PDGFRA D842V in GIST is imatinib-RESISTANT (distinct from imatinib-sensitive PDGFRA non-D...
Vista determinista de la entidad fuente YAML. La autoridad clínica sigue con los ID de fuente citados y estado de firma del revisor.
| ID | BMA-PDGFRA-D842V-GIST |
|---|---|
| Tipo | Relevancia terapéutica |
| Situación | reviewed 2026-04-27 | pending_clinical_signoff | actionability review required |
| Enfermedades | DIS-GIST |
| Fuentes | SRC-CIVIC SRC-FDA-CDS-2026 SRC-NCCN-MELANOMA-2025 |
Hechos relativos a la posibilidad de adoptar medidas
| Biomarcador | BIO-PDGFRA |
|---|---|
| Variante | D842V (loop de activación, éxon 18 — ~7% de GIST, predominantemente gástrico) |
| Enfermedad | DIS-GIST |
| El nivel de ESCAT | IA |
| Combinaciones recomendadas | avapritinib en monoterapia (1L para el GIST avanzado D842V — independientemente de la línea) |
| Monoterapia contraindicada | imatinib (D842V resistant), sunitinib (D842V resistant), regorafenib (D842V resistant), ripretinib (modest activity in D842V; reserve for avapritinib failure) |
| Resumen de las pruebas | PDGFRA D842V in GIST is imatinib-RESISTANT (distinct from imatinib-sensitive PDGFRA non-D842V mutations). Avapritinib (NAVIGATOR phase 1/2 + VOYAGER phase 3, Heinrich Lancet Oncol 2020 / Kang JCO 2022 — ORR 88-91% in D842V GIST; treatment-naive cohort) is FDA-approved for advanced D842V GIST. Imatinib, sunitinib, regorafenib are ineffective. |
Notas
ESCAT IA. OncoKB Level 1. Source-gap: SRC-NCCN-SARCOMA / SRC-NCCN-GIST-2025 / SRC-NAVIGATOR / SRC-VOYAGER not yet ingested. CNS toxicity (cognitive effects, intracranial hemorrhage) is on-target / dose- related — dose modifications standard. Companion-diagnostic genotyping via NGS panel mandatory before avapritinib initiation. Adjuvant imatinib has NO benefit in D842V GIST — these patients should be observed post-resection.
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