ASCO 2025: Expert Perspectives in Gastrointestinal Stromal Tumor Treatment - Episode 1
Panelists discuss how gastrointestinal stromal tumors (GISTs) are the most common sarcoma with specific genetic mutations, requiring comprehensive mutational analysis to guide treatment decisions and understand both primary and secondary resistance patterns.
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This OncLive Peer Exchange brings together leading sarcoma specialists to discuss cutting-edge GIST treatment strategies. The expert panel features Dr Shreyaskumar Patel, Dr Richard Riedel, Dr Priscilla Merriam, and Dr Gina D'Amato, who collectively represent decades of experience in GIST management and sarcoma care.
GISTs represent the most common type of sarcoma, with approximately 5000 new cases diagnosed annually in the US. These tumors originate from connective tissue within the gastrointestinal tract, with 60% occurring in the stomach and one-third developing in the small intestine. The remaining cases distribute between esophageal (5%) and rectal (5%) locations. Patients typically present with abdominal pain, nausea, anemia from intraluminal bleeding, or abdominal distension, making early recognition crucial for optimal treatment outcomes.
Accurate GIST diagnosis requires specialized testing beyond standard biopsies, as these tumors are often submucosal rather than intraluminal. Endoscopic ultrasound, percutaneous biopsy, and comprehensive molecular panel testing are essential for confirming KIT receptor overexpression and identifying specific mutations. The most common mutation involves KIT exon 11, though other primary mutations in PDGFR-alpha, NF1, and SDH deficiency exist. Understanding these genetic alterations is critical for treatment selection, as different mutations respond variably to targeted kinase inhibitor therapies.