V indikaci metastatického GIST zůstávají standardem preparáty imatinib, sunitinib, regorafenib. Avapritinib (nový TK-inhibitor) je nově schválen v indikaci 1. linie metastatického GIST s mutací PDGFR D842, ale neprokázal superioritu oproti regorafenibu v celé populace GIST. Mezi další zajímavé tyrosinkinázové inhibitory patří kabozantinib, pazopanib, ripretinib. Data o efektivitě BRAF blokátorů a imunoterapii anti-PD-1 preparáty jsou zatím velmi omezená. Znovunasazení imatinibu po selhání předchozí léčby imatunibem, sunitinibem a regorafenibem se zdá být efektní jen minimálně. Doporučený standard 3leté adjuvantní léčby imatinibemu pacientů po resekci GIST vysokého rizika nezměnily ani výsledky studie PERSIST s aplikovaným imatinibem v adjuvantní indikaci po dobu 5 let.
Imatinib, sunitinib, and regorafenib have remained the standard therapy for metastatic GIST. Avapritinib (a novel TK inhibitor) has been newly approved as the first-line treatment of metastatic GIST with a PDGFR D842 mutation, but has not been shown to be superior compared with regorafenib in the entire GIST population. Other interesting tyrosine kinase inhibitors include cabozantinib, pazopanib, and ripretinib. Data on the efficacy of BRAF inhibitors and immunotherapy with anti-PD-1 drugs have been limited so far. Repeated administration of imatinib after failure of previous treatment with imatinib, sunitinib, and regorafenib appears to have a minimum effect only. The recommended standard of 3-year adjuvant therapy with imatinib in patients after high-risk GIST resection has remained unchanged by the results of the PERSIST clinical trial with a 5-year administration of adjuvant imatinib.
- Keywords
- regorafenib, cabozantinib, avapritinib, ripretinib,
- MeSH
- Anilides administration & dosage therapeutic use MeSH
- Phenylurea Compounds administration & dosage therapeutic use MeSH
- Gastrointestinal Stromal Tumors * therapy MeSH
- Antibodies, Monoclonal, Humanized therapeutic use MeSH
- Imatinib Mesylate administration & dosage therapeutic use MeSH
- Humans MeSH
- Urea analogs & derivatives MeSH
- Naphthyridines administration & dosage therapeutic use MeSH
- Antineoplastic Agents MeSH
- Pyrazoles administration & dosage therapeutic use MeSH
- Pyridines administration & dosage therapeutic use MeSH
- Pyrroles administration & dosage therapeutic use MeSH
- Sunitinib administration & dosage therapeutic use MeSH
- Triazines administration & dosage therapeutic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
Pokroky v molekulární klasifikaci gastrointestinálního stromálního nádoru (GIST), zejména jeho subklasifikace podle zjištěných genetických alterací i vývoj nových léků v posledních dvou letech výrazným způsobem ovlinily volbu léčebných postupů jak v časné fázi nemoci, tak i vedení léčby paliativní.
The advances in molecular biology of gastrointestinal stromal tumors (GIST) in recent years has allowed to distinguish various tumor subtypes that respond differently to anticancer therapy. This fact together with the development of new active drugs has led to the changes in standards of care in both adjuvant and palliative settings.
- Keywords
- avapritinib, ripretinib, pazopanib, regorafenib,
- MeSH
- Chemotherapy, Adjuvant methods MeSH
- Gastrointestinal Stromal Tumors * diagnosis drug therapy genetics classification MeSH
- Imatinib Mesylate therapeutic use MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Antineoplastic Agents therapeutic use MeSH
- Check Tag
- Humans MeSH
- Keywords
- avapritinib, pazopanib, cerotiximab, entrektinib,
- MeSH
- Benzamides therapeutic use MeSH
- Child MeSH
- Adult MeSH
- Indazoles therapeutic use MeSH
- Precision Medicine * methods trends MeSH
- Protein Kinase Inhibitors therapeutic use MeSH
- Clinical Trials as Topic MeSH
- Drug Therapy, Combination MeSH
- Medical Oncology * methods trends MeSH
- Humans MeSH
- Biomarkers, Tumor * genetics MeSH
- Pyrazoles therapeutic use MeSH
- Pyrimidines therapeutic use MeSH
- Receptors, Vascular Endothelial Growth Factor therapeutic use MeSH
- Sequence Analysis, DNA MeSH
- Sulfonamides therapeutic use MeSH
- High-Throughput Nucleotide Sequencing MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Publication type
- Review MeSH
