The designation expands the investigational immunotherapy’s development across tumor types for patients whose disease progresses after prior treatment, including immune checkpoint inhibition.
|Videos|June 22, 2020
A 68-Year-Old Man With Gastrointestinal Stromal Tumor
Author(s)Margaret von Mehren, MD
Margaret von Mehren, MD, describes the rationale for treating a man with GIST with ripretinib as fourth-line therapy.
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Case: A 68-Year-Old Man With Gastrointestinal Stromal Tumor
Initial presentation
- A 68-year-old man complains of a 5-month history early satiety and vague abdominal pain
- PMH: hypertension, medically controlled; colonoscopy at age 55 unremarkable; no family history of cancer
- PE: diffuse abdominal pain on palpation; otherwise unremarkable
Clinical workup
- Labs: Hb 10.1 g/dL, plt 100 x 109/L; other lab values WNL
- Endoscopy: showeda submucosal ~ 5 cm mass with ulceration
- EUS-FNA biopsy: irregular borders on extraluminal surfaces of the stomach with evidence of heterogeneous echogenicity
- Biopsy showed gastrointestinal tumor with mitotic activity showed >5 mitoses/50 HPFs
- Abdominal/pelvic CT confirmed a 5.4 cm lesion in the body of the stomach
- MRI showed evidence of peritoneal metastases
- IHC and genetic mutational analysis: KIT exon 11 mutation
- ECOG 0
Treatment
- He was started on imatinib 400 mg PO qDay, continued for 26 months until he complained of increased abdominal pain and decreased appetite
- ECOG 1; Imatinib was discontinued due to progressive disease
- Treatment with sunitinib 50 mg PO qDay for 4 weeks, with a 2-week drug-free interval was started
- Treatment was well tolerated for 9 cycles when he developed an altered sense of taste, occasional vomiting and diarrhea; sunitinib was discontinued
- Regorafenib 160 mg (four 40 mg tablets) PO qDay for the first 21 days of each 28-day cycle was started and tolerated except for hand-foot syndrome
- Regorafenib was discontinued on progression of disease
- The patient was started on ripretinib 150 mg PO qDay
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