56-Year-Old Woman with Unresectable GIST
A 56-year-old woman diagnosed with an unresectable GIST began treatment 3 months ago with imatinib 400 mg orally daily. Her tumor is positive for the KIT exon 9 mutation.
She was diagnosed after experiencing severe abdominal pain. She has mild hypertension and suffers from depression.
Unfortunately, after just 3 months of imatinib therapy, her CT scans showed significant disease progression — metastases in the liver, lungs, and peritoneum have developed despite compliance with her imatinib dosing instructions.
According to NCCN guidelines, imatinib dosage can be increased as tolerated, or another tyrosine kinase inhibitor, sunitinib, can be utilized.
Given the extent of the patient’s progression in such a short period, would you consider adding an immune checkpoint inhibitor to sunitinib? Why or why not?
What advice would you give this patient regarding clinical trials?