PMC10242384_01
Case 1, a case of multiline treatment (retroperitoneal) for stromal tumor:summary of imaging data of the fourth-line and subsequent treatment. (A) Patient newly started on ripretinib (baseline). (B) Partial response after 1.5 months of ripretinib treatment from baseline. (C) Disease progression after 6 months of ripretinib treatment from baseline. (D) Disease progression after 9 months of ripretinib treatment from baseline. (E) Stable disease after 2 months of treatment with ripretinib and imatinib combination. (F) Disease progression after 7 months of ripretinib and imatinib combination treatment.
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Hence, regorafenib was discontinued and ripretinib 150 mg QD treatment was started on 13 March 2021 and a PR was achieved 46 days later on 28 April 2021 as evident by significantly reduced internal density of the left abdominal mass and reduced diameter of the lesion between the right liver and the diaphragm on CT indicating obvious cystic degeneration (Supplementary Figure S1; Figures 1A, B). In September 2021, CT showed lesion of left upper quadrant shrank further, but the lesion of the right liver capsule was enlarged which were evaluated as disease progression (Figure 1C). Three months later (December 2021), CT showed lesion of left upper quadrant shrank further, but lesion of right liver capsule significantly enlarged indicating PD (Figure 1D) and was started on combination therapy of ripretinib 100 mg QD + imatinib 200 mg QD based on genetic tests, clinical efficacy, and tolerability profile of prior drug treatments along with multidisciplinary team discussion. The patient showed stable lesions with necrosis on a follow-up examination after 2 months in February 2022 indicating a SD (Figure 1E). However, CT examinations in July 2022 revealed significantly enlarged lesions indicating PD (Figure 1F) and discontinued the TKI therapy later.
Treatment summary for case 1 (retroperitoneal stromal tumor).
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The complete timeline of the treatment is illustrated in Figure 2.
PMC10242384_02
Case 2, a case of duodenal stromal tumor with multiple metastases treated with multiple lines:summary of image data of the fourth-line and subsequent treatment. (A) Disease progression after 5 months of treatment with imatinib. (B) Patient newly started on ripretinib (baseline). (C) Stable disease after 1 month of treatment with ripretinib. (D) Disease progression after 7 months of ripretinib treatment from baseline. (E) Disease progression after 2 months of increased ripretinib dose. (F) Stable disease after treatment with ripretinib and sunitinib combination.
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In March 2021, the patient showed presence of the new tumor around the cardia indicating metastasis (Figure 3A) and a PD. Before starting on ripretinib, the patient had a large tumor burden and compression around the cardia (Figure 3B). CT after 1 month of treatment with ripretinib (June 2021) showed a reduced tumor size, whereas the multiple liver metastases had partially increased in a few regions and decreased in others indicating reduced tumor load (Figure 3C). In December 2021, a CT examination revealed highly heterogeneous lesions, with right posterior lobe lesion shrinkage and a change in the shape of the tumor around the cardia and multiple enlarged liver metastases indicating PD (Figure 3D). However, in February 2022, tumors still showed heterogeneous manifestations, with overall size increase and regression in right posterior lobe (Figure 3E). A follow-up examination in April 2022 showed slightly improved symptoms with stable blood parameters (Figure 3F) suggesting a SD.
Treatment summary for case 2 (duodenal stromal tumor with multiple metastases).
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