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1. A 68-year-old patient comes with his partner into clinic for a routine evaluation after starting avapritinib 300 mg PO daily 2 months ago. While evaluating adverse effects the patient is experiencing, his partner mentions that he seems to be more absent-minded lately and sometimes forgets where he has placed items around the house. What recommendation would you make?

A. Hold avapritinib and re-evaluate the patient in 1 month B. Discontinue avapritinib permanently and switch to another therapy C. Dose-reduce avapritinib and follow symptoms closely D. Continue avapritinib and re-evaluate in 4 weeks E. Unsure

2. A 43-year-old patient has been on ripretinib 150 mg PO daily for the past 3 years. Their latest scans demonstrate interval progression of their tumor. What is the best option for this patient?

A. Increase ripretinib to 150 mg twice daily B. Switch therapy to avapritinib C. Continue ripretinib 150 mg daily and obtain scans in 4 weeks D. Hold ripretinib therapy for 2 weeks and then restart at same dose E. Unsure

3. A patient on sunitinib comes into clinic complaining of redness and burning of his feet and hands. What is the optimal management for palmar-plantar erythrodysesthesia (PPE), commonly known as hand-foot-skin reaction (HFSR)?

A. Soak feet in hot water with Epsom salt B. Use a urea-based cream on hands and feet C. Apply triamcinolone 0.1% cream twice-daily D. Keep feet warm by wearing thick socks E. Unsure

4. In a visit with the patient, a decision is made to start regorafenib 160 mg PO daily x 21 days in a 28-day cycle. Providing patient education about dosing and potential adverse effects is recommended:

A. When prescription is written B. When the patient receives medication from specialty pharmacy C. In follow-up phone call with the patient D. Every time there is a point of contact with the patient E. Unsure

5. A 38-year-old patient was recently diagnosed with metastatic gastrointestinal stromal tumor (GIST). When the tumor is sequenced, it is found that he has a PDGFR-? exon 18 mutation, specifically D842V. What therapy is most effective in this patient?

A. Avapritinib B. Sunitinib C. Imatinib D. Ripretinib E. Unsure

6. A 73-year-old female with GIST comes for a follow-up visit after beginning sunitinib 50 mg daily for 4 weeks, then off for 2 weeks. She has a complex past medical history, including compensated heart failure, hypertension, and psoriatic arthritis. She is experiencing several adverse effects, including elevated blood pressure, hand-foot-skin reaction, and nausea. She also admits that she has missed several doses and is finding it hard to remember to take it. Which of the following would be part of a multidisciplinary approach to caring for this patient?

A. Dermatologist, hepatologist, nurse B. Nurse practitioner, pharmacist, dermatologist C. Nurse practitioner, neurologist, pharmacist D. Pharmacist, dermatologist, cardiologist E. Unsure

7. An 89-year-old patient is currently on imatinib 400 mg PO daily for their metastatic GIST. They have a significant cardiac history and have tolerated the therapy well except for some periorbital edema. The tumor has been indolent with slow growth over the past 6 months. What is the best option for this patient at this time?

A. Continue imatinib B. Switch to ripretinib C. Start avapritinib D. Start regorafenib E. Unsure

8. A patient is experiencing grade 3 diarrhea while on sunitinib. They have used loperamide but it is not helping. The patient's quality of life is reduced, and they have missed a couple of doses because they want to be able to go out for the day. What can be done first for this patient?

A. Discontinue sunitinib and begin regorafenib B. Optimize antidiarrheals and continue sunitinib C. Reduce sunitinib dose by 50% D. Hold therapy for 2 weeks and reassess E. Unsure

Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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2. A 43-year-old patient has been on ripretinib 150 mg PO daily for the past 3 years. Their latest scans demonstrate interval progression of their tumor. What is the best option for this patient?

3. A patient on sunitinib comes into clinic complaining of redness and burning of his feet and hands. What is the optimal management for palmar-plantar erythrodysesthesia (PPE), commonly known as hand-foot-skin reaction (HFSR)?

4. In a visit with the patient, a decision is made to start regorafenib 160 mg PO daily x 21 days in a 28-day cycle. Providing patient education about dosing and potential adverse effects is recommended:

5. A 38-year-old patient was recently diagnosed with metastatic gastrointestinal stromal tumor (GIST). When the tumor is sequenced, it is found that he has a PDGFR-? exon 18 mutation, specifically D842V. What therapy is most effective in this patient?

8. A patient is experiencing grade 3 diarrhea while on sunitinib. They have used loperamide but it is not helping. The patient's quality of life is reduced, and they have missed a couple of doses because they want to be able to go out for the day. What can be done first for this patient?

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Maintenance is scheduled for 8/7/2023 7:00 AM EST - 8:00 AM EST.

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2. A 43-year-old patient has been on ripretinib 150 mg PO daily for the past 3 years. Their latest scans demonstrate interval progression of their tumor. What is the best option for this patient?

3. A patient on sunitinib comes into clinic complaining of redness and burning of his feet and hands. What is the optimal management for palmar-plantar erythrodysesthesia (PPE), commonly known as hand-foot-skin reaction (HFSR)?

4. In a visit with the patient, a decision is made to start regorafenib 160 mg PO daily x 21 days in a 28-day cycle. Providing patient education about dosing and potential adverse effects is recommended:

5. A 38-year-old patient was recently diagnosed with metastatic gastrointestinal stromal tumor (GIST). When the tumor is sequenced, it is found that he has a PDGFR-? exon 18 mutation, specifically D842V. What therapy is most effective in this patient?

8. A patient is experiencing grade 3 diarrhea while on sunitinib. They have used loperamide but it is not helping. The patient's quality of life is reduced, and they have missed a couple of doses because they want to be able to go out for the day. What can be done first for this patient?

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