What is the role of Sunitinib in the management of GIST?

Sunitinib is a tyrosine kinase inhibitor that plays a crucial role in the management of gastrointestinal stromal tumors (GIST), particularly as a second-line therapy. It is used in patients who show resistance or intolerance to imatinib (Gleevac), which is the standard first-line treatment for GIST.

When imatinib fails, either due to disease progression or the development of secondary mutations in the PDGFRA or KIT genes, sunitinib is an effective option to consider. Studies have shown that sunitinib can be beneficial in prolonging progression-free survival in imatinib-resistant cases. The approval of sunitinib for this indication highlights its role as an important alternative therapy when standard treatment is no longer effective.

In contrast, using sunitinib as first-line therapy for all cases is not supported by current guidelines, as imatinib remains the preferred initial treatment. Additionally, sunitinib does not serve as a surgical alternative for low-risk patients, who are typically managed with surgery alone if feasible and do not necessarily need systemic therapy. Therefore, the distinction as a second-line therapy aligns with clinical practices and evidence-based guidelines in the management of GISTs.