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GIST — SCE Medical Oncology MCQ

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HardGI CancersGISTSCE Medical Oncology

A 60-year-old man with a gastric GIST (8 cm, KIT exon 9 mutation, mitotic rate 12/50 HPF) undergoes complete resection. What is the correct imatinib dosing for this mutation in the adjuvant setting?

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Correct answer: D — Imatinib 400 mg daily

For adjuvant treatment of resected GIST, imatinib 400 mg daily for 3 years is the standard dose regardless of KIT mutation type (NICE TA572). This differs from the METASTATIC setting where KIT exon 9 mutations warrant imatinib 800 mg daily (based on MetaGIST meta-analysis showing improved PFS with high-dose for exon 9). The adjuvant dose is 400 mg because the SSGXVIII/AIO trial used 400 mg. Dose escalation to 800 mg is reserved for metastatic exon 9 GIST or progression on 400 mg.

Reference: NICE TA572 Adjuvant imatinib; ESMO 2024 GIST Guidelines; MetaGIST