Case of A 68-Year-Old Man With Gastrointestinal Stromal Tumor - Episode 4
Neeta Somaiah, MD: Patients with GIST [gastrointestinal stromal tumor] who progress beyond frontline therapy on imatinib and move on to second-line therapies, invariably require third-line, fourth-line therapy, and beyond because their time on the TKIs [tyrosine kinase inhibitors] after imatinib tend to be more short-lived. This points to the type of resistance that they have developed in their tumors and might point to whether they get benefits on their second, third, or fourth-line therapies.
When they come to see me, a third-line approved agent is regorafenib, and most patients with an exon 17 secondary mutation, and even some patients with wild-type GIST, do quite well on regorafenib. They do invariably progress, and prior to recently, we didn’t have an approved fourth-line agent, and we used to treat them with other available TKIs that you could prescribe, such as pazopanib, nilotinib, and ponatinib. These are tough to get approvals for insurance, but there are published data of response, and on occasion, patients would respond to these TKIs.
The standard thing to do as well, if you don’t have an approved agent, is to put the patient back on the TKI they have previously responded to well because the progression tends to be slower when they’re on the TKI than when they’re off the therapy.
Transcript edited for clarity.
A 68-Year-Old Man With Gastrointestinal Stromal Tumor