Arun S. Singh, MD, associate professor, UCLA David Geffen School of Medicine, discusses challenges for patients with gastrointestinal stromal tumors (GIST).
There are several challenges that remain for GIST, says Singh, as it is a disease that is molecularly characterized. There are drugs that work well, but they are not curing patients. While there are some patients who experience prolonged disease control and eradication, once tyrosine kinase inhibitors (TKIs) are stopped in patients with advanced disease, the disease comes back.
According to Singh, better drugs are needed, and there are some in clinical trials that look promising. Immunotherapy is another way forward. Most of the drugs now are TKIs that work inside the cell. Immunotherapy is a way of attacking from the outside by eliciting an immune response.
For the regular management of GIST, there are several prognosticators that have been established, says Singh. A challenge is deciding whether patients should receive small biopsies, because physicians are often unable to do molecular sequencing of the tumors in patients with GIST due to risk. Patients can be frail, so other markers are needed to determine how this disease is going to behave.