[Advanced GIST: Which treatments in 2022?]

Area of Science:

• Oncology
• Gastroenterology
• Molecular Biology

Background:

• Gastrointestinal stromal tumors (GIST) are rare digestive neoplasms.
• Activating KIT mutations (~70%) and PDGFRA mutations (~10-15%) are primary drivers.
• Rare subgroups include SDH deficiency and alterations in NF1, BRAF, RAS, or NTRK genes.

Purpose of the Study:

• To review recent clinical trials and therapeutic strategies for advanced GIST.
• To evaluate the role of new tyrosine kinase inhibitors (TKIs) in GIST management.
• To summarize emerging treatments for specific molecular subgroups of GIST.

Main Methods:

• Review of recent clinical trials and published data on advanced GIST treatments.
• Analysis of efficacy and safety data for novel TKIs like ripretinib and avapritinib.
• Evaluation of treatment guidelines and emerging therapeutic strategies for GIST.

Main Results:

• Ripretinib is approved as fourth-line therapy for advanced GIST with KIT/PDGFRA non-D842V mutations.
• Avapritinib shows efficacy in D842V-mutated GIST, becoming a first-line option for this subgroup.
• Avapritinib may offer an option for pre-treated patients without D842V mutations, requiring further clarification.

Conclusions:

• New TKIs are significantly improving advanced GIST management.
• Personalized treatment approaches based on molecular profiling are crucial for GIST.
• Ongoing research promises further advancements in GIST therapy.