Management of recurrent gastrointestinal cancer with ripretinib and surgery

Ripretinib is a tyrosine kinase inhibitor that was approved by the United States FDA in 2020 for treatment of advanced gastrointestinal stromal tumor (GIST) in patients who received prior treatment with three or more tyrosine kinase inhibitors.

In a new case report, researchers Mohamed A. Gouda, Filip Janku, Neeta Somaiah, Kelly K. Hunt, Sireesha Yedururi, and Vivek Subbiah from The University of Texas MD Anderson Cancer Center and Sarah Cannon Research Institute describe the use of ripretinib in a patient with recurrent GIST harboring a KIT exon 11 mutation following treatment with multiple TKIs. The patient was managed with ripretinib and surgical resection of progressing lesions at multiple time points which led to extended clinical benefit.

The report was published in Oncoscience on September 20, 2023, entitled, "Multi-disciplinary management of recurrent gastrointestinal stromal tumor harboring KIT exon 11 mutation with the switch-control kinase inhibitor ripretinib and surgery."

"[…] we show the durable clinical benefit achieved in a patient with GIST by using ripretinib and repeated timely surgical resection of limited disease progression," write the authors

A Hispanic female in her late 20s presented with left lower quadrant pain initially attributed to an ovarian cyst. A workup with computed tomography (CT) evaluation, revealed an incidental 6cm duodenal mass with central necrosis. She underwent exploratory laparotomy with resection of the mass which was diagnosed as GIST with high malignant potential and positive immunohistochemistry for c-KIT. The total time on ripretinib was 43 months which is longer than the current reported data from ripretinib clinical trials.

"Such an approach for using multi-disciplinary disease management can improve the durability of response to tyrosine kinase inhibitors, including ripretinib, and associated clinical outcomes," say the researchers.