In most cases, treatments for GIST do not vary by mutation type. However, there are cases where treatments can be individualized according to mutation type. This is especially true during adjuvant therapy. The Treatment by Mutation menu provides a method of navigating different treatments by mutation type.
Mutation type can affect clinical treatment as well as clinical trial choice. For example, patients with KIT exon 9 mutations typically need a higher dose of Gleevec. European guidelines for adjuvant Gleevec exclude treatment for patients with the D842V mutation (since it is not responsive to Gleevec). When combined with risk factors for recurrence, mutation type can be used to select patients that might be good candidates for adjuvant therapy, as well as to suggest which patients might be less likely to benefit for adjuvant therapy.
Several new clinical trials, which are targeted at specific subgroups, are recruiting. These include a trial for the hard-to-treat D842V mutation that is resistant to both Gleevec and Sutent. This trial is open to both first-line patients as well as patients that have already failed other therapies.
Another trial is recruiting patients that have overexpression of the IGF1R protein. Research has suggested that this protein is overexpressed in patients with pediatric-like GIST (SDH-deficient GIST). Another trial for young patients (mostly pediatric-like GIST) that have GIST is currently recruiting.
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