Ripretinib and avapritinib have demonstrated activity in the late-line treatment of gastrointestinal stomal tumors (GISTs). We investigated whether patients previously treated with ripretinib benefit from avapritinib, and vice versa. Patients diagnosed with metastatic/unresectable GIST and treated with both drugs at two institutions in 2000–2021 were included. Patients were grouped by drug sequence: ripretinib–avapritinib (RA) or avapritinib–ripretinib (AR). Radiographic response was evaluated using RECIST 1.1. Kaplan–Meier and log-rank tests were used to compare time-to-progression (TTP) and overall survival (OS). Thirty-four patients (17 per group) were identified, with a median age of 48 years. The most common primary site was the small bowel (17/34, 50%), followed by the stomach (10/34, 29.4%). Baseline characteristics and tumor mutations were not significantly different between groups. Response rates (RRs) for ripretinib were 18% for RA and 12% for AR; RRs for avapritinib were 12% for AR and 18% for RA. Median TTPs for ripretinib were 3.65 months (95%CI 2–5.95) for RA and 4.73 months (1.87–15.84) for AR. Median TTPs for avapritinib were 5.39 months (2.86–18.99) for AR and 4.11 months (1.91–11.4) for RA. Median OS rates following RA or AR initiation were 29.63 (95%CI 13.8–50.53) and 33.7 (20.03–50.57) months, respectively. Both ripretinib and avapritinib were efficacious in the late-line treatment of GIST, with no evidence that efficacy depended on sequencing.
瑞派替尼和阿伐替尼在胃肠道间质瘤（GIST）的晚期治疗中已显示出活性。本研究旨在探讨既往接受瑞派替尼治疗的患者是否能从阿伐替尼治疗中获益，反之亦然。研究纳入了2000年至2021年间在两所机构确诊为转移性/不可切除性GIST并先后接受过这两种药物治疗的患者。根据用药顺序将患者分为两组：瑞派替尼-阿伐替尼序贯组（RA）和阿伐替尼-瑞派替尼序贯组（AR）。采用RECIST 1.1标准评估影像学反应，使用Kaplan-Meier法和时序检验比较疾病进展时间（TTP）和总生存期（OS）。共纳入34例患者（每组各17例），中位年龄48岁。最常见原发部位为小肠（17/34，50%），其次为胃（10/34，29.4%）。两组患者的基线特征和肿瘤突变无显著差异。瑞派替尼在RA组和AR组的缓解率（RR）分别为18%和12%；阿伐替尼在AR组和RA组的缓解率分别为12%和18%。RA组和AR组瑞派替尼治疗的中位TTP分别为3.65个月（95%CI 2-5.95）和4.73个月（1.87-15.84）；AR组和RA组阿伐替尼治疗的中位TTP分别为5.39个月（2.86-18.99）和4.11个月（1.91-11.4）。从启动RA或AR序贯治疗开始计算的中位OS分别为29.63个月（95%CI 13.8-50.53）和33.7个月（20.03-50.57）。瑞派替尼和阿伐替尼在GIST晚期治疗中均显示疗效，且无证据表明疗效与用药顺序相关。
Outcomes of Late-Line Systemic Treatment in GIST: Does Sequence Matter?
肿瘤(癌症)患者之家