Symptom-Driven Treatment Decisions

Dale R. Shepard, MD, PhD, of Cleveland Clinic, compares the 2 approved colony-stimulating factor 1 receptor (CSF1R) inhibitors for tenosynovial giant cell tumor (TGCT), pexidartinib and vimseltinib, with R. Lor Randall, MD, FACS, of UC Davis Health, and Alexander B. Christ, MD, of UCLA Health. Dr Shepard says efficacy and patient-reported outcomes are similar, but the liver toxicity and required safety monitoring program with pexidartinib, plus twice-daily dosing with a low-fat diet and hypopigmentation, worried many patients. New starts now favor vimseltinib, although he keeps stable patients on pexidartinib rather than switching. He guides treatment by symptoms and often considers stopping after about a year once symptoms resolve. Dr Christ calls TGCT a symptom-driven disease in which experienced patients help direct their own care. Dr Shepard notes that patients often self-reduce doses or take breaks, and Dr Christ describes a patient bothered more by periorbital edema than by his knee.