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

July 16, 2020
Neeta Somaiah, MD

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

Case:


A 68-Year-Old Man With Gastrointestinal Stromal Tumor

Initial presentation

  • 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

Clinical workup

  • 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
  • Mutational testing: WT-GIST
  • 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
  • Stage IV; ECOG 0

Treatment

  • 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
    • ECOG 1; Imatinib was discontinued
  • 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