1. Ripretinib
No information is available on the use of ripretinib during breastfeeding. Because ripretinib and its metabolite are more than 99% bound to plasma proteins, the amounts in milk are likely to be low. However, their half-lives are long. The manufacturer recommends that mothers should not breastfeed during treatment with ripretinib and for 1 week after the final dose.
2. Ripretinib in gastrointestinal stromal tumor: the long-awaited step forward
César Serrano, David García-Illescas, M Julia Lostes-Bardaji, Claudia Valverde Ther Adv Med Oncol . 2021 Jan 7;13:1758835920986498. doi: 10.1177/1758835920986498.
Gastrointestinal stromal tumor (GIST) represents a paradigm for clinically effective targeted inhibition of oncogenic driver mutations in cancer. Five drugs are currently positioned as the standard of care for the treatment of advanced or metastatic GIST patients. This is the result of continuous, deep understanding of KIT and PDGFRA GIST oncogenic drivers as well as the resistance mechanisms associated to tumor progression. However, the complexity of GIST molecular heterogeneity is an evolving field, and critical questions remain open. Specifically, the clinical benefit of approved and/or investigated targeted agents is strikingly modest at advanced stages of the disease when compared with the activity of first-line imatinib. Ripretinib is a novel switch-pocket inhibitor with broad activity against KIT and PDGFRA oncoproteins and has recently demonstrated antitumoral activity across phase I to phase III clinical trials. Therefore, ripretinib has emerged as a new standard of care for advanced, multi-resistant GIST patients. Based on this data, the Food and Drug Administration has granted in 2020 the approval of ripretinib for GIST patients after progression to imatinib, sunitinib and regorafenib. This, in turn, constitutes a major breakthrough in sarcoma drug development, as there have not been new treatment approvals in GIST for nearly a decade. Herein, we provide a critical review on the preclinical and clinical development of ripretinib in GIST. Furthermore, we seek to assess the biological and clinical impact of this new standard of care on the course of the disease, aiming to provide an insight on future treatments strategies for the next coming years.
3. Ripretinib in advanced gastrointestinal stromal tumors: an overview of current evidence and drug approval
Myles J Smith, Khin Thway, Anna Stansfeld, Caitriona Goggin, Robin L Jones, Preethika Mahalingam, Andrea Napolitano, Paul Huang Future Oncol . 2022 Aug;18(26):2967-2978. doi: 10.2217/fon-2022-0226.
Over the past 20 years, the management of gastrointestinal stromal tumors has acted as an important model in the advancement of molecularly targeted therapies for solid tumors. The success of imatinib has established it as a lasting therapy in the management of early-stage and advanced disease in the first-line setting. Imatinib resistance inevitably develops, resulting in the need for further lines of therapy. Ripretinib is an orally administered switch-control tyrosine kinase inhibitor, specifically developed to target both primary and secondary KIT and PDGFRα resistance mutations. Herein, the authors discuss the molecular rationale, the preclinical evidence and the clinical use of ripretinib in the treatment of gastrointestinal stromal tumors in the advanced stages of disease.
