Advances in GIST Care: Treatments You Should Know

Gastrointestinal Stromal Tumor (GIST) Treatments

GIST often leads to symptoms such as abdominal pains, nausea, vomiting, feeling full easily and more. With Qinlock (ripretinib), you can treat GISTs by targeting enzymes that promote tumor growth.

Qinlock

Qinlock (ripretinib) is a targeted therapy specifically developed for advanced GIST, particularly in patients who have exhausted other treatment options. It is a tyrosine kinase inhibitor, a once-daily oral tablet (TKI) that works by blocking multiple kinases involved in tumor growth and survival, targeting mutations that often develop resistance to other treatments.

Qinlock addresses mutations commonly emerging in advanced GIST, particularly in patients who have already received other TKIs. By inhibiting these mutations, Qinlock helps to prevent tumor progression and can extend survival in patients with limited options. Some side effects can include fatigue, nausea and muscle pain.

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Other Common Treatment Options

Treatment options for GIST vary depending on the severity of the condition. Best results often require a combination of surgery, targeted therapy and sometimes chemotherapy, depending on the tumor’s stage and location. Primary treatment strategies include:

1. Surgery

Surgery is often the first line of treatment for localized GISTs that have not yet spread. The goal of surgery is to remove the tumor completely to prevent further growth and spread. In cases where the tumor is accessible and has not invaded surrounding organs, surgery may be curative.

• Complete resection: Removing the tumor with clear margins is the goal, reducing the risk of recurrence.
• Challenges: In advanced stages, surgery alone may not be sufficient, especially if the tumor has metastasized.

2. Targeted Therapy with Tyrosine Kinase Inhibitors (TKIs)

Targeted therapies have transformed GIST treatment by focusing on specific genetic mutations within the tumor. The following TKIs are commonly used:

• Imatinib (gleevec): Often used as a first-line treatment for metastatic or inoperable GIST, imatinib targets specific mutations in the tumor cells, such as KIT or PDGFRA, which drive tumor growth.
• Sunitinib (sutent): Sunitinib is typically used when Gleevec becomes less effective. It offers an alternative approach by inhibiting additional mutations.
• Regorafenib (stivarga): This TKI is usually prescribed when both imatinib and sunitinib fail. It works by targeting different kinases involved in tumor growth and progression.

3. Chemotherapy and Radiation

Unlike many cancers, GIST does not respond well to traditional chemotherapy. Radiation is also rarely used due to its limited effectiveness on GIST. However, in certain cases where other options are not viable, chemotherapy may be considered as a supplementary approach.

4. Additional Medications and Symptom Management

• Pain management: Pain relief medications, including NSAIDs and opioids, can help manage discomfort, especially in advanced stages.
• Anti-nausea medication: To help with symptoms related to both the condition and side effects of treatment, anti-nausea drugs are often prescribed.

Other factors that affect treatment for GIST include:

Size of the Tumor

The longer the tumor has been in your body, the more likely it is to have spread to the bloodstream.

Growth Rate of the Tumor

The growth of a tumor can be determined by how many cells are actively dividing within the tumor.

Location of the Tumor

If the GIST is in a larger area, like the stomach, it can often grow larger without spreading to other organs. But if the GIST is in a more vascular area with a lot of nearby structures such as in the small intestine or rectum, it’s more likely to metastasize or spread. If that’s the case, treatment needs to be more intensive.

Emerging Research and Future Treatments

As understanding of GIST genetics and tumor biology advances, new therapies and drug combinations are under development. Personalized medicine and next-generation TKIs are being researched to tackle resistant mutations and improve outcomes for patients with advanced GIST.

Regular follow-ups are crucial for patients with GIST, as the risk of recurrence remains even after successful treatment. Periodic imaging and monitoring of tumor markers allow doctors to detect any changes early, adjusting treatments as necessary.

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