La progression sous traitement dans les GIST métastatiques: L'anticiper, l'évaluer, la prendre en charge

Treatment of metastatic GIST is based on tyrosine kinase inhibitors (TKIs). Despite the activity of these TKIs, prognosis of advanced GIST remains dismal and, as only three treatment lines are available, each of them has to be optimized before interrupting and or changing treatment. Four progression types are individualized, depending on clinical symptoms and radiological aspects. The clinician has to assess progression by using robust radiological taking into account both tumor size and density. Still underutilized, dynamic contrast-enhanced ultrasound is the most sensible technique to evaluate GIST progression. Analysis of progression kinetics is critical because it will condition the subsequent management. When facing progressive disease, clinicians have to ensure that compliance is optimal and that there is no drug-drug interaction. Plasmatic dosages of medication are highly useful in this context. Finally, modifications of therapeutic scheme or local treatment have to be considered.