Management strategy for gastrointestinal stromal tumors (GIST): current status and future perspectives
Kondratskyi Yu.M., Koval N.O., Kolesnyk A.V., Kozak E.O., Pepenin M.O., Dobrzhanskyi O.Yu., Shudrak Y.A., Horodetskyi A.V., Svichkar Y.O., Ukrainets I.O., Turchak V.O.
Summary. Objective. To summarize current approaches to the treatment of gastrointestinal stromal tumors (GIST), considering the role of surgical, pharmacological, and endoscopic modalities. Materials and methods. More than 30 sources were analyzed, including clinical guidelines (National Comprehensive Cancer Network — NCCN, European Society for Medical Oncology — ESMO), systematic reviews, population-based studies (Mucciarini M.), SEER-based analyses (Woodall C.), AFIP publications (Miettinen M.), and results from recent clinical trials and registries on imatinib, avapritinib, ripretinib, sunitinib, as well as the efficacy of minimally invasive techniques. Results. Complete surgical resection (R0) remains the cornerstone of treatment for localized GIST. Tumors with a high risk of recurrence require adjuvant imatinib therapy. Emerging data support the efficacy of laparoscopic and endoscopic approaches, particularly for tumors ≤5 cm, with specific emphasis on submucosal tunneling endoscopic resection (STER). The importance of molecular profiling is increasing: mutations in KIT (exons 11, 9), PDGFRA (exon 18, D842V), and wild-type GISTs are critical in guiding targeted therapy selection. In the fourth-line setting, ripretinib has been shown to prolong survival (INVICTUS trial). Avapritinib demonstrates an objective response rate (ORR) exceeding 80% in patients with PDGFRA D842V-mutated tumors. Prognostic models, such as TGM staging, support clinical risk stratification. According to Mucciarini M., 47% of patients present with high-risk tumors, while 22.6% have metastases at diagnosis (Woodall C., SEER). Conclusions. GIST management is grounded in a multidisciplinary, personalized approach. Early diagnosis, implementation of minimally invasive technologies, and molecular profiling are pivotal to optimizing outcomes. Patients with wild-type tumors require novel targeted strategies. The role of clinical registries and biobanking is steadily expanding.
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