The Management of Unresectable, Advanced Gastrointestinal Stromal Tumours

Tiffany Foo¹, David Goldstein², Eva Segelov³, Jeremy Shapiro⁴, Nick Pavlakis⁵, Jayesh Desai⁶, Desmond Yip⁷, John Zalcberg⁸, Timothy J Price⁹, Adnan Nagrial¹⁰, Lorraine Chantrill¹¹, Matt Burge¹², Christos S Karapetis¹, Niall Tebbutt¹³, Amitesh C Roy¹⁴

Affiliations

¹ Flinders Centre for Innovation in Cancer/Flinders University, Bedford Park, SA, 5042, Australia.
² Department of Medical Oncology, Prince of Wales Hospital, University of NSW, Sydney, NSW, Australia.
³ Department of Medical Oncology, School of Clinical Sciences, Monash University and Monash Health, Melbourne, VIC, Australia.
⁴ Cabrini Health, Monash University, Melbourne, VIC, Australia.
⁵ Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
⁶ Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
⁷ Department of Medical Oncology, Canberra Region Cancer Centre, The Canberra Hospital, Canberra, ACT, Australia.
⁸ Alfred Health, Monash University, Melbourne, VIC, Australia.
⁹ The Queen Elizabeth Hospital/University of Adelaide, Adelaide, SA, Australia.
¹⁰ Department of Medical Oncology, Westmead and Blacktown Hospitals, University of Sydney, Sydney, NSW, Australia.
¹¹ Department of Medical Oncology, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Illawarra, NSW, Australia.
¹² Department of Cancer Care Services, Royal Brisbane Hospital, University of Queensland, Herston, QLD, Australia.
¹³ Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia.
¹⁴ Flinders Centre for Innovation in Cancer/Flinders University, Bedford Park, SA, 5042, Australia. amitesh.roy@sa.gov.au.

PMID: 35290591
PMCID: PMC8995292
DOI: 10.1007/s11523-022-00869-y

Review

The Management of Unresectable, Advanced Gastrointestinal Stromal Tumours

Tiffany Foo et al. Target Oncol. 2022 Mar.

. 2022 Mar;17(2):95-110.

doi: 10.1007/s11523-022-00869-y. Epub 2022 Mar 15.

Authors

Affiliations

¹ Flinders Centre for Innovation in Cancer/Flinders University, Bedford Park, SA, 5042, Australia.
² Department of Medical Oncology, Prince of Wales Hospital, University of NSW, Sydney, NSW, Australia.
³ Department of Medical Oncology, School of Clinical Sciences, Monash University and Monash Health, Melbourne, VIC, Australia.
⁴ Cabrini Health, Monash University, Melbourne, VIC, Australia.
⁵ Department of Medical Oncology, Royal North Shore Hospital, University of Sydney, Sydney, NSW, Australia.
⁶ Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
⁷ Department of Medical Oncology, Canberra Region Cancer Centre, The Canberra Hospital, Canberra, ACT, Australia.
⁸ Alfred Health, Monash University, Melbourne, VIC, Australia.
⁹ The Queen Elizabeth Hospital/University of Adelaide, Adelaide, SA, Australia.
¹⁰ Department of Medical Oncology, Westmead and Blacktown Hospitals, University of Sydney, Sydney, NSW, Australia.
¹¹ Department of Medical Oncology, Wollongong Hospital, Illawarra Shoalhaven Local Health District, Illawarra, NSW, Australia.
¹² Department of Cancer Care Services, Royal Brisbane Hospital, University of Queensland, Herston, QLD, Australia.
¹³ Department of Medical Oncology, Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Heidelberg, VIC, Australia.
¹⁴ Flinders Centre for Innovation in Cancer/Flinders University, Bedford Park, SA, 5042, Australia. amitesh.roy@sa.gov.au.

PMID: 35290591
PMCID: PMC8995292
DOI: 10.1007/s11523-022-00869-y

Abstract

Gastrointestinal stromal tumours (GISTs) are the most common gastrointestinal tract mesenchymal tumours. Tyrosine kinase inhibitors (TKIs) have transformed the management of advanced GIST. Imatinib was the first TKI to gain approval as management for patients with advanced GIST, establishing a new standard of care. Since then, as a result of several trials including the GRID and INVICTUS studies, we now have five lines of approved targeted therapy, including imatinib, sunitinib, regorafenib, ripretinib and avapritinib for the treatment of unresectable, advanced GISTs. In this review, the Australasian Gastrointestinal Trials Group (AGITG) provide an overview of the key trials that have changed clinical practice, discuss the molecular drivers of GISTs, the importance of molecular testing and directing therapy according to molecular targets, as well as future strategies in the management of advanced GISTs.

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Conflict of interest statement

Tiffany Foo, David Goldstein, Eva Segelov, Jeremy Shapiro, Nick Pavlakis, Jayesh Desai, Desmond Yip, John Zalcberg, Adnan Nagrial, Lorraine Chantrill, Matt Burge, Christos S. Karapetis, Niall Tebbutt, and Amitesh C. Roy declare they have no conflicts of interest that might be relevant to the contents of this manuscript. Timothy Price reports advisory roles for MSD, Servier and BioGene.

Figures

**Fig. 1**
Driver genes in GIST. Created with BioRender.com. *GIST* gastrointestinal stromal tumours, *SDH* succinate dehydrogenase

**Fig. 2**
Timeline of US FDA approval for tyrosine kinase inhibitors for the treatment of advanced or metastatic GISTs. *GISTs* gastrointestinal stromal tumours

See this image and copyright information in PMC

References

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The Management of Unresectable, Advanced Gastrointestinal Stromal Tumours

Affiliations

The Management of Unresectable, Advanced Gastrointestinal Stromal Tumours

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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