PDGFRA D842V-mutant GIST: the decisions you may face
3 treatment settings, 1 with more than one named option. Each section lays out the options the standard of care names, what each is for, the trials behind them with their recorded results, the side effects and cautions on record, and questions to ask. Built from the cancer page's standard-of-care rows; nothing here is advice for your case.
Localised, resectable
Surgical resection; no adjuvant imatinib because the mutation is resistant to it.
Surgeons operate through small incisions using robotic arms with tremor-free precision and 3D vision.
- Precision, shorter stay
- Enables complex minimally invasive resections
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
- Cost
- Loss of haptic feedback
- Not superior for every indication
- Is Robotic & minimally invasive surgery the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (localised, resectable), which of the standard options do you recommend and why?Why: Guideline options include: Surgical resection; no adjuvant imatinib because the mutation is resistant to it.
Add these to your appointment list, or take the full question set for this cancer.
Advanced, first line
Avapritinib 300 mg daily (NAVIGATOR), with monitoring for cognitive effects and bleeding.
Avapritinib is the first drug for GIST driven by the PDGFRA D842V mutation, which resists every other kinase inhibitor; it is also approved for systemic mastocytosis.
No trial record is attached to this row yet. The trials tab lists what is recruiting and the landmark trials for this cancer.
No side-effect rates or interaction flags are recorded for these options yet. The side-effect lookup and interaction checker cover the products that have them.
- Is Avapritinib the only reasonable path for me, or is there a trial, a different sequence or a wait-and-see option?Why: A single standard does not mean a single choice; timing and trials are decisions too.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (advanced, first line), which of the standard options do you recommend and why?Why: Guideline options include: Avapritinib 300 mg daily (NAVIGATOR), with monitoring for cognitive effects and bleeding.
- Am I a candidate for Avapritinib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
Add these to your appointment list, or take the full question set for this cancer.
Progression on avapritinib
No established therapy; clinical trials, surgery or embolisation for isolated progression; regorafenib and other kinase inhibitors have low activity.
A sorafenib successor that became the first second-line drug proven to prolong life in liver cancer (2017).
A blood test that reads fragments of DNA shed by the tumour, so you can genotype or monitor cancer without a needle in the tumour.
- Minimally invasive, repeatable
- Whole-body clonal picture
- Third/fourth-line GIST: avapritinib vs regorafenib
PFS HR 1.25 (negative).
Progression-free survival (median) (months): Avapritinib 4.2 (n=240) vs Regorafenib 5.6 (n=236) · HR 1.25 · source
- Take with a low-fat breakfast (under 30% fat).
- Not recommended in severe impairment; hepatotoxicity is a boxed warning.
- Low shedding in some tumours (brain, early-stage)
- Clonal haematopoiesis false positives
- Between Regorafenib and Liquid biopsy (ctDNA), which do you recommend for me, and what about my case would make you choose differently?Why: Guidelines list several reasonable options; the choice turns on details of your tumour, your health and your priorities.
- What is each option trying to achieve: cure, long control, or relief of symptoms, and over what time?Why: The aim shapes how much side effect and disruption is worth accepting.
- How closely do I match the people in VOYAGER, and does that change what the results mean for me?Why: Trial populations are selected; age, fitness, prior treatment and biomarkers all affect how far results carry.
- What happens if I delay, or decline this step for now? Is the decision reversible?Why: Some decisions can wait for a second opinion or a trial slot; others cannot. Knowing which is part of the choice.
- For my situation (progression on avapritinib), which of the standard options do you recommend and why?Why: Guideline options include: No established therapy; clinical trials, surgery or embolisation for isolated progression; regorafenib and other kinase inhibitors have low activity.
- Am I a candidate for Regorafenib, and what side effects should I expect?Why: Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of VOYAGER apply to someone like me?Why: Trial populations differ from individual patients; ask how closely you match.
Add these to your appointment list, or take the full question set for this cancer.