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Cancers & treatments·Sequencing

Imatinib-resistant GIST: lines of therapy

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4 standard-of-care settings across 2 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comers
Second line2
Third line and beyond2

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersProgression on imatinib 400 mgConfirm adherence and plasma level; dose escalation to 800 mg (especially exon 9); local therapy for isolated progression while continuing imatinib.
ImatinibThermal ablation (RFA, microwave, cryo)KIT
78
All comersSecond lineSunitinib; ripretinib as an alternative, preferred where the secondary mutation is in exon 17 or 18 (INTRIGUE subgroup; INSIGHT ongoing).
SunitinibRipretinibA Study of Ripretinib vs Sunitinib in Advanced GIST Patients After Treatment With ImatinibINSIGHTLiquid biopsy (ctDNA)
90

Third line and beyond

SubgroupSettingApproachProducts and trialsEvidence
All comersThird lineRegorafenib (GRID).
Regorafenib
85
All comersFourth line and beyondRipretinib (INVICTUS); imatinib rechallenge; trials of next-generation KIT inhibitors.
RipretinibINVICTUSImatinibIDRX-42NB003Bezuclastinib
78

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.