The Evolving Treatment Landscape of GIST and NETs

Sharlene Gill, MD, MPH, FACP, FRCPC, University of British Columbia, highlights significant research data on developments in the treatment of  gastrointestinal stromal tumors (GIST) and neuroendocrine tumors (NETs) that were presented at the 2020 ESMO World Congress on Gastrointestinal Cancer.

Transcript

Hi. My name is Sharlene Gill. I'm a professor of medicine at the University of British Columbia and a medical oncologist at BC Cancer in Vancouver, Canada. I was delighted to be invited by the Scientific Committee for World Congress GI this year to discuss two important abstracts in the arenas of GISTs (gastrointestinal stromal tumors) and NETs (neuroendocrine tumors).

I'll start with the abstract presented by Professor Serrano looking at a crossover analysis from the INVICTUS Trial. The INVICTUS Trial, which has been previously reported, was a very important phase III trial randomizing patients with pretreated GIST to receive either ripretinib or placebo in a two to one fashion.

That trial as we all know demonstrated a very meaningful progression-free survival and overall survival for patients in that refractory setting and have led to the approval of ripretinib for the same.

The purpose of this analysis was to focus on the patients on the placebo ward who were permitted to crossover. That represented 29 patients in this cohort or about 65 percent.

What was interesting was that despite the fact that these are patients who were initially assigned to placebo and then had crossed over at progression, they still achieved a benefit in terms of prolongation of progression-free survival and a more favorable overall survival with the opportunity to crossover

We have to remind ourselves so that, that meant a third of the patients were unable to crossover either due to progression or death that related to disease. The importance of looking at this active agent in earlier lines of therapy so that patients have an opportunity to benefit is key.

Professor Serrano highlighted the fact that the intrigued trial is an ongoing trial comparing ripretinib to our current second-line standard of sunitinib. I think the landscape of gastrointestinal stromal tumors is certainly evolving from a molecular selection perspective.

This unit does represent exciting data, but also highlights for us the need to recognize that due to treatment attrition across lines of therapy or at the time of progression, earlier access to efficacious therapy is important.

The second abstract goes very pleased to discuss was from Professor Rifleman looking at the space of neuroendocrine tumors, and specifically looking at the likelihood of finding potentially, likely pathogenic variants or pathogenic variants of cancer predisposing genes in a young cohort of patients who had seemingly sporadic neuroendocrine tumors.