Unresectable Metastatic Gastrointestinal Stromal Tumor: Case 1

August 2014

• A 59—year-old Caucasian female presented with acute onset abdominal pain
• Past medical history was remarkable for hyperlipidemia
  • Her performance status was ECOG 1
• Abdominal CT findings showed an 11-cm mass in the jejunum and a 3-cm lesion in the liver
  • Biopsy confirmed primary gastrointestinal stromal tumor (GIST) in the jejunum
  • The tumor was determined to be unresectable at the time because of its size and location
• IHC was positive for CD117 (c-KIT); molecular analysis demonstrated an exon 11 mutation
• Mitotic activity was high with >5 mitoses/50 high-power fields
• Treatment was initiated with imatinib 400 mg once daily
• No further disease progression was noted

​October 2016

• During routine follow-up, the patient complained of recurring abdominal pain
• Abdominal CT scan showed a slight increase in the primary tumor size and a new small metastatic tumor in the liver
  • Her ECOG performance status was 1
• The patient was switched to sunitinib 37.5 mg and showed stable disease on follow-up imaging at 3 months

March 2017

• At her 6-month follow-up, abdominal CT scan revealed additional metastases in the liver
• ECOG performance status had changed to 2
• The patient was subsequently referred to an academic center for treatment and was switched to regorafenib 160 mg on days 1-21 of every 28-day cycle
• Three weeks after initiating treatment with regorafenib, she complained of increased fatigue
• She presented with hand-foot skin reaction, which presented as tingling, burning sensations on her palms and a decreased tolerance for touching hot objects