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Innovative Medicines & Omics Subdural hematoma associated with avapritinib

and decreased appetite. ICH, anemia, liver toxicity, and
memory issues are some of the rare but severe side effects.
Avapritinib is a vital treatment option for patients with
specific mutations but requires careful monitoring because
of its potentially serious side effects. 13

ICH is a severe side effect of avapritinib. ICH signs
include severe headaches, dizziness, nausea, vomiting,
neurological issues, and altered consciousness. Patients
with hypertension and blood clotting disorders or those on
anticoagulants may have a higher risk of ICH. Immediate
interventions, including stopping avapritinib and
providing emergency care, are necessary. Regular brain
imaging and blood tests are recommended for patients
on this treatment, especially if they have higher bleeding
risks. 14
Figure 3. Repeat computed tomography post-surgery showing an overall
decrease in the subdural collection volume, midline shift, and prominence 4. Conclusion
of the ventricular system.
This case highlights the rare but severe potential drug-
was planned for follow-up in the clinic in 2 – 4 weeks to related complication of SDH occurring in a patient
discuss future management of metastatic GISTs. treated with avapritnib for GISTs, without other known
contributing factors. Such an adverse event underscores the
The patient came back to the emergency department a
few days later because he had not been eating and drinking importance of careful monitoring of neurological symptoms
in patients receiving targeted therapies. Clinicians should
and was progressively weak with a fever. A CT image remain vigilant regarding potential bleeding complications,
of the head showed an increase in the low-attenuation particularly in patients with pre-existing risk factors. This
component of the left SDH with an increase in sulcal case reinforces the need for further research to enhance
effacement, left lateral ventricle effacement, and midline the understanding of the relationship between avapritnib
shift. The hyperdense hemorrhagic component appeared and hematological risks, improve patient outcomes, and
unchanged. The patient was admitted to the intensive determine the most optimal treatment protocols.
care unit, with stable hemodynamics; however, he was
increasingly somnolent. His encephalopathy continued to Acknowledgments
worsen. A component of metabolic encephalopathy was
not suspected, although toxic encephalopathy/underlying None.
bacterial infection could play a role. No hypoxia, uremia, or Funding
significant glucose abnormalities were noted. The patient’s
condition continued to decline despite repeat washout and None.
antibiotic therapy. According to the patient and his wife’s
desire, the decision was to pursue comfort measures only. Conflict of interest
He was transferred to a palliative care unit and died a few Syed A. A. Rizvi is an Editorial Board Member of this
days later. journal but was not in any way involved in the editorial
and peer-review process conducted for this paper, directly
3. Discussion or indirectly. Separately, other authors declared that they

Avapritinib is a targeted therapy primarily used to treat have no known competing financial interests or personal
GISTs. It is extremely effective for patients with PDGFRA relationships that could have influenced the work reported
exon 18 mutation, including D842V mutation, which is in this paper.
resistant to other treatments. Avapritinib is also used to
11
treat advanced systemic mastocytosis, a rare disorder that Author contributions
involves abnormal mast cell accumulation. Avapritinib, Conceptualization: Syed M. Imam
12
a tyrosine kinase inhibitor, blocks proteins driving cancer Investigation: Syed M. Imam
growth, particularly in PDGFRA- and KIT-mutant Methodology: Syed M. Imam, Faryal Haider
tumors. Common side effects include fatigue, nausea, Writing – original draft: All authors
diarrhea, swelling around the eyes, cognitive impairment, Writing – review & editing: All authors

Volume 2 Issue 1 (2025) 96 doi: 10.36922/imo.7068