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Gastrointestinal stromal tumors (GIST), driven by KIT and PDGFRA mutations, are the most common mesenchymal tumors of the gastrointestinal tract. Although tyrosine kinase inhibitors (TKIs) have advanced treatment, resistance mutations and off-target toxicity limit their efficacy. This study develops covalent TKIs targeting drug-resistant GIST through structure-based design, synthesis, and biological evaluation. SAR studies provided key insights into mutant KIT and PDGFRA interactions, and the first crystal structure of PDGFRA bound to a covalent inhibitor is reported. These findings highlight the promise of covalent inhibitors for overcoming resistance and advancing safer, more effective therapies for advanced GIST.
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http://dx.doi.org/10.1021/acs.jmedchem.4c02472 | DOI Listing |
Gastric Cancer
September 2025
Department of Gastroenterological Surgery, The University of Osaka Graduate School of Medicine, 2-2, Yamadaoka, Suita, Osaka, 565-0871, Japan.
Background: The tyrosine kinase inhibitor (TKI) imatinib targets KIT and PDGFRA, offering significant therapeutic benefits in advanced gastrointestinal stromal tumors (GISTs). However, the high rate of recurrence following treatment discontinuation suggests that drug-tolerant persister cells (DTPs) may contribute to therapy resistance. Elucidating the mechanisms underlying DTP survival is critical for the development of curative strategies.
View Article and Find Full Text PDFPediatrics
September 2025
Joana de Gusmão Children's Hospital, Florianópolis, Santa Catarina, Brazil.
Gastrointestinal stromal tumors (GISTs) account for approximately 3% of gastrointestinal tumors and are the most prevalent mesenchymal tumors, primarily affecting the stomach and small intestine. In pediatrics, they are considered rare tumors and differ from GISTs that are found in adults because they often lack mutations in the KIT or platelet-derived growth factor α (PDGFRA) genes and are thereby classified as "wild-type." Currently, there are few specific guidelines for treating this type of tumor in the pediatric population.
View Article and Find Full Text PDFJ Exp Med
November 2025
Shanghai Institute of Nutrition and Health, University of Chinese Academy of Sciences, Chinese Academy of Sciences , Shanghai, China.
The only approved systemic treatments for gastrointestinal stromal tumors (GISTs) are KIT/PDGFRA-directed tyrosine kinase inhibitors (TKIs), which eventually lead to the development of secondary polyclonal resistance mutations. Complementary treatment strategies are urgently needed. Using transcriptomic profiling, CRISPR screens, and chemical screens, we identify aurora kinase B (AURKB) as a previously less recognized therapeutic vulnerability to advanced GISTs.
View Article and Find Full Text PDFBackground: Gastrointestinal stromal tumors (GISTs) are rare tumors of the digestive tract that have seen significant advances in diagnosis and treatment in recent years. A key breakthrough was the identification of c-KIT and PDGFRA gene mutations, which enabled the introduction of targeted therapies. The cornerstone of the treatment for localized disease is radical (R0) surgical resection, with adjuvant imatinib recommended for patients at high risk of recurrence.
View Article and Find Full Text PDFPharmaceutics
July 2025
Department of Gastrointestinal Surgery, The First Hospital of China Medical University, Shenyang 110001, China.
Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract, primarily driven by activating mutations in KIT (CD117) and platelet-derived growth factor receptor alpha (PDGFRA). The introduction of tyrosine kinase inhibitors (TKIs), especially imatinib, has significantly transformed GIST treatment. However, the emergence of both primary and secondary resistance to imatinib presents ongoing therapeutic challenges.
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