OpenOnco · Treatment Plan

Treatment plan — Gastrointestinal stromal tumor

PLAN-VAR-GIST-HIGHRISK-V1 · v1 · 2026-05-12

Patient

VAR-GIST-HIGHRISK · Algorithm: ALGO-GIST-1L

DiagnosisGastrointestinal stromal tumor

MOH / ICD-10C49

ICD-O-38936/3; C15, C16, C17, C18, C19, C20, C26

Clinical significance of mutations (ESCAT)

Tumor-board context — the engine does not use these tiers to rank tracks

✅ Covered biomarkers (matched in KB)

Biomarker	Variant	ESCAT	Evidence	Clinical significance	Drugs	Sources
No clinically actionable variants matched in this profile.

⚠️ Not included in plan

Biomarker	Status
BIO-PDGFRA	BIO definition in KB; no ESCAT BMA entry — verify with clinician

Primary current-line option

Aggressive plan

★ DEFAULT

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

Primary current-line option per algorithm ALGO-GIST-1L: selected default was filtered; promoted first remaining current-line track

Red flags — PRO / CONTRA aggressive

PRO-AGGRESSIVE

Triggers that push toward the aggressive track

PDGFRA D842V substitution mutation in advanced or metastatic GIST. The PDGFRA D842V variant accounts for approximately 6-7% of all GIST and is the most common PDGFRA exon 18 mutation (~65-70% of PDGFRA-mutant GIST). D842V confers primary resistance to imatinib, sunitinib, and regorafenib due to steric interference with drug binding at the activation loop. The type I kinase inhibitor avapritinib binds the active conformation of PDGFRA D842V and achieves ORR ~88% (NAVIGATOR phase 1; Heinrich CANCER DISCOV 2020) and confirmed ORR ~91% in the phase 3 NAVIGATOR expansion cohort. Imatinib is ineffective (historical ORR <10% for D842V) and must not be used as 1L for confirmed D842V-mutant GIST. Fires to route ALGO-GIST-1L step 1 to avapritinib (IND-GIST-1L- AVAPRITINIB-PDGFRA-D842V) instead of imatinib (IND-GIST-1L-IMATINIB). NCCN GIST 2025 Category 1 preferred: avapritinib 300 mg PO QD for PDGFRA D842V-mutant unresectable/metastatic GIST. Detection: PDGFRA D842V is detectable on targeted NGS, hotspot PCR, or PDGFRA-specific IHC (D842V antibody). Tissue or ctDNA-based molecular testing of all GIST at diagnosis is standard of care per NCCN GIST 2025. PDGFRA non-D842V exon 18 mutations (e.g., D842del, DI842-843IM): intermediate imatinib sensitivity — these are NOT covered by this RF. The RF fires exclusively on the D842V substitution. Non-D842V exon 18 PDGFRA mutations route to imatinib (ALGO-GIST-1L step 2 default path). RF-GIST-PDGFRA-D842V

CONTRA-AGGRESSIVE

Hard contraindications to escalation

What NOT to do

Explicit prohibitive rules, each grounded in a regimen / supportive care / contraindication entity

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 advanced/metastatic 1L; PDGFRA D842V)

28-day cycles × Continuous until progression

MDT brief

MDT talk tree (3 steps)

#	Owner	Topic	Action
1	clinical_pharmacist	Specialist review	Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
2	molecular_geneticist	Specialist review	Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
3	radiologist	Specialist review	Imaging findings present — radiologist needed for staging/restaging.

Skills (recommended) — for consideration (3)

Clinical pharmacist recommended
Chemoimmunotherapy regimen — drug-drug interactions, dose adjustments, premedication.
Molecular geneticist / molecular oncologist recommended
Indication references an actionable genomic biomarker — mutation / target / actionability interpretation needed.
Radiologist recommended
Imaging findings present — radiologist needed for staging/restaging.

Data quality

Usable with caveats. No critical default-track gap was found, but the MDT should review the listed caveats before final sign-off.

Biomarker coverage: 1/1 known (100%), 0 missing, 0 default-track gaps
Unevaluated RedFlags: RF-GIST-FRAILTY-AGE, RF-GIST-HIGH-RISK-BIOLOGY, RF-GIST-INFECTION-SCREENING, RF-GIST-ORGAN-DYSFUNCTION, RF-GIST-PDGFRA-D842V, RF-GIST-TRANSFORMATION-PROGRESSION

Technical MDT skill metadata (3/16 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	Domain
Cellular therapy specialist (CAR-T)	`cellular_therapy_specialist`	v0.1.0	2026-04-25	cellular_therapy
Clinical pharmacist	`clinical_pharmacist`	v0.1.0	2026-04-25	clinical_pharmacy
Hematologist / oncohematologist	`hematologist`	v0.1.0	2026-04-25	hematology_oncology
Hematopathologist (lymphoma / leukemia / myeloma)	`hematopathologist`	v0.1.0	2026-04-25	hematopathology
Infectious disease / hepatology	`infectious_disease_hepatology`	v0.1.0	2026-04-25	infectious_diseases
Medical oncologist (solid-tumor chemotherapist)	`medical_oncologist`	v0.1.0	2026-04-25	solid_oncology
Molecular geneticist / molecular oncologist	`molecular_geneticist`	v0.1.0	2026-04-25	molecular_oncology
Palliative care	`palliative_care`	v0.1.0	2026-04-25	palliative_care
Pathologist (general)	`pathologist`	v0.1.0	2026-04-25	pathology
Primary care / family physician	`primary_care`	v0.1.0	2026-04-25	primary_care
Psycho-oncologist	`psychologist`	v0.1.0	2026-04-25	psychosocial
Radiation oncologist	`radiation_oncologist`	v0.1.0	2026-04-25	radiation_oncology
Radiologist	`radiologist`	v0.1.0	2026-04-25	diagnostic_imaging
Social worker / case manager	`social_worker_case_manager`	v0.1.0	2026-04-25	psychosocial
Surgical oncologist	`surgical_oncologist`	v0.1.0	2026-04-25	surgical_oncology
Transplant specialist (BMT)	`transplant_specialist`	v0.1.0	2026-04-25	cellular_therapy

Sources cited

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)

Third plan track — open-enrollment trials from ClinicalTrials.gov. Render-time metadata; engine selection is not affected by this block (CHARTER §8.3). Last synced: 2026-05-12.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT05905887	Rivoceranib Plus Paclitaxel in Patients With Gastrointestinal Stromal Tumor	PHASE2	RECRUITING	Asan Medical Center	—	Small N (<50) Single country
NCT06640361	A Study of Olverembatinib in SDH-deficient GIST.	PHASE3	RECRUITING	Ascentage Pharma Group Inc.	—	Small N (<50) Surrogate endpoint only Single country
NCT05440357	Second-line Pharmacotherapy Patterns and Outcomes of Advanced Gastrointestinal Stromal Tumor: A Real-world Study	N/A	RECRUITING	Xinhua Zhang, MD	—	Surrogate endpoint only Single country
NCT05408897	Prediction of Postoperative Treatment Efficacy and Recurrence Risk of High-risk GIST Based on Liquid Biopsy MRD	N/A	RECRUITING	Peking University People's Hospital	—	Small N (<50) Single country
NCT06326346	GIST Oral Paclitaxel(Liporaxel)	PHASE2	RECRUITING	Asan Medical Center	—	Small N (<50) Single country
NCT07411118	RCT of EFTR Versus STER for GIST Treatment	NA	RECRUITING	Chinese University of Hong Kong	—	—
NCT03602092	Observational Registry Data on GIST Patients	N/A	RECRUITING	National Health Research Institutes, Taiwan	—	Single country
NCT05366816	ctDNA-Guided Sunitinib And Regorafenib Therapy for GIST	PHASE2	RECRUITING	University of Miami	—	Small N (<50) Surrogate endpoint only Single country
NCT05957367	A Study of Inlexisertib (DCC-3116) in Combination With Anticancer Therapies in Participants With Advanced Malignancies	PHASE1 / PHASE2	RECRUITING	Deciphera Pharmaceuticals, LLC	—	Surrogate endpoint only
NCT01048281	Clinical & Pathological Studies of Upper Gastrointestinal Carcinoma	N/A	RECRUITING	Stanford University	—	Single country

Verify recruitment status directly with the trial site. ctgov data can lag behind current UA-site status.

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
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
Trial · NCT05905887 Rivoceranib Plus Paclitaxel in Patients With Gastrointestinal Stromal Tumor No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06640361 A Study of Olverembatinib in SDH-deficient GIST. No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05440357 Second-line Pharmacotherapy Patterns and Outcomes of Advanced Gastrointestinal Stromal Tumor: A Real-world Study No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05408897 Prediction of Postoperative Treatment Efficacy and Recurrence Risk of High-risk GIST Based on Liquid Biopsy MRD No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06326346 GIST Oral Paclitaxel(Liporaxel) No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07411118 RCT of EFTR Versus STER for GIST Treatment No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03602092 Observational Registry Data on GIST Patients No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05366816 ctDNA-Guided Sunitinib And Regorafenib Therapy for GIST No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05957367 A Study of Inlexisertib (DCC-3116) in Combination With Anticancer Therapies in Participants With Advanced Malignancies No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT01048281 Clinical & Pathological Studies of Upper Gastrointestinal Carcinoma No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor

Cost information is orientation. Verify with a specific pharmacy / foundation / trial site. Status updated: 2026-05-12.

plan_id: PLAN-VAR-GIST-HIGHRISK-V1 | version: 1 | generated: 2026-05-12T18:41:26.411555+00:00

Per FDA non-device CDS positioning (CHARTER §15): Outpatient oncology treatment planning to support tumor-board discussion. Not a medical device; not for autonomous clinical decision-making.

Per FDA non-device CDS positioning (CHARTER §15): Both treatment options below are presented for review. The engine's selection of a 'recommended' default does not constitute a clinical decision. Final treatment selection requires HCP judgment incorporating information not available to the system.

This document is an informational resource supporting tumor-board discussion (per CHARTER §11). It is not a system that makes clinical decisions. Every recommendation must be verified by the treating physician.