How do you modify therapy for patients with severe intolerance to imatinib in the adjuvant setting for GIST?  

Either of the potential solutions (dose reduce or switch to an alternative TKI) is possible. Depending on the specific intolerance, it would be reasonable to try a dose reduction. If the patient still cannot tolerate the imatinib and the patient is a high risk, then sunitinib may be better tolerated...