Imatinib 400 mg/day as adjuvant therapy, For 3 years, it is the standard of care for patients at significant risk of recurrence.
KITexon 9 mutation: 800 mg or more of ima tinib, 3 years.
PDGFRA D842V mutation, preoperative avapritinib may be considered; or should not be used adjuvant therapy.
Patients with ruptured tumors are at very high risk of recurrence, and therefore, imatinib should be considered for these patients.
In general, surgery is performed 6-12 months after neoadjuvant therapy, because after 12 months, very few There is further tumor shrinkage and secondary resistance may develop. Functional imaging can very rapidly assess tumor response to treatment within a few weeks.
NF1-related and SDH-negative GIST cases: avoid imatinib; SDH-deficient versus sunitinib and Regorafenib may have some sensitivity.
BRAFmutations: benefit from BRAF inhibitors, including BRAF-MEK inhibitors combination).
NTRKrearrangements: treatment with NTRK inhibitors (eg, larotrectinib, entrectinib) sensitive.
Patients with metastatic tumors should continue imatinib therapy indefinitely until clinically relevant disease progression or intolerance, because treatment Relatively rapid tumor progression usually occurs after interruption, even if the lesion has previously been surgically removed.
In cases of confirmed progression to imatinib or rare intolerance, the standard second-line treatment is sunitinib; The 4-week on/2-week off regimen, continuous dosing of 50 mg per day or 37.5 mg per day orally, was effective and well tolerated.
After progression on sunitinib, regorafenib (third-line therapy) 160 mg daily can be tried every 3/4 weeks.
Ripretinib 150 mg daily is the standard IV line therapy.
Follow-up, long-term effects, and survival
< span>There are no data to suggest optimal routine follow-up policy for surgically treated patients with localized disease.
Recurrences are more common in the liver and/or peritoneum; bone lesions and other metastatic sites may be rare. Nuclear fission affects the speed of relapse. Risk assessment based on mitotic count, tumor size, and tumor location aids in the selection of routine follow-up policies. High-risk patients typically relapse within 1-3 years after adjuvant therapy ends. Low-risk patients may relapse later.
In general, high-risk patients receive routine follow-up with abdominal CT scans or MRIs every 3-6 months during adjuvant therapy for 3 years ( Side effects of adjuvant therapy due to the need for more rigorous clinical follow-up), unless contraindicated, then discontinue adjuvant therapy every 3 months for 2 years, then every 6 months until 5 years after discontinuation of adjuvant therapy, Then stop once a year for another 5 years.
The usefulness of routine follow-up for low-risk tumors is unclear; if chosen, this can be done with abdominal CT scan or MRI, eg, Every 6-12 months for 5 years.
Very low-risk GIST may not require routine follow-up, although the risk is not zero. X-ray exposure is a factor to consider, especially in low-risk GIST, where abdominal MRI is an alternative.