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Genótipo adverso ou risco anatômico no GIST: PDGFRA D842V (resistente ao imatinib — avapritinib...

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Origem da bandeira vermelha

Lógica de Desencadeamento

{
  "any_of": [
    {
      "finding": "BIO-PDGFRA",
      "value": "D842V"
    },
    {
      "finding": "BIO-KIT",
      "value": "exon-9"
    },
    {
      "finding": "sdh_deficient",
      "value": true
    },
    {
      "finding": "kit_pdgfra_wildtype",
      "value": true
    },
    {
      "finding": "tumor_rupture",
      "value": true
    },
    {
      "comparator": ">",
      "finding": "mitotic_rate_per_50hpf",
      "threshold": 10
    },
    {
      "comparator": ">",
      "finding": "primary_tumor_size_cm",
      "threshold": 10
    }
  ],
  "type": "biomarker"
}

Notas

Genotype is the dominant decision axis in GIST. PDGFRA D842V is imatinib-RESISTANT — avapritinib 1L (NAVIGATOR / VOYAGER, ORR ~88%). KIT exon 9 (typically small bowel) requires imatinib 800 mg/day from start (B2222 / EORTC-62005 dose effect; PFS ~19 vs 6 mo on 400 mg). SDH-deficient (Carney triad / Carney-Stratakis, gastric, young) responds poorly to TKI — clinical trial preferred. Tumor rupture upgrades to highest-risk per Joensuu / NIH consensus → 6 yr extended adjuvant (SSG-XXII). Mitoses >10/50 HPF + size >10 cm + non-gastric primary all push to extended adjuvant duration.

Usado por

Algoritmos

• ALGO-GIST-1L - ALGO-GIST-1L

Indicação

• IND-GIST-4L-RIPRETINIB - IND-GIST-4L-RIPRETINIB