New treatment options for Gastrointestinal stromal tumour (GIST)

The treatment landscape for patients with gastrointestinal stromal tumor (GIST) has undergone significant changes over the past two decades. Currently, there are several FDA-approved agents available for GIST treatment, namely sunitinib (Sutent), regorafenib (Stivarga), ripretinib (Qinlock), and avapritinib (Ayvakit).

Initially, the targeted therapy drug imatinib (Gleevec) is commonly used as the first-line treatment for GIST patients. However, patients with advanced GIST or those who cannot continue using imatinib due to adverse effects require alternative options.

In such cases, sunitinib is currently considered the standard second-line treatment for these patients. Sunitinib works by targeting the KIT gene and inhibiting blood vessel growth in tumors. Another option is regorafenib.

Additionally, other targeted therapies like ripretinib, which has been included in the National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines, may be employed in the treatment of GIST patients when sunitinib is no longer effective.

For patients who do not respond to these therapies, there are additional options available in the form of tyrosine kinase inhibitors, such as pazopanib (Votrient), nilotinib (Tasigna), and dasatinib (Sprycel).

Novel target therapies included in the following table:

[1] https://www.targetedonc.com/view/treatment-of-gist-recent-changes-and-recommendations. Last accessed date: 19 Oct 2023.

[2] Mazzocca A, Minelli A, Paternostro F, Silletta M, Napolitano A, Vincenzi B. New molecularly targeted drugs for gist after imatinib, sunitinib and regorafenib: a narrative review. Gastrointest Stromal Tumor 2022;5:4.