First- and Second-Line Treatments for Patients With GIST


Edwin Choy, MD, director of the Sarcoma Program at the Division of Hematology Oncology at Massachusetts General Hospital, a founding member of Mass General Brigham, associate professor of medicine at Harvard Medical School, discusses recommendations for the treatment of frontline and second-line gastrointestinal stromal tumor (GIST).

According to Choy, some of treatment options for patients with GIST include sunitinib (Sutent), regorafenib (Stivarga), ripretinib (Qinlock), avapritinib (Ayvakit), and imatinib (Gleevec).


0:08 | We want to sequence tumor DNA. When one says frontline, I think of metastatic disease, because if they don't have metastases, I'm only thinking of neoadjuvant or adjuvant. In metastatic disease, before I make a decision, I would make sure that everyone has their tumor DNA sequenced. If it shows an imatinib-sensitive mutation, then imatinib is my first choice for first-line therapy and I would treat that at 400 milligrams per day.

0:46 | I would continue to use imatinib while repeating scans and we read lengths to make sure that there's no recurrence. I would continue to use imatinib as long as the patient tolerates the drug and the scans do not show for the progression of disease.

1:05 | If the patient does not have imatinib-sensitive mutations, with less data, I would use whatever drug that the tumor profile seems to indicate. Again, if you have the D842 mutation, I would use avapritinib. If you have the NTRK mutation, I would use one of the NTRK inhibitors, and if one has an SDH deletion, I would think about using sunitinib, but try to involve the patients in a clinical trial.

1:40 | In the second-line, we like to use sunitinib because that is what we have the most data for. There are clinical trials ongoing to see if 1 of the newer drugs like avapritinib or riptretinib can be superior to sunitinib prior to a second-line therapy. Those trials are still not mature in terms of their data. Unless the tumor mutation profile shows us to do something different, I think largely, sunitinib is our preferred second-line therapy.

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