Management of Patients With Advanced Gastrointestinal Stromal Tumor: Emphasis on Fourth-Line Treatment With Ripretinib.

Sandra Brackert, Kathleen Polson
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Abstract

Gastrointestinal stromal tumors (GISTs) are considered rare, yet they represent the most common sarcomas of the gastrointestinal tract. The development of tyrosine kinase inhibitors (TKI) for the treatment of GISTs changed the way we treat patients and has greatly impacted outcomes. However, most patients who initially benefit from TKIs eventually develop disease progression and require subsequent therapies. Ripretinib is a switch-control TKI approved for the treatment of adult patients with advanced GIST who received prior treatment with three or more TKIs, including imatinib. Our objective was to review existing treatment options for patients with advanced GIST, focusing on management optimization for heavily pretreated patients receiving ripretinib. With the integration of ripretinib as a fourth-line therapy, the GIST treatment landscape continues to evolve. As the treatment paradigm becomes increasingly complex, successful management of adverse events and individualized supportive care remain crucial to maintaining effective treatment and patient quality of life. Additionally, we present a detailed case study of a heavily pretreated patient with advanced GIST who received ripretinib as fourth-line therapy. The information provided here should help inform advanced practitioners on the effective management of patients with GIST who have progressed on multiple therapies. Advanced practitioners are well positioned to provide the necessary supportive care to achieve optimal outcomes and drug compliance.

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晚期胃肠道间质瘤患者的治疗:重点是利普雷替尼的一线治疗。
胃肠道间质瘤(gist)被认为是罕见的,但它们代表了最常见的胃肠道肉瘤。用于治疗gist的酪氨酸激酶抑制剂(TKI)的发展改变了我们治疗患者的方式,并极大地影响了结果。然而,大多数最初受益于tki的患者最终会发展为疾病进展并需要后续治疗。利普雷替尼是一种开关控制TKI,被批准用于治疗先前接受过三种或更多TKI治疗的成年晚期GIST患者,包括伊马替尼。我们的目的是回顾晚期GIST患者的现有治疗方案,重点关注接受利普雷替尼的重度预处理患者的管理优化。随着利普雷替尼作为第四线治疗的整合,GIST的治疗前景继续发展。随着治疗模式变得越来越复杂,不良事件的成功管理和个性化的支持护理仍然是维持有效治疗和患者生活质量的关键。此外,我们提出了一个详细的病例研究,重度预处理的晚期GIST患者接受了利普雷替尼作为第四线治疗。这里提供的信息应该有助于告知高级从业人员对经多种治疗进展的GIST患者的有效管理。高级从业人员能够很好地提供必要的支持性护理,以实现最佳结果和药物依从性。
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