OpenOnco · Treatment Plan

Treatment plan — Gastrointestinal stromal tumor

PLAN-VERIFIED-GIST-L2-GIST_2L_SUNITINIB-V1 · v1 · 2026-07-15

Patient

VERIFIED-GIST-L2-GIST_2L_SUNITINIB · Algorithm: ALGO-GIST-2L

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

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

Primary current-line option

Standard plan

★ DEFAULT

Indication

IND-GIST-2L-SUNITINIB

Regimen

Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant)

Drugs + NSZU

Sunitinib (DRUG-SUNITINIB) 50 mg PO once daily for 4 weeks on, 2 weeks off (4/2 schedule); continuous 37.5 mg alternative (per physician preference) · 4 weeks on / 2 weeks off (standard GIST dosing); repeat cycles until progression · PO ⚠ Out-of-pocket

Hard contraindications

CI-LVEF-LOW-FOR-ANTHRACYCLINE

Reason

Primary current-line option selected by ALGO-GIST-2L at step 2.

Sequencing / non-current-line candidates

Shown for audit and future-line context; not part of the current treatment choice.

Indication	Authored line	Regimen	Why separated
`IND-GIST-1L-AVAPRITINIB-PDGFRA-D842V`	line 1	Avapritinib monotherapy (GIST advanced/metastatic 1L; PDGFRA D842V)	Prior-line candidate only: indication line 1, patient line 2; not a current treatment option

Pre-treatment investigations

Investigations before treatment start · critical / standard / desired · merged across tracks

ID	Name	Priority	Category	Where to order	Needed for
TEST-CBC	Complete Blood Count with Differential	Critical	lab	—	all tracks
TEST-CMP	Comprehensive Metabolic Panel	Critical	lab	—	all tracks
TEST-LFT	Liver Function Tests (ALT, AST, bilirubin, ALP, GGT, albumin)	Critical	lab	—	all tracks
TEST-ECHO	Echocardiography	Standard	imaging	—	all tracks

What NOT to do

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

Standard plan (IND-GIST-2L-SUNITINIB)

Do NOT use for PDGFRA D842V — sunitinib is ineffective; avapritinib preferred regardless of line
Do NOT skip baseline echo + ECG — cardiotoxicity (LVEF decline, QTc prolongation)
Do NOT ignore TSH monitoring — hypothyroidism in ~36% with long-term use
Do NOT ignore BP monitoring — hypertension in ~34%; antihypertensives for G2+
Do NOT continue without dose reduction for G3+ hand-foot syndrome (PPE)

Timeline

Treatment timeline — derived from regimen + monitoring schedule

Standard plan

Induction · Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant)

42-day cycles × Continuous until progression

MDT brief

MDT talk tree (1 steps)

#	Owner	Topic	Action
1	social_worker_case_manager	Specialist review	Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

Skills (recommended) — for consideration (1)

Social worker / case manager recommended
Plan includes drugs without NSZU reimbursement — patient access pathway must be assessed.

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: 0/0 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 (1/16 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)

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: 2026-07-15.

NCT	Title	Phase	Status	Sponsor	UA	Signals
NCT07171203	Preoperative Imatinib and Fampridine in KIT Mutant Gastrointestinal Stromal Tumor	PHASE1	RECRUITING	University of California, San Diego	—	Phase 1 only Small N (<50) Single country
NCT04181970	Observational Study, for Quality Assessment, of Sarcoma in European and Latin American Multidisciplinary NETWORK	N/A	RECRUITING	Grupo Espanol de Investigacion en Sarcomas	—	—
NCT07218926	A Study of IDRX-42 (GSK6042981) Versus (vs) Sunitinib in Participants With Gastrointestinal Stromal Tumors After Imatinib Therapy	PHASE3	RECRUITING	GlaxoSmithKline	—	Surrogate endpoint only
NCT03716089	Comparison of Tumor Efficacy Safety in Laparoscopic Resection of Gastrointestinal Stromal Tumors Between Favorable and Unfavorable Site	N/A	RECRUITING	Fujian Medical University	—	Surrogate endpoint only Single country
NCT05867901	Clinical Research of Drug Holiday Based on MRD Detection in GIST Patients at High Risk of Recurrence	N/A	RECRUITING	Peking University People's Hospital	—	Small N (<50) Surrogate endpoint only Single country
NCT05500391	Assessment of Compliance With Monitoring Conducted by a Physician in Person or by a Nurse in Remote Monitoring	PHASE2	RECRUITING	Centre Oscar Lambret	—	Single country
NCT06926374	Prospective Evaluation of Cornerstone Robotics Sentire Surgical System in Major Gastrointestinal and Urologic Surgery	NA	RECRUITING	Chinese University of Hong Kong	—	Single country
NCT05938309	A Cohort Study on the Safety of Laparoscopic Resection of 5cm or Larger Gastric Gastrointestinal Stromal Tumors	N/A	RECRUITING	Fujian Medical University	—	Single country
NCT05152472	A Prospective, Randomized, Multicenter, Comparative Study of the Efficacy of Imatinib Resumption Combined With Atezolizumab Versus Imatinib Resumption Alone in Patients With Unresectable Advanced Gastrointestinal Stromal Tumors (GIST) After Failure of Standard Treatments	PHASE2	RECRUITING	Centre Leon Berard	—	Surrogate endpoint only Single country
NCT07379047	Efficacy and Safety of NB003 in Patients With Advanced Gastrointestinal Stromal Tumors (GIST)	PHASE2 / PHASE3	RECRUITING	Ningbo Newbay Technology Development Co., Ltd	—	Surrogate endpoint only

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
Standard plan Sunitinib monotherapy (GIST 2L; imatinib-resistant/intolerant) (REG-SUNITINIB-GIST-2L) 1/1 component drug(s) not on NSZU formulary	✓ registered	✗ out-of-pocket	₴-? — verify pathway	not recorded
Trial · NCT07171203 Preoperative Imatinib and Fampridine in KIT Mutant Gastrointestinal Stromal Tumor No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT04181970 Observational Study, for Quality Assessment, of Sarcoma in European and Latin American Multidisciplinary NETWORK No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07218926 A Study of IDRX-42 (GSK6042981) Versus (vs) Sunitinib in Participants With Gastrointestinal Stromal Tumors After Imatinib Therapy No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT03716089 Comparison of Tumor Efficacy Safety in Laparoscopic Resection of Gastrointestinal Stromal Tumors Between Favorable and Unfavorable Site No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05867901 Clinical Research of Drug Holiday Based on MRD Detection in GIST Patients at High Risk of Recurrence No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05500391 Assessment of Compliance With Monitoring Conducted by a Physician in Person or by a Nurse in Remote Monitoring No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT06926374 Prospective Evaluation of Cornerstone Robotics Sentire Surgical System in Major Gastrointestinal and Urologic Surgery No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05938309 A Cohort Study on the Safety of Laparoscopic Resection of 5cm or Larger Gastric Gastrointestinal Stromal Tumors No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT05152472 A Prospective, Randomized, Multicenter, Comparative Study of the Efficacy of Imatinib Resumption Combined With Atezolizumab Versus Imatinib Resumption Alone in Patients With Unresectable Advanced Gastrointestinal Stromal Tumors (GIST) After Failure of Standard Treatments No UA site listed — international referral required	— unknown	— unknown	self-pay: ₴0/course	Trial sponsor
Trial · NCT07379047 Efficacy and Safety of NB003 in Patients With Advanced Gastrointestinal Stromal Tumors (GIST) 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: 2026-07-15.

plan_id: PLAN-VERIFIED-GIST-L2-GIST_2L_SUNITINIB-V1 | version: 1 | generated: 2026-07-15T13:33:22.867293+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.