Tom 10, Nr 5 (2024)
Artykuł przeglądowy
Opublikowany online: 2024-10-31
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Ripretynib w leczeniu chorych z zaawansowanymi nowotworami podścieliskowymi przewodu pokarmowego (GIST)
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Onkol Prakt Klin Edu 2024;10(5):364-376.
Streszczenie
Nowotwory podścieliskowe przewodu pokarmowego (GIST, gastrointestinal stromal tumor) występują stosunkowo rzadko (0,4 do 2 przypadków na 100 000 rocznie) i stanowią około 1–2% nowotworów przewodu pokarmowego. Zgodnie z najnowszą klasyfikacją mięsaków opracowaną przez Światową Organizację Zdrowia (WHO, World Health Organization) w 2020 roku wszystkie GIST określa się jako nowotwory złośliwe, niezależnie od wielkości lub indeksu mitotycznego. W leczeniu systemowym GIST stosuje się inhibitory receptora kinazy tyrozynowej KIT i receptora płytkopochodnego czynnika wzrostu (PDGFRA, platelet-derived growth factor receptor), takie jak imatynib, sunitynib lub regorafenib. Skuteczność imatynibu jest znacznie mniejsza w przypadku mutacji wtórnych w genie KIT. Najnowszy lek z grupy inhibitorów KIT — ripretynib — jako pierwszy wykazał skuteczność w przypadku większości mutacji związanych z opornością, a także GIST typu dzikiego, w którym nie stwierdzono mutacji KIT i PDGFRA. Analiza wyników badania INVICTUS wykazała korzystny wpływ ripretynibu w zalecanej dawce 150 mg/dobę na czas przeżycia wolnego od progresji choroby (PFS, progression-free survival) u chorych z zaawansowanym lub przerzutowym GIST leczonych wcześniej co najmniej trzema innymi inhibitorami. Wstępne wyniki badania klinicznego III fazy INTRIGUE nie wykazały jednak poprawy PFS u chorych na GIST otrzymujących ripretynib w terapii drugiej linii w porównaniu z sunitynibem. Ripretynib wykazuje korzystny i akceptowalny profil bezpieczeństwa i jest zalecany w leczeniu chorych z zaawansowanym GIST w czwartej linii leczenia. W przedstawionej publikacji podsumowano najważniejsze dane dotyczące skuteczności i bezpieczeństwa ripretynibu w leczeniu chorych na GIST oraz zalecenia dotyczące jego stosowania.
Słowa kluczowe: GISTKITPDGFRAripretynibinhibitor kinazy tyrozynowej
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