Dr Agulnik on the Evolving Management of Heterogenous Disease in GIST

Mark Agulnik, MD, professor, clinical medicine, vice chair, faculty development, Department of Medicine; section chief, Sarcomas & Melanoma, Keck School of Medicine at the University of Southern California, discusses the evolving management of heterogeneous disease types in gastrointestinal stromal tumors (GIST).

The standard approach to managing GIST necessitates understanding each patient’s genetic mutations at diagnosis or upon establishing metastatic disease, Agulnik begins, noting that this approach is evolving. Agulnik states that he and other oncologists treating a high volume of patients with GIST are increasingly re-evaluating these mutations at various time points.

For a patient with metastatic disease presenting in clinic, Agulnik explains that his first step would be to identify the genetic abnormality driving the tumor. Upon disease progression, reassessing the tumor’s genetic signature, either through another biopsy or a circulating tumor DNA liquid biopsy, may be beneficial, Agulnik suggests. Then, a new therapeutic regimen would be initiated, he says. If the patient does not respond to subsequent treatment, it is again essential to gather more tissue or blood to identify the next mutation that has emerged, Agulnik notes.

Since the genetic signatures of tumors may evolve over time, it becomes increasingly important to ensure treatments are targeting current abnormalities rather than those detected in the initial tissue sample, Agulnik continues. A patient’s individual disease profile will change over time, and the disease being detected and managed in 2021 is not the same disease being managed in 2024, he reiterates. Therefore, continuous monitoring of tumor mutations is necessary to avoid the use of outdated therapies and ensure that targeted treatments remain effective, he emphasizes.

This evolving treatment approach underscores the importance of personalized medicine in managing GIST, ensuring each therapy is tailored to each tumor’s current genetic landscape, Agulnik concludes. It also ensures that clinicians make informed decisions based on the latest genetic information, thereby optimizing treatment outcomes for patients with GIST.