ON THIS PAGE: You will learn about the different types of treatments doctors use for people with a gastrointestinal stromal tumor (GIST). Use the menu to see other pages.
This section explains the types of treatments, also known as therapies, that are the standard of care for GIST. “Standard of care” means the best treatments known. Information in this section is based on medical standards of care for GIST in the United States. Treatment options can vary from one place to another.
When making treatment plan decisions, you are encouraged to discuss with your doctor whether clinical trials offer additional options to consider. A clinical trial is a research study that tests a new approach to treatment. Doctors learn through clinical trials whether a new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug, a new combination of standard treatments, or new doses of standard drugs or other treatments. Clinical trials are an option for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
How a GIST is treated
GIST is rare, and research shows that patients have better outcomes if they are treated at a center with experience treating sarcomas. These are called "sarcoma specialty centers."
Different types of doctors who specialize in treating tumors, called oncologists, often work together to create a patient’s overall treatment plan that combines different types of treatments. This is called a multidisciplinary team. It is important for people with a GIST to have their treatment plan determined by a medical team that specializes in sarcomas, as it has been shown that this improves a person's chances of survival. Cancer care teams include other health care professionals, such as physician assistants, nurse practitioners, oncology nurses, social workers, pharmacists, counselors, dietitians, physical therapists, occupational therapists, and others. Learn more about the clinicians who provide cancer care.
Treatment options and recommendations depend on several factors, including the type and stage of tumor, possible side effects, the patient’s preferences, and the patient’s overall health. The doctor will look at many factors to determine the best treatment, including the tumor’s:
Number of dividing cells
Whether it has already spread
Whether the tumor ruptured, either on its own or as a result of surgery
Take time to learn about all of your treatment options and be sure to ask questions about things that are unclear. Talk with your doctor about the goals of each treatment and what you can expect while receiving the treatment. These types of conversations are called “shared decision-making.” Shared decision-making is when you and your doctors work together to choose treatments that fit the goals of your care. Shared decision-making is important for GIST because there are different treatment options. Learn more about making treatment decisions.
The common types of treatments used for GIST are described below. Your care plan also includes treatment for symptoms and side effects, an important part of cancer care.
Surgery is the removal of the tumor and some surrounding healthy tissue during an operation. A surgical oncologist is a doctor who specializes in treating cancer by surgery.
For people with a localized GIST, surgery is the standard treatment and should be performed whenever possible. If the GIST cannot be completely removed by surgery, such as if it has spread somewhere else, it often cannot be cured and the doctor will talk with you about other treatment options, mainly targeted therapy (see below), to control the tumor. However, surgery may be considered if there is only a limited amount of disease.
Before surgery, talk with your health care team about the possible side effects from the specific surgery you will have. Learn more about the basics of cancer surgery.
Therapies using medication
The treatment plan may include medications to destroy tumor cells. Medication may be given by mouth or through the bloodstream to reach tumor cells throughout the body. When a drug is given this way, it is called systemic therapy.
This treatment is generally prescribed by a medical oncologist, a doctor who specializes in treating cancer with medication.
Medications are often given through an intravenous (IV) tube placed into a vein using a needle or as a pill or capsule that is swallowed (orally). If you are given oral medications to take at home, be sure to ask your health care team about how to safely store and handle them.
Targeted therapy is the main type of medication used for GIST. Different targeted therapies are discussed below in more detail. A person may receive 1 type of medication at a time or a combination of medications given at the same time. They can also be given as part of a treatment plan that includes surgery and/or radiation therapy.
The medications used to treat cancer are continually being evaluated. Talking with your doctor is often the best way to learn about the medications prescribed for you, their purpose, and their potential side effects or interactions with other medications.
It is also important to let your doctor know if you are taking any other prescription or over-the-counter medications or supplements. Herbs, supplements, and other drugs can interact with cancer medications, causing unwanted side effects or reduced effectiveness. Learn more about your prescriptions by using searchable drug databases.
Targeted therapy is a treatment that targets the cancer’s specific genes, proteins, or the tissue environment that contributes to cancer growth and survival. This type of treatment blocks the growth and spread of cancer cells and limits damage to healthy cells.
Not all tumors have the same targets. Because some of these genetic changes in the tumor may mean the drugs described below may not work well, your doctor may run tests to identify the genes, proteins, and other factors in your tumor. This helps doctors better match each patient with the most effective treatment whenever possible. In addition, research studies continue to find out more about specific molecular targets and new treatments directed at them.
Tyrosine kinase inhibitors (TKIs) are drugs that target specific proteins called kinases that contribute to the tumor’s growth and survival. TKIs are often used to treat GIST. In general, it is important to talk with your health care team about any TKI you are taking and what to expect regarding possible side effects, as well as new or ongoing problems you may experience during treatment.
The drugs described in this section are listed in the order in which they were approved by the U.S. Food and Drug Administration (FDA). The order in which they are used may depend on factors discussed above. Learn more about the basics of targeted treatments.
Talk with your doctor about the possible side effects for each medication and how they can be managed.
Imatinib (Gleevec). This was the first targeted therapy approved for GIST by the FDA. It is often the first drug used to treat an advanced GIST. GIST is considered to be advanced when it cannot be removed by surgery. Since this drug became available, the prognosis for patients with an advanced GIST has improved a lot.
Research is being done to find out how long imatinib should be given after surgery to help delay or prevent a recurrence, and imatinib is the only drug approved for this use. If a GIST has spread to other parts of the body, imatinib or another TKI is taken for the rest of the patient’s life to help control the tumor.
The usual dose of imatinib is 400 milligrams (mg) daily. For some patients, the dose may be increased up to 800 mg daily, especially for those who have an exon 9 genetic mutation in the KIT gene.
Imatinib does have some common side effects that are often successfully managed. The dose can be adjusted to reduce side effects, or other medications can be added to the treatment plan to manage side effects. The most common side effects of imatinib are fluid accumulation, rash, nausea, diarrhea, fatigue, and minor muscle aches. Serious but relatively rare side effects include bleeding and inflammation of the liver. Many of these side effects can be managed with the help of the health care team. Also, some side effects get better over time. People who have serious side effects may take a lower dose of imatinib and still benefit from it. If you want to stop treatment because of the side effects, talk with your health care team first to learn whether this is the best option.
Sunitinib (Sutent). Sunitinib is a TKI that works in many different ways to kill tumor cells and slow tumor growth. Sunitinib also blocks both KIT and the process of making new blood vessels, which is called angiogenesis. Sunitinib is used to treat a GIST that continues to grow even after treatment with imatinib. Sunitinib may also be used when the side effects of imatinib are too serious.
The side effects of sunitinib include fatigue, diarrhea, nausea and vomiting, heartburn, changes in taste, high blood pressure, low blood counts, and changes in skin color.
Regorafenib (Stivarga). Regorafenib is a TKI that works in many different ways to kill tumor cells and slow tumor growth, including blocking the KIT molecule and blocking blood vessel growth into tumors. It has been approved for people with later-stage GIST that cannot be surgically removed and when both imatinib and sunitinib did not work or caused severe side effects.
The side effects of regorafenib include fatigue, nausea, hand-foot syndrome, high blood pressure, diarrhea, and inflammation of the liver.
Avapritinib (Ayvakit). Avapritinib is a TKI that also targets tumors with a specific mutation in the PDGFRA exon 18 gene. It is approved by the FDA to treat patients with metastatic GISTs that have a mutation in PDGFRA exon 18 that cannot be removed with surgery.
The common side effects of avapritinib include fluid accumulation, nausea, fatigue, problems with attention, memory, or thinking, vomiting, loss of appetite, diarrhea, hair color changes, increased production of tears from the eyes, abdominal pain, constipation, rash, and dizziness.
Ripretinib (Qinlock). Ripretinib is a TKI approved to treat patients with advanced GIST after 3 or more previous treatments with TKIs, including imatinib, have not stopped the tumor from growing and spreading.
The common side effects of ripretinib include hair loss, fatigue, nausea, abdominal pain, constipation, muscle pain, diarrhea, loss of appetite, hand-foot syndrome, and vomiting. There is also a risk of serious side effects, including skin cancer, high blood pressure, and heart problems.
Uncommon genetic changes. A small percentage of GISTs, less than 1%, have a mutation in other genes that can be targeted with approved therapies.
BRAF V600E. The targeted therapy combination of dabrafenib (Tafinlar) plus trametinib (Mekinist) targets tumors with this specific mutation. If a GIST with this mutation is metastatic or surgery is not an option and previous treatments have not stopped the tumor, then this combination may be an option.
NTRK fusion. Larotrectinib (Vitrakvi) and entrectinib (Rozlytrek) are NTRK inhibitors that are approved for any cancer that has a specific mutation in the NTRK gene. These NTRK mutations are not found in the most common types of GIST, including those with KIT, PDGFR, SDH, and RAF mutations.
The most common side effects include fatigue, nausea, dizziness, vomiting, increased liver enzymes, cough, constipation, and diarrhea.
Chemotherapy is the use of drugs to destroy cancer cells, usually by keeping the cancer cells from growing, dividing, and making more cells. However, standard chemotherapy is not effective for treating GIST and should not be used.
Radiation therapy is the use of high-energy x-rays or other particles to destroy cancer cells. A doctor who specializes in giving radiation therapy to treat cancer is called a radiation oncologist. The most common type of radiation treatment is called external-beam radiation therapy, which is radiation given from a machine outside the body. When radiation treatment is given using implants, it is called internal radiation therapy or brachytherapy.
A radiation therapy regimen, or schedule, usually consists of a specific number of treatments given over a set period of time.
Radiation therapy is not often used to treat people with a GIST. However, it may be used as a palliative treatment to relieve pain, such as bone pain, or to stop bleeding. Radiation therapy may damage healthy cells as well as tumor cells. Side effects from radiation therapy include tiredness, mild skin reactions, upset stomach, and loose bowel movements.
Most side effects go away soon after treatment is finished. Learn more about the basics of radiation therapy.
A GIST and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative and supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the tumor.
Palliative and supportive care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative and supportive care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.
Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments, such as drug therapy, surgery, or radiation therapy, to improve symptoms.
Before treatment begins, talk with your doctor about the goals of each treatment in the recommended treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative and supportive care options. Many patients also benefit from talking with a social worker and participating in support groups. Ask your doctor about these resources, too.
Medical care is often expensive, and navigating health insurance can be difficult. Ask your doctor or another member of your health care team about talking with a financial navigator or counselor who may be able to help with your financial concerns.
During treatment, your health care team may ask you to answer questions about your symptoms and side effects and to describe each problem. Be sure to tell the health care team if you are experiencing a problem. This helps the health care team treat any symptoms and side effects as quickly as possible. It can also help prevent more serious problems in the future.
Different treatments may be recommended for each stage of a GIST. General options by stage are described below. For more detailed descriptions of available treatments, see “How a GIST is treated,” above. Talk with doctors who have experience in treating GIST about a personalized plan for you. Your doctor will work with you to develop a specific treatment plan based on the tumor's stage and other factors. Clinical trials may also be a treatment option for each stage of GIST.
A localized GIST is a tumor that has stayed in the part of the body where it began. A smaller localized GIST may be removed completely with surgery. For some, this may be the only treatment that is needed.
If the tumor is large or involves nearby organs, it may first be treated with imatinib (see "Targeted therapy," above). The purpose of this approach is to shrink the tumor, so it is easier to remove with surgery. This is called neoadjuvant or preoperative therapy. The surgeon will eventually try to remove the entire tumor to reduce the risk that the tumor will come back or block the gastrointestinal (GI) tract.
To remove the entire tumor, the surgeon may have to remove parts of nearby organs, depending on the tumor’s location. The removal of lymph nodes is not generally needed because GISTs do not often spread to the lymph nodes. Lymph nodes are small, bean-shaped organs that help fight infection. A tumor that cannot be removed using surgery is called "unresectable." The doctor will recommend targeted therapy for an unresectable localized GIST.
GIST has the ability to come back after being surgically removed and can spread to other organs. Some GISTs have a higher risk of returning or spreading than others. After surgery for a localized GIST, people who may have a high risk of recurrence often receive imatinib for at least 3 years to help prevent or delay it from coming back. This type of treatment after surgery is called adjuvant or postoperative therapy.
If a GIST has spread to another part in the body from where it started, doctors call it metastatic. If this happens, it is a good idea to talk with doctors who have experience in treating this stage of GIST. Doctors can have different opinions about the best standard treatment plan. Clinical trials might also be an option. Learn more about getting a second opinion before starting treatment, so you are comfortable with your chosen treatment plan. In many instances, people with metastatic GIST are able to live normal lives for many years, being treated only with pills and regular hospital visits. Learn more about receiving long-term cancer treatment.
Depending on previous treatment, your treatment plan may include surgery, a higher dose of your current treatment or a different TKI, or treatment through a clinical trial. Your doctor may continue to recommend imatinib, sunitinib, regorafenib, ripretinib, or avapritinib, even if they are not working perfectly. They may also recommend going back to 1 of these drugs after the others have been tried and/or after they have stopped working. As the approved TKIs can allow patients to live many years with a good quality of life, in general some treatment with targeted therapy for GIST is better than no treatment at all. Palliative and supportive care will also be important to help relieve symptoms and side effects.
For many people, a diagnosis of metastatic GIST is very stressful and difficult. You and your family are encouraged to talk about how you feel with doctors, nurses, social workers, or other members of your health care team. It may also be helpful to talk with other patients, such as through a support group or other peer support program.
A remission is when the tumor cannot be detected in the body and there are no symptoms. This is also called having “no evidence of disease” or NED.
A remission may be temporary or permanent. This uncertainty causes many people to worry that the tumor will come back. While many remissions are permanent, it is important to talk with your doctor about the possibility of the tumor returning. Understanding your risk of recurrence and the treatment options may help you feel more prepared if the tumor does return. Learn more about coping with the fear of recurrence.
If the tumor returns after the original treatment, it is called a recurrent tumor. It may come back in the same place (called a local recurrence), nearby (regional recurrence), or in another place (distant recurrence).
If a recurrence happens, a new cycle of testing will begin to learn as much as possible about it. After this testing is done, you and your doctor will talk about the treatment options. Often the treatment plan will include the treatments described above, such as surgery and targeted therapy. However, they may be used in a different combination or given at a different pace. Your doctor may suggest clinical trials that are studying new ways to treat a recurrent GIST. Whichever treatment plan you choose, palliative and supportive care will be important for relieving symptoms and side effects.
People with a recurrent or metastatic GIST sometimes experience emotions such as disbelief or fear. You are encouraged to talk with your health care team about these feelings and ask about support services to help you cope. Learn more about dealing with a recurrence.
Recovery from a GIST is not always possible. If the growth of the tumor cannot be controlled, you may not ever recover from the disease. This condition is called terminal.
This diagnosis is stressful, and for some people, advanced cancer is difficult to discuss. However, it is important to have open and honest conversations with health care team to express your feelings, preferences, and concerns. The health care team has special skills, experience, and knowledge to support patients and their families and is there to help. Making sure a person is physically comfortable, free from pain, and emotionally supported is extremely important.
Planning for your future care and putting your wishes in writing is important, especially at this stage of disease. Then, your health care team and loved ones will know what you want, even if you are unable to make these decisions. Learn more about putting your health care wishes in writing.
People who are expected to live less than 6 months may want to consider hospice care. Hospice care is designed to provide the best possible quality of life for people who are near the end of life. You and your family are encouraged to talk with your doctor or a member of your palliative care team about hospice care options, which include hospice care at home, a special hospice center, or other health care locations. Nursing care and special equipment can make staying at home a workable option for many families. Learn more about advanced care planning.
After the death of a loved one, many people need support to help them cope with the loss. Learn more about grief and loss.
The next section in this guide is About Clinical Trials. It offers more information about research studies that are focused on finding better ways to care for people with a GIST. Use the menu to choose a different section to read in this guide.