Integrating surgery and targeted therapies in the management of recurrent/metastatic gastrointestinal stromal tumors

Targeted therapy with tyrosine kinase inhibitors (TKIs) has revolutionized the treatment of unresectable advanced gastrointestinal stromal tumors (GISTs), significantly prolonging the survival and improving the quality of life of affected patients worldwide. However, resistance to TKIs inevitably occurs. Surgery following TKI therapy has been investigated for its clinical benefits in patients with advanced GISTs. Recent advancements have enhanced our understanding of using TKIs to create opportunities for and facilitate subsequent surgical interventions. These interventions appear feasible for highly selected cases and demonstrate survival benefits. Current evidence primarily comes from combining first-line treatment with imatinib and surgery, with limited clinical studies on second- and later-line TKIs. When formulating optimal treatment strategies, key factors such as surgical timing, factors influencing surgical benefit (including treatment response, disease extent at the time of surgery, and completeness of surgery), surgical morbidity, and TKI selection should be carefully assessed. Multidisciplinary care involving targeted therapy with suitable TKIs and appropriate surgical modalities may extend the duration of TKI treatment and improve associated clinical outcomes. Therefore, further studies, particularly randomized trials, on a global scale, are warranted. This commentary review offers insights for treatment decision-making in clinical practice, aiming to optimize patient-centered care for individuals with advanced GISTs and ultimately enhance survival benefits and quality of life for these patients.