Various Cisplatin Cons And Tips On How To Eliminate Every one of them

5?mg/day administered as a continuous daily dosing (CDD) regimen to patients intolerant to imatinib or who had tumors that were imatinib resistant, interim results revealed an estimated median PFS of 34?weeks, a PR rate of 13% and an SD (��24?weeks) rate of 40%.48 It remains unclear whether CDD of sunitinib is as active as the standard regimen (50?mg/day; Cisplatin 4?weeks on/2?weeks off). Nevertheless, the use of both regimens is supported by the NCCN and ESMO guidelines (Table?2).26,27 The GIST genotype can also play an important role in the tumor response to sunitinib. In a Phase I/II trial of sunitinib conducted in patients with imatinib-resistant tumors the PR rate was significantly higher in patients with GIST with primary KIT exon 9 mutations than those with exon 11 mutations (37 vs 5%; P?=?0.002).6 Additionally, patients with KIT exon 9 mutations or WT KIT had significantly longer PFS and OS compared with patients with exon 11 mutations (median PFS: 19.4 INPP5D and 19.0 vs 5.1?months, respectively; median OS: 26.9 and 30.5 vs 12.3?months, respectively; all P-values?selleck chemicals llc advanced GIST who progress on imatinib 400?mg/day can either be dose-escalated to imatinib 800?mg/day or switched to sunitinib. For patients who progress on first-line imatinib 800?mg/day, switching to sunitinib is the most appropriate approach. However, no published clinical trials have addressed this important question. The decision to use high-dose imatinib or switch to sunitinib is likely to be influenced by the cause of imatinib failure, the specific KIT/PDGFRA mutations involved and tolerance to imatinib therapy. Dose escalation from 400 to 800�mg/day in all patients is generally appropriate, as long as the therapy is tolerable and the tumors are sensitive to the treatment. In cases in which dose escalation does not result in adequate effectiveness, switching to sunitinib should be considered. The NCCN and ESMO guidelines recommend using high-dose imatinib (up to 800�mg/day) upon progression on standard-dose imatinib.26,27 Moreover, these guidelines support using high-dose imatinib in patients with GIST with KIT exon 9 mutations, if they are not already receiving the higher dose. Following progression or intolerance to imatinib, the guidelines recommend switching to sunitinib.