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ASCO 2025: Expert Perspectives in Gastrointestinal Stromal Tumor Treatment - Episode 4

Treating Patients With Gastrointestinal Stromal Tumors

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Panelists discuss how patient adherence to kinase inhibitors is crucial for disease control, requiring proactive adverse effect management, careful radiological monitoring, and strategies such as dose escalation to maximize treatment duration and effectiveness.

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    Maintaining continuous kinase inhibitor therapy is absolutely essential in gastrointestinal stromal tumor (GIST) management, as these treatments suppress receptor activity without altering underlying genetic mutations. Discontinuation results in rapid disease progression, as demonstrated in placebo-controlled trials where untreated patients experienced swift tumor growth. Patient education about the chronic nature of treatment and the critical importance of adherence becomes paramount, with health care providers emphasizing that temporary symptom management is preferable to treatment interruption and subsequent disease acceleration.

    Proactive adverse effect management significantly impacts treatment adherence and long-term outcomes in patients with GIST. Common adverse effects include gastrointestinal symptoms (nausea, vomiting, diarrhea), hypertension with later-line agents, and fluid retention with imatinib. Expert oncologists recommend starting second- and third-line agents at reduced doses with rapid escalation based on tolerance, rather than beginning at full labeled doses. This approach, combined with prophylactic antiemetics, antihypertensives, and regular monitoring, helps maximize treatment duration and effectiveness.

    Regular CT imaging every 2 to 3 months provides the primary method for assessing treatment response and disease progression in patients with GIST. Radiological evaluation requires expertise in recognizing treatment response patterns, as effective kinase inhibition may initially cause tumor swelling while creating necrosis and decreased density (measured in Hounsfield units). Upon detecting progression through increased size or new lesions, circulating tumor DNA testing for resistance mutations guides treatment modifications. Close collaboration between oncologists and radiologists, supported by clinical pharmacists and nursing staff for adherence monitoring, ensures optimal patient outcomes and timely treatment adjustments.

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