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Larotrectinib for Advanced Lung Cancer With Novel NCOR2-NTRK1 Fusion: Case Study

By: Kayci Reyer
Posted: Sunday, August 1, 2021

A case study presented in BMC Pulmonary Medicine described a patient with advanced lung adenocarcinoma who had a novel NCOR2-NTRK1 fusion and a high tumor mutational burden. The patient underwent treatment with both the PD-L1 inhibitor camrelizumab and the TRK inhibitor larotrectinib.

“This report provided a new driver of lung adenocarcinoma expanding the mutational spectrum of NTRK1 fusion variants and suggested using larotrectinib as the targeted therapy [may be] more effective than [an] anti–PD-1 inhibitor in lung adenocarcinoma harboring NTRK fusion, positive PD-L1 expression, and [a] high tumor mutational burden simultaneously,” concluded Lei Zhang, of The Fourth Affiliated Hospital of China Medical University, and colleagues.

The patient was a woman aged 60 diagnosed with advanced lung adenocarcinoma. She harbored a novel NCOR2-NTRK1 fusion and a tumor mutational burden of 58.58 mutations/Mb; both were discovered through next-generation sequencing–based molecular profiling. Immunohistologic staining revealed PD-L1 expression in 20% to 30% of the tumor cells, and the patient underwent anti–PD-L1 immune checkpoint inhibitor treatment with camrelizumab. A CT scan performed after two treatment cycles showed disease progression.

Following the CT scan, the patient’s treatment was switched from camrelizumab to larotrectinib. A CT scan performed a month into this treatment showed a decrease in the volume of multiple lesions. No metastasis was noted. The patient continued to receive larotrectinib for several months, during which time many lesions either reduced in size or disappeared altogether. At the end of follow-up, the patient remained alive.

Disclosure: The authors reported no conflicts of interest.

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