Dr Randall on Factors Influencing the Choice Between Systemic Therapy and Surgery in TGCT

"The [FDA approval of vimseltinib] is exciting [and will require] medical oncologists to partner [with other sarcoma specialists]. [Oncologists treating] patients with TGCT need to make informed decisions with their orthopedic surgery colleagues. [The TGCT field] needs to have a tumor board or consensus around when to treat and when not to treat [each patient]."

R. Lor Randall, MD, FACS, the David Linn Endowed Chair for Orthopedic Surgery, chair of the Department of Orthopedic Surgery, and a professor at the University of California, Davis, discusses disease factors and patient characteristics informing the choice between vimseltinib (Romvimza), pexidartinib (Turalio), and surgery for patients with tenosynovial giant cell tumor (TGCT).

On ​February 14, 2025, the FDA approved vimseltinib for the treatment of patients with symptomatic TGCT for whom surgical resection will potentially cause worsening functional limitation or severe morbidity, making this agent the newest addition to the TGCT treatment paradigm. When choosing between vimseltinib, pexidartinib, and surgery for patients with TGCT, several factors must be considered to determine the most appropriate treatment approach, Randall begins. These include disease factors, such as tumor size, tumor location, and the severity of symptoms, he states.

Patient characteristics also heavily influence the decision, Randall continues. For patients already responding well to pexidartinib, switching to vimseltinib is generally not necessary unless pexidartinib becomes ineffective or intolerable, he says. The choice between the 2 drugs is also influenced by each of their efficacy and safety profiles, with vimseltinib offering a promising treatment option for patients who do not respond to pexidartinib, Randall notes.

Since patients with TGCT often experience issues related to function and pain rather than life-threatening concerns, their treatment should be focused on symptom management, Randall emphasizes, noting that the potential toxicities associated with therapeutic approaches and the risks associated with surgery should each be weighed carefully. A multidisciplinary approach involving collaboration between medical oncologists and orthopedic surgeons is essential to ensure that each patient receives a tailored treatment plan that addresses their specific needs and circumstances, he concludes.