Patient
BMA-NTRK_FUSION_GIST · Algorithm: ALGO-GIST-1L
Clinical significance of mutations (ESCAT)
Tumor-board context — the engine does not use these tiers to rank tracks
| Biomarker | Variant | ESCAT | Evidence | Clinical significance | Drugs | Sources |
|---|
| BIO-NTRK-FUSION | NTRK1/3 fusion (rare in KIT/PDGFRA wild-type GIST) | IA | Evidence cited from clinical guidelines; per-source evidence levels not yet structured. See Phase-2-of-CIViC-pivot for re-cite roadmap. | NTRK fusion in GIST is rare and confined to KIT/PDGFRA wild-type GIST (which is itself ~10-15% of GIST). Larotrectinib and entrectinib are FDA tumor-agnostic for NTRK-fusion solid tumors; GIST cohort small but consistent with pan-tumor response rates. | larotrectinib monotherapy
entrectinib monotherapy | |
Treatment options (2 tracks)
- Indication
- IND-GIST-1L-IMATINIB
- Regimen
- Imatinib (GIST advanced/metastatic 1L; KIT/PDGFRA imatinib-sensitive)
- Drugs + NSZU
- Imatinib (DRUG-IMATINIB) 400 mg PO once daily with food + large glass of water (KIT exon 11; PDGFRA non-D842V exon 18; PDGFRA exon 12/14) · Continuous, until progression or unacceptable toxicity · PO ✓ NSZU covered
- Reason
- Engine default per algorithm ALGO-GIST-1L: {'step': 3, 'outcome': False, 'branch': {'result': 'IND-GIST-1L-IMATINIB'}, 'fired_red_flags': [], 'winner_red_flag': None}
- Indication
- IND-GIST-1L-AVAPRITINIB-PDGFRA-D842V
- Regimen
- Avapritinib monotherapy (GIST advanced/metastatic 1L; PDGFRA D842V)
- Drugs + NSZU
- Avapritinib (DRUG-AVAPRITINIB) 300 mg PO once daily on empty stomach (≥1 h before / ≥2 h after food) · Continuous, until progression or unacceptable toxicity · PO ✗ Not registered in UA
- Reason
- Alternative track presented for HCP consideration
What NOT to do
Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity
Standard plan (IND-GIST-1L-IMATINIB)
- Do NOT start imatinib in PDGFRA D842V GIST — it is intrinsically resistant; route to avapritinib.
- Do NOT use imatinib 400 mg/day for KIT exon 9 — escalate to 800 mg/day from start.
- Do NOT skip mutation testing (KIT/PDGFRA NGS) prior to 1L systemic therapy — genotype determines drug + dose.
Aggressive plan (IND-GIST-1L-AVAPRITINIB-PDGFRA-D842V)
- Do NOT use imatinib (any dose) for PDGFRA D842V — intrinsic resistance.
- Do NOT start avapritinib without baseline brain MRI — cerebral microbleed surveillance is required (boxed warning).
- Do NOT continue avapritinib through gr ≥2 cognitive AEs without dose reduction (300 → 200 mg).
Timeline
Treatment timeline — derived from regimen + monitoring schedule
Aggressive plan
Induction · Avapritinib monotherapy (GIST
28-day cycles × Continuous until progression
MDT brief
Skills (recommended) — for consideration (2)
- Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
skill: clinical_pharmacistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
- Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
skill: molecular_geneticistv0.1.0reviewed 2026-04-25STUBsign-offs: 0lead: TBD
Open questions (1, 0 blocking)
Data quality
- Unevaluated RedFlags: RF-GIST-FRAILTY-AGE, RF-GIST-HIGH-RISK-BIOLOGY, RF-GIST-INFECTION-SCREENING, RF-GIST-ORGAN-DYSFUNCTION, RF-GIST-TRANSFORMATION-PROGRESSION
Skill catalog (2/16 activated in this plan)
All registered virtual specialists. ✓ — activated for this case; ○ — not activated (available for other clinical scenarios).
| Specialist | skill_id | Version | Last reviewed | Sign-offs | Domain |
|---|
| Cellular therapy specialist (CAR-T) | cellular_therapy_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
| Clinical pharmacist | clinical_pharmacist | v0.1.0 | 2026-04-25 | 0 | clinical_pharmacy |
| Hematologist / oncohematologist | hematologist | v0.1.0 | 2026-04-25 | 0 | hematology_oncology |
| Hematopathologist (lymphoma / leukemia / myeloma) | hematopathologist | v0.1.0 | 2026-04-25 | 0 | hematopathology |
| Infectious disease / hepatology | infectious_disease_hepatology | v0.1.0 | 2026-04-25 | 0 | infectious_diseases |
| Medical oncologist (solid-tumor chemotherapist) | medical_oncologist | v0.1.0 | 2026-04-25 | 0 | solid_oncology |
| Molecular geneticist / molecular oncologist | molecular_geneticist | v0.1.0 | 2026-04-25 | 0 | molecular_oncology |
| Palliative care | palliative_care | v0.1.0 | 2026-04-25 | 0 | palliative_care |
| Pathologist (general) | pathologist | v0.1.0 | 2026-04-25 | 0 | pathology |
| Primary care / family physician | primary_care | v0.1.0 | 2026-04-25 | 0 | primary_care |
| Psycho-oncologist | psychologist | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Radiation oncologist | radiation_oncologist | v0.1.0 | 2026-04-25 | 0 | radiation_oncology |
| Radiologist | radiologist | v0.1.0 | 2026-04-25 | 0 | diagnostic_imaging |
| Social worker / case manager | social_worker_case_manager | v0.1.0 | 2026-04-25 | 0 | psychosocial |
| Surgical oncologist | surgical_oncologist | v0.1.0 | 2026-04-25 | 0 | surgical_oncology |
| Transplant specialist (BMT) | transplant_specialist | v0.1.0 | 2026-04-25 | 0 | cellular_therapy |
Sources cited
- SRC-IRIS-OBRIEN-2003: Imatinib compared with interferon and low-dose cytarabine for newly diagnosed chronic-phase chronic myeloid leukemia (2003)
- SRC-NCCN-GIST-2025: NCCN Clinical Practice Guidelines — Gastrointestinal Stromal Tumors (GIST) (2025.v1)
- SRC-ONCOKB: OncoKB — Precision Oncology Knowledge Base (continuous (last verified 2026-04-25))
Experimental options (clinical trials)
Last synced: 2026-05-04 · ctgov.
No active trials matched this scenario in ctgov.
Option availability in Ukraine
Per-track UA registration · NSZU · cost · access pathway. Render-time metadata; engine selection does not depend on these fields (CHARTER §8.3).
| Option | UA registration | NSZU | Cost orientation | Access pathway |
|---|
| Standard plan Imatinib (GIST advanced/metastatic 1L; KIT/PDGFRA imatinib-sensitive) (REG-IMATINIB-GIST-1L) | ✓ registered | ✓ covered | ₴-? — verify pathway | NSZU formulary |
| Aggressive plan Avapritinib monotherapy (GIST advanced/metastatic 1L; PDGFRA D842V) (REG-AVAPRITINIB-GIST-1L) 1/1 component drug(s) not registered in Ukraine +1 | ✗ not registered | ✗ out-of-pocket | ₴-? — verify pathway | not recorded |
Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-04.