• Heikki Joensuu, Mikael Eriksson, Sundby HallKirstenK, Jörg T Hartmann, Daniel Pink, Jochen Schütte, Giuliano Ramadori, Peter Hohenberger, Justus Duyster, Salah-Eddin Al-Batran, Marcus Schlemmer, Sebastian Bauer, Eva Wardelmann, Maarit Sarlomo-Rikala, Bengt Nilsson, Harri Sihto, Odd R Monge, Petri Bono, Raija Kallio, Aki Vehtari, Mika Leinonen, Thor Alvegård, and Peter Reichardt.
• Department of Oncology, Helsinki University Central Hospital, Haartmaninkatu 4, PO Box 180, FIN-00029 Helsinki, Finland. heikki.joensuu@hus.fi
• JAMA. 2012 Mar 28; 307 (12): 1265-72.

ContextAdjuvant imatinib administered for 12 months after surgery has improved recurrence-free survival (RFS) of patients with operable gastrointestinal stromal tumor (GIST) compared with placebo.ObjectiveTo investigate the role of imatinib administration duration as adjuvant treatment of patients who have a high estimated risk for GIST recurrence after surgery.Design, Setting, And PatientsPatients with KIT-positive GIST removed at surgery were entered between February 2004 and September 2008 to this randomized, open-label phase 3 study conducted in 24 hospitals in Finland, Germany, Norway, and Sweden. The risk of GIST recurrence was estimated using the modified National Institutes of Health Consensus Criteria.InterventionImatinib, 400 mg per day, orally for either 12 months or 36 months, started within 12 weeks of surgery.Main Outcome MeasuresThe primary end point was RFS; the secondary end points included overall survival and treatment safety.ResultsTwo hundred patients were allocated to each group. The median follow-up time after randomization was 54 months in December 2010. Diagnosis of GIST was confirmed in 382 of 397 patients (96%) in the intention-to-treat population at a central pathology review. KIT or PDGFRA mutation was detected in 333 of 366 tumors (91%) available for testing. Patients assigned for 36 months of imatinib had longer RFS compared with those assigned for 12 months (hazard ratio [HR], 0.46; 95% CI, 0.32-0.65; P < .001; 5-year RFS, 65.6% vs 47.9%, respectively) and longer overall survival (HR, 0.45; 95% CI, 0.22-0.89; P = .02; 5-year survival, 92.0% vs 81.7%). Imatinib was generally well tolerated, but 12.6% and 25.8% of patients assigned to the 12- and 36-month groups, respectively, discontinued imatinib for a reason other than GIST recurrence.ConclusionCompared with 12 months of adjuvant imatinib, 36 months of imatinib improved RFS and overall survival of GIST patients with a high risk of GIST recurrence.Trial Registrationclinicaltrials.gov Identifier: NCT00116935.

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