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Opinion|Videos|April 7, 2025

Post-Imatinib Progression: Decision Factors and Treatment Options

Author(s)Breelyn Wilky, MD, Jason Sicklick, MD, FACS, Seth M. Pollack, MD

Experts discuss key factors influencing decision-making when patients with advanced gastrointestinal stromal tumors (GIST) progress on imatinib, reviewing standard second-line options, considerations for increasing imatinib dosing vs switching to a different tyrosine kinase inhibitor (TKI), and clinical or radiographic patterns that guide therapy changes or dose escalation at progression.

Episodes in this series

EP. 1 Optimizing TKI Selection and Sequencing Strategies in Advanced GIST Beyond First-Line Therapy

EP. 1 Optimizing TKI Selection and Sequencing Strategies in Advanced GIST Beyond First-Line Therapy

EP. 2 Biological Mechanisms of GIST Resistance and Tumor Heterogeneity

EP. 2 Biological Mechanisms of GIST Resistance and Tumor Heterogeneity

EP. 3 Monitoring Tumor Heterogeneity and Detecting Resistance

EP. 3 Monitoring Tumor Heterogeneity and Detecting Resistance

EP. 4 Post-Imatinib Progression: Decision Factors and Treatment Options

EP. 4 Post-Imatinib Progression: Decision Factors and Treatment Options

EP. 5 INVICTUS Trial: Ripretinib in Fourth-Line Setting

EP. 5 INVICTUS Trial: Ripretinib in Fourth-Line Setting

EP. 6 INTRIGUE Trial: Key Findings in Second-Line Setting

EP. 6 INTRIGUE Trial: Key Findings in Second-Line Setting

EP. 7 ctDNA Biomarkers in INTRIGUE: Understanding Resistance Patterns

EP. 7 ctDNA Biomarkers in INTRIGUE: Understanding Resistance Patterns

EP. 8 Managing Adverse Events With Different TKIs

EP. 8 Managing Adverse Events With Different TKIs

EP. 9 Next-Generation Treatment Strategies for GIST: Evaluating Combination Therapies and Mutation-Specific Approaches

EP. 9 Next-Generation Treatment Strategies for GIST: Evaluating Combination Therapies and Mutation-Specific Approaches

EP. 10 Practical Recommendations for Community Oncologists

EP. 10 Practical Recommendations for Community Oncologists

Video content above is prompted by the following:

With imatinib as our established first-line therapy for advanced GIST, what key factors influence your decision-making when patients progress? What are our standard second-line options, and what factors influence this treatment selection?
What specific clinical or molecular factors would lead you to consider increasing imatinib dosing rather than switching to a different TKI?
What specific clinical or radiographic patterns at the time of progression signal would definitively guide you to switch therapies vs dose escalation?

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