First- and Later-Line Therapies in Patients With GIST


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Domenech Asbun, MD, discusses first-, second-, and later lines of therapy for patients with gastrointestinal stromal tumor.

Domenech Asbun, MD, hepatobiliary, pancreas and foregut surgeon, Miami Cancer Institute at Baptist Health South Florida, discusses first-, second-, and later lines of therapy for patients with gastrointestinal stromal tumor (GIST).

According to Asbun, surgery is typically the first-line treatment for GIST with the goal of removing the tumor completely. However, not all GIST tumors are surgically resectable, leaving the need for additional treatment options.

In the first-line, one of the most common non-surgical treatments for GIST is imatinib (Gleevec), a targeted therapy that has been well-tolerated, effective in shrinking GIST tumors, and beneficial in improving survival rates.

If patients do not respond well to imatinib, other treatments are available, including sunitinib (Sutent), regorafenib (Stivarga), and more. Further, some patients with GIST may require third-line or later-line treatment, which are typically treatments reserved for patients who have not responded to any of the other available therapies.


0:10 | To fully treat this, we usually consider surgery to be the definitive therapy. Like with a lot of cancers, if you can't get the surgery right away, then your goal is to hopefully be able to give something to make the tumor go from unresectable to resectable. GIST tumors are 1 of those types of tumors. A lot of times in patients, either because [they were] originally too dangerous to take out or because they're big and they would be easier to take out when they're smaller, we a lot of times give other medication.

0:40 | In that sense, the first-line treatment, apart from surgery, would be to give a medication called imatinib, that is also known as Gleevec. Other medications tend to be reserved for patients who don't have a great response to imatinib. Second-line tends to be sunitinib, and then there are other medications that you will use that don't seem to have as great of efficacy as imatinib or sunitinib might, but they can be a good option for patients that aren't having response to those first 2 medications.

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