What are the NCCN treatment guidelines for unresectable or metastatic GISTs?

Updated: Sep 02, 2018
  • Author: Steven C Katz, MD, FACS; Chief Editor: Edwin Choy, MD, PhD  more...
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Answer

Answer

NCCN treatment recommendations for unresectable or metastatic disease include the following [6] :

  • Imatinib (category 1), with initial standard dose of 400 mg/day, which may be increased to 800 md/day if progression is observed on initial standard dose [1]
  • After assessment of therapeutic effect, resection may be considered or imatinib may be continued if resection is not feasible. Treatment for more than 6 months may be required to elicit maximal response to imatinib.
  • Continuous daily dosing of sunitinib for patients with imatinib-resistant GIST
  • Regorafenib (category 1) for patients with disease progression on imatinib and sunitinib
  • Tyrosine kinase inhibitor (TKI) therapy should be continued as long as patients are receiving clinical benefit (response or stable disease)
  • Continuation of TKI therapy lifelong for palliation of symptoms is an essential component of best supportive care
  • Resection or ablative therapy may be considered in cases of focal or limited progression

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