June 13, 2017

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