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Abrupt onset of severe parkinsonism in a patient with metastatic gastrointestinal stromal tumor receiving treatment with avapritinib: A case report. Brain Behav Immun Health 2023 Feb;27:100570



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Scopus ID

2-s2.0-85144087911 (requires institutional sign-in at Scopus site)   1 Citation


Gastrointestinal stromal tumors (GISTs) are tumors of the digestive tract. To date, there have been no neurological paraneoplastic syndromes or symptoms associated with metastatic GISTs. Tyrosine kinase inhibitors (TKIs) are the typical class of agents used in management of this malignancy. Avapritinib, a new TKI, has been associated with myriad neurological adverse events with fairly rapid resolution in clinical trials. Herein, we present the case of a patient with metastatic GIST who, after starting treatment with avapritinib, developed rapidly progressive and persisting severe neuropsychiatric symptoms, including profound parkinsonism and encephalopathy, while concurrently receiving therapy with the antipsychotic olanzapine. We posit that the patient could be conceptualized as having a relative vulnerability to medication effects in the setting of metastatic GIST - possibly driven by an immune-mediated process - and that the addition of avapritinib triggered an overtly evident, clinically significant cascade of neurological deterioration.

Author List

Drom C, Schenheit K, Matzke M, Obeidat AZ, Molinaro J, Charlson J, Knight JM


John A. Charlson MD Associate Professor in the Medicine department at Medical College of Wisconsin
Jennifer M. Knight MD Associate Professor in the Psychiatry and Behavioral Medicine department at Medical College of Wisconsin
Ahmed Zayed Obeidat MD, PhD Associate Professor in the Neurology department at Medical College of Wisconsin