Neeta Somaiah, MD

Presentation of a Gastrointestinal Stromal Tumor Case

Molecular Testing in Gastrointestinal Stromal Tumors

Treatment Options in Gastrointestinal Stromal Tumors

Progressing Gastrointestinal Stromal Tumor

Understanding the INVICTUS Trial

Future Directions of Gastrointestinal Stomal Tumors

A 68-Year-Old Man With Gastrointestinal Stromal Tumor

A 68-year-old man complains of a 4-month history of decreased appetite, vague abdominal discomfort and a sensation of fullness

PMH: DM, medically controlled; colonoscopy at age 50 was unremarkable; no family history of cancer

PE: abdominal pain on deep palpation; otherwise unremarkable



Labs: Hb 10.5 g/dL, plt 105 x 109/L; other lab values WNL

Endoscopy: showeda submucosal ~6 cm mass with ulceration

EUS: irregular borders on extraluminal surfaces with marginal halo and hyperechogenic spots

FNA biopsy: mitotic activity showed >5 mitoses/50 HPFs

Abdominal/pelvic CT confirmed a 6.2 cm lesion with indistinct margins in the body of the stomach

MRI showed 3 small hepatic lesions consistent with metastases

He was started on imatinib 400 mg PO qDay, continued for 24 months until he complained of increased abdominal pain and an additional 8-lb weight loss

Treatment initiated with sunitinib 50 mg PO qDay for 4 weeks, with a 2-week drug-free interval

Treatment was well tolerated for 3 cycles when he developed nausea and vomiting; dose reduced to 25 mg PO qDay without resolution of AEs; sunitinib was discontinued

Regorafenib 160 mg (four 40 mg tablets) PO qDay for the first 21 days of each 28-day cycle was started, poorly tolerated

Repeat lab work showed: Hb 8.9, AST 65 IU/I; regorafenib was discontinued

The patient was started on ripretinib 150 mg PO qDay

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Neeta Somaiah, MD, reviews the case of a 68-year-old man with gastrointestinal stromal tumor.

Case of A 68-Year-Old Man With Gastrointestinal Stromal Tumor

Neeta Somaiah, MD, an assistant professor in the Department of Sarcoma Medical Oncology at The University of Texas MD Anderson Cancer Center, discusses the evolution of treatment options for patients with a unique sarcoma.

Over the last year, there has been a number of advances for desmoid fibromatosis, says Somaiah. This disease is not actually a sarcoma because it is not considered malignant, but it falls under the sarcoma category. It’s a morbid disease because patients can have local progression, although these tumors do not metastasize. Patients are usually young and have an altered quality of life due to the morbidity of the disease.

Sorafenib (Nexavar) has shown efficacy in terms of an increased response rate in a phase III clinical trial against placebo. However, the placebo-treated patients did respond in a sense that you do have to understand the biology of disease. Most patients may not need treatment and can be followed, says Somaiah. Only patients who progress require therapy.

Nirogacestat (PF-03084014) is a newer drug, which is a gamma secretase inhibitor. It attacks the basis of these desmoid tumors in decreasing fibroblast deposition, says Somaiah. It has shown responses and is well tolerated among these patients. Other β-catenin inhibitors are also available in this treatment landscape. β-catenin is over expressed in most of these tumors because of the mutation expressed. Another β-catenin inhibitor is under evaluation in a phase I trial of desmoid tumors.

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Neeta Somaiah, MD, discusses the evolution of treatment options for patients with a unique sarcoma.

Neeta Somaiah, MD | Authors

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Case of A 68-Year-Old Man With Gastrointestinal Stromal Tumor

Treatment Options Evolve for Patients With Desmoid Fibromatosis