How do you integrate surgery in treatment of recurrent tenosynovial giant cell tumors (TGCT) when using Pexidartinib?

This is an interesting question, but one that has little (if any) data to guide management. With recurrent TGCT, the patient presumably already had surgery. It is possible that a good response to pexidartinib may reduce the morbidity of a repeat surgery but the risk of additional recurrence would remain high. In general, I would recommend weighing the patient's experience on pexidartinib and tolerance of the drug vs any expected morbidity of the surgery that would be required. If they are tolerating the drug well, then we do not routinely perform repeat surgeries as they can carry significant morbidity. If a patient is not tolerating pexidartinib or if there is progression in spite of treatment, then surgery can be a salvage option.