Mention GIST to any respectable med onc and the next word out of his mouth is sure to be Gleevec (aka imatinib). After resections of high-risk GIST, imatinib is recommended in the adjuvant setting. But NCCN is nothing short of vague on the duration. Most data shows if you follow patients long enough, rates of progression after completion of adjuvant imatinib eventually catch up with those who were just observed. In the phase 2 PERSIST-5 trial, 91 patients were enrolled with a plan for 5 years of adjuvant imatinib, and half completed it. Of those who completed therapy, only one recurred and had a genetic profile insensitive to imatinib. TBL: No patient with resected imatinib-sensitive GIST as defined in NCCN recurred after 5 years of adjuvant imatinib. | Raut, JAMA Oncol 2018


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