Info
Avapritinib
- TKI w/ exceptional activity against PDGFR-α exon 18 muts, including D842V Mt pts on NAVIGATOR trial who had ORR of 88% (Lancet Onc 2020;21:935)
- FDA approved in PDGFRA exon 18 Mts; NCCN recommends use in place of imatinib for these pts in the neoadj & 1st-line settings
- Cognitive s/e can be problematic, monitor closely
- Other TKIs may have utility after failure of the above-eg, sorafenib, pazopanib, nilotinib, cabozantinib; dasatinib for PDGFR-α D842V after avapritinib
- May be a role for augmentation of TKIs w/ mTOR inhibition on progression
- Investigational: TKI + MEK inhibitor combinations
- Monitoring: CT-CAP/MRI q3mos, responses can correlate w/ Δ density, consider Choi criteria, which incorporates Hounsfield units as a measure of density (JCO 2007;25:1753)
- Consider metastasectomy or RT in cases of limited progression (Ann Surg 2006;244:176, Cancer 2006;107:2833)