Recent advances in the management of gastrointestinal stromal tumor

Table 5 Treatment options of resectable gastrointestinal stromal tumors

Resectable GISTs with minimum morbidity

Resectable GISTs with significant morbidity

Resection followed by risk stratification on pathology: (1) Very low or low risk category – no TKI; and (2) Intermediate or high risk category - TKI.

Preoperative TKI: (1) If patient responds to TKI: continue TKI and proceed with surgery; and (2) If patient does not respond to TKI: surgery if feasible. If surgery not feasible: (a) For limited progression -options include radiofrequency ablation, embolization, chemoembolization, and palliative radiation; and (b) For widespread progression – increase the dose of imatinib as tolerated, If that fails – sunitinib followed by regorafinib followed by avapritinib should be tried. If GIST continues to progress despite TKIs, other options include clinical trials, systemic agents against GIST and best supportive care.

GIST: Gastrointestinal stromal tumor; TKI: Tyrosine kinase inhibitor.