. The typical adult GIST (about 50% female) has mutations in KIT (75%) or PDGFR (15%), stomach as main location and an overall 5-years survival of 65% (SEER data). As data on AYA with GIST are very limited, we aimed to study the clinical and genetic characteristics and outcome of this specific group.

Methods

AYA GIST patients (18-40 years at diagnosis) diagnosed between 2009-2019 and registered in the Dutch GIST Registry (DGR) were included. Patients without mutations in KIT/PDGFR/BRAF and SDH deficiency (by immunohistochemistry) were considered quadruple wildtype (WT). Overall survival (OS) was estimated using Kaplan-Meier method. Furthermore, two subgroups were compared: 18-29 years vs. 30-40 years (Chi-square, Fisher’s exact, Mann-Whitney U test).

Results

From 1011 patients in the DGR, 52 AYA patients (5%) were identified: 54% male, median age 35 years. Main primary tumor locations were stomach (46%) and small intestine (46%). Four AYA patients had a known genetic predisposition: 2 Neurofibromatosis 1 (NF1), 1 Carney Triad, 1 KIT exon 11 germline mutation. GIST genetic profiles were reported as KIT mutation 64%, PDGFR mutation 6%, KIT/PDGFR WT 6%, quadruple WT 8%, SDH deficient 6% and NF1 associated 4%. At diagnosis, 42% had high-risk GIST and 13% metastatic disease.

With a median follow-up of 43 months (0-113), median OS for all patients was 8.9 years with a 5-year survival of 85%. No significant differences were found between the two subgroups with regard to gender, location, size, morphology, risk classification and mutation status.

Conclusions

GIST presenting at AYA age is rare. AYA GIST differ from the well-known paediatric GIST, but are also not fully similar to the typical adult GIST. In our series a remarkable high percentage of small intestine GIST and high-risk tumours were observed, 30% non-KIT/PDGFR mutations and a relatively good survival.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The Netherlands Cancer Institute.

Funding

An unrestricted research grant for the Dutch GIST Registry was received from Novartis, Bayer and Pfizer.

Disclosure

I.M.E. Desar: Research grant / Funding (institution): Novartis; Advisory / Consultancy, advisory board: Eisai; Advisory / Consultancy, advisory board: Lilly. R.H.J. Mathijssen: Research grant / Funding (institution), Travel / Accommodation / Expenses: Astellas; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Boehringer; Research grant / Funding (institution): Cristal Therapeutics; Honoraria (institution), Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pamgene; Research grant / Funding (institution), Travel / Accommodation / Expenses: Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Sanofi; Honoraria (institution): Servier. N. Steeghs: Research grant / Funding (institution): AstraZeneca/MedImmune; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Bristol-Myers Squibb; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): GlaxoSmithKline; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Genentech/Roche; Research grant / Funding (institution): Boehringer Ingelheim; Research grant / Funding (institution): Blueprint Medicines; Research grant / Funding (institution): AB science; Research grant / Funding (institution): Deciphera; Research grant / Funding (institution): Genentech; Research grant / Funding (institution): Merck Sharp & Dohme; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Lilly; Research grant / Funding (institution): Incyte; Research grant / Funding (institution): Merus. W.T.A. van der Graaf: Research grant / Funding (institution): Novartis; Advisory / Consultancy: Bayer. All other authors have declared no conflicts of interest.