Outside of a clinical trial, how do you approach upfront therapy for a PDGFRA D842V-mutant GIST?   

These are usually indolent surgical tumors (until they are not) that belong in the care of a sarcoma center and not in the community. There are two trials of agents that are being tested for D842V mutations at this time (NCT02508532 and NCT02847429).

I agree that these patients are not well-managed in a cookie-cutter NCCN guideline way that is often employed in the community. For example, the risk stratification (and decision point) for adjuvant therapy in GIST is based on size and mitotic rate. There is no consideration of driver mutation when ...