Esophageal GIST with Primary Non-Resectability: What Comes After Neoadjuvant TKI Therapy?

This protocol is for patients with esophageal gastrointestinal stromal tumor (GIST) who presented with primary non-resectability and have already received systemic neoadjuvant therapy aimed at downstaging the tumor. It defines the structured next step once that prior line has run its course.

Clinical Scenario

Esophageal GIST with primary non-resectability. According to current ESMO guidelines, neoadjuvant treatment for downstaging is the indicated approach in this setting, with radiological tumor response evaluated at 3–4 monthly intervals.

Previous Treatment Line & Its Endpoint

The prior line consisted of systemic neoadjuvant therapy — imatinib, sunitinib, regorafenib, or avapritinib, selected according to mutational profile — with the target of achieving maximal radiological tumor regression. This protocol is triggered once that regression endpoint has been reached and confirmed on serial imaging.

Next Step (Partial Overview)

Once maximal radiological tumor regression is confirmed, a surgical approach becomes the indicated course. The complete structured regimen — including full criteria, sequencing, and clinical decision points — is available via the link below.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1515/iss-2023-0011

According to the latest ESMO guidelines, neoadjuvant treatment for downstaging is indicated in case of primary non-resectability, with evaluation of tumor regression in 3–4 monthly intervals.

Surgical resection is then scheduled once maximal radiological tumor regression is achieved.

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