A 55-year-old male presented to emergency with complains of upper GI bleed. The doctor on duty stabilized the patient. He underwent upper GI endoscopy, that was found to be normal. An extra-luminal mass found on CECT abdomen. CECT is given below, Then CT guided biopsy was taken for histopathological examination revealed the diagnosis as follows. Studies revealed DOG-1 marker positivity and SDH-1 gene mutation. What of the following drugs can be given in the above condition: -

This is a case of GIST with SDH-1 mutation mean it is resistant to tyrosine kinase inhibitors. The image spindle shaped neoplastic cells - suggestive of GIST. Upper GI bleeding is the most common clinical manifestation of GISTs, manifesting as hematemesis or melena. Bleeding occurs because of pressure necrosis and ulceration of the overlying mucosa with resultant hemorrhage from disrupted vessels. Most common site of GIST is stomach. Upper GI endoscopy is usually normal because of extraluminal mass so usually detected on CT scan. CECT Is IOC for GIST. BUT for recurrent GIST IOC Is PET Scan. Most specific marker is DOG-1 > CD117. Imatinib shows the highest activity in GISTs that contain the mutation in exon 11 of KIT. Most GISTs with PDGFRA gene mutations respond to imatinib. GISTs with mutations in the succinate dehydrogenase (SDH) gene that result in deficiency of SDH are also generally resistant to TKI therapy. Surgical resection is the mainstay of treatment for localized tumors in these patients