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Rare Case of Mesenchymal Sarcoma With NTRK1 Gene Translocation

By: Hope Craig, MSPH
Posted: Friday, September 10, 2021

In the World Journal of Surgical Oncology, researchers at Fudan University, China, published a rare case of a patient with mesenchymal sarcoma carrying an NTRK1 gene translocation. Diagnostic work included pathologic and immunohistochemical analysis. Yingyong Hou, MD, PhD, and colleagues at Zhongshan Hospital, reported that the off-label use of the ALK inhibitor crizotinib effectively controlled the patient’s disease progression.

The patient, a 33-year-old man, presented with a mesenchymal malignant tumor on the top left side of his head. Biopsy revealed a 2.5 x 1.5 x 1.0 cm mass with solid grayish-red coloring. Several months later, the patient returned with a left ear rash and a mass on his neck and upper right back; biopsy showed tumor metastasis and skin involvement, and needle biopsy of the tissue confirmed consistency with the scalp tumor.

For financial reasons, the patient was not treated with larotrectinib; he received crizotinib off label at 250 mg/twice a day, orally. Due to side effects, including moderate transaminase elevation, anorexia, nausea, and vomiting, the patient’s dosage was reduced to 125 mg/twice a day for 2 months and then restored to 250 mg/twice per day; a reduced dose of the herbal supplement glutathione was taken daily. After taking crizotinib for 3 months, the patient was followed by observation and a general checkup every 6 months. As recently as July 2020, the patient continued to show a complete response to crizotinib, without disease progression.

This case is particularly interesting, noted the authors, because a molecular target was identified, even though the tumor was unclassified. Although crizotinib is not currently approved for treatment of patients whose cancer has an NTRK gene fusion, this case offers insights into diagnosis and treatment for patients with mesenchymal sarcoma with NTRK1 gene translocation.

Disclosure: The authors reported no conflicts of interest.



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