Chicago area patients seek a "center of excellence"

University of Chicago is treating 30+ GIST’ers, evaluating new therapies

The Chicago chapter of the Life Raft Group has been looking for a “center of excellence” for GIST in the area, and the University of Chicago appears to be answering that call.

“One of our concerns is that we have been unable to find a center of excellence for GIST patients in the Chicago area,” says Richard Kinzig, coordinator for the Chicago chapter. “Most of the knowledge is based in OHSU in Portland, Memorial Sloan Kettering, M.D. Anderson or Dana-Farber. Trials occur at these locations for Gleevec, Sugen and drugs such as Novartis’ RAD-001, PKC-412, PKC-787, etc. There must be hundreds of patients in the Chicago area that are in need of the latest technology and treatment options who would avail themselves of a center for GIST treatment.”

Dr. Hedy Lee Kindler of the University of Chicago has responded to those concerns. Kindler is director of gastrointestinal oncology at the University of Chicago and is in charge of GIST research. Kindler writes: “… this is an unusual disease which requires expert management, hence we are trying to make UC a Center of Excellence for the management of GIST. I also think it is a tumor with a fascinating biology which makes it ripe for drug discovery. We are currently taking care of more than 30 GIST patients, most of whom are on clinical trials.”

The university currently has three Gleevec trials:

The first is for patients with metastatic disease. The trial is closed (not accepting new patients) but current patients are still being followed.

The second is using Gleevec as adjuvant therapy for patients at high risk of recurrence. It recently closed, but with patients on study.

The third is for patients with an intermediate risk of recurrence, using adjuvant (randomization to Gleevec or placebo). This trial is still open.

“We are now approaching the point where quite a few of our patients are now beginning to fail therapy with Gleevec,” says Kindler. “For these patients we have several options.”

A widely known therapy is the Sugen drug SU11248. U Chicago will soon open the phase III study of SU11248 for patients who have progressed on Gleevec. “Obviously we are very excited that another drug has already made it to phase III evaluation for this disease, and we are delighted to be able to offer it to our patients,” says Kindler.

Another one currently being offered is SDX-102. This is a “targeted antimetabolite” therapy. It is only offered to patients who have a particular mutation in their tumor-loss of the MTAP gene on chromosome 9p. The tumor is screened for this deletion and if it is present, the drug is far more likely to work. It is given as a continuous infusion over five days every three weeks, and is well tolerated. Deletions of 9p in GIST have been shown to correlate with more aggressive tumors, hence this drug may be able to benefit those patients who need it most.

One trial that recently filled will test BAY439006. This oral drug — a “Raf” inhibitor — targets signaling pathways downstream from c-kit. This trial includes several GIST patients.

There is also PKC787, an oral drug that inhibits c-kit and is an antiangiogenic drug.

“We have a very large phase I (early drug development program) here at U Chicago,” says Kindler, “hence we can offer many other novel agents to our patients long before they become available to patients in other studies. We select drugs based on their mechanism of action and how this relates to the biology of GIST tumors.

“Our intention is to evaluate these drugs in GIST patients, and once it becomes evident that these drugs have activity in GIST patients, we will explore which patients it is most likely to benefit (based on the mutations in their tumors) and evaluate it in larger trials exclusively in GIST patients.

“We do not wish to merely copy the studies being done at other centers, we want to evaluate new therapies that may further advance the knowledge in this field and thus offer the greatest benefit to patients with this disease.”

Kindler also notes that a colleague, Dr. Mitchell Posner, who also has a research interest in GIST, has a great deal of experience operating on GIST patients. “Patients from other hospitals who were told that they were inoperable have successful surgeries with Dr Posner,” said Kindler.

Those interested in an appointment at the university can call the intake coordinator, Karen, at (773) 834-7424.