Alexander E. Drilon, MD

Alexander Drilon, MD, medical oncologist and chief of the Early Drug Development Service at Memorial Sloan Kettering Cancer Center, discusses what community oncologists should know about testing for NTRK gene fusions in patients with solid tumors.

With more research examining the presence of NTRK gene fusions in solid tumors and the activity of the currently available TRK inhibitors, the more potential there is for superior precision medicines in the community setting. Most recently, multiple studies have shown the promise of larotrectinib (Vitrakvi) as it has elicited robust and durable responses in both adult and pediatric patients.

Drilon notes that a good first step to take when treating a patient with an NTRK fusion-positive tumor is to identify it. Due to the rarity of these fusions and limited exposure to this patient population in community practice, he notes the importance of learning how to test for NTRK fusions.

My advice is that people might look at this and say that I've never seen a patient with an NTRK fusion, or in the cancers that I treat, the frequency is rare. But as you can see from the data that's been presented, not just the activity data, but also the safety data, that we have really good drugs. Finding one of these fusions is essentially a jackpot for someone because things can turn around substantially. They can be on it for a very long time, much longer than some of our standard treatments like chemotherapy.

I think that as a community, we need to come together to try to increase things like coverage for molecular profiling awareness so that we know how to test for this. Hopefully, by doing that, we'll get ourselves to a better place where it's not so onerous to try to find these, orwe do a large comprehensive test, as mentioned, that looks for this and several other drivers of oncogenesis that might match your patient with a targeted therapy.

Videos

Alexander Drilon, MD, discusses what community oncologists should know about testing for NTRK gene fusions in patients with solid tumors.


Testing for NTRK Gene Fusions in the Community Setting

Alexander Drilon, MD, a medical oncologist, and chief of the Early Drug Development Service at Memorial Sloan Kettering Cancer Center, discusses the differences in how 

 fusions manifest in older patients vs younger patients.

According to Drilon, research has revealed that the presence of 

 gene fusions in solid tumors and the activity of the TRK inhibitors that are currently available have allowed for new innovations in regard to precision medicine in this setting.

 gene fusions can be found in a wide variety of patients, including infants, children, and adults. Because of this, multiple studies have examined larotrectinib in both adult and pediatric patients, including patients with central nervous system involvement. Findings have revealed that larotrectinib shows promise and elicits robust and durable responses in this patient population.

 family of proteins is intimately involved in both the development and maintenance of the nervous system. From a practical perspective, in adults, that means that it controls things like appetite, the functioning of nerves that are involved in maintaining balance, and other nerves. When they are irritated or hyper activated, that might result in paresthesia.

 fusions are found across many different cancers both in adults and in pediatric patients, and that includes infants, children, adolescents, and young adults. The different cancers that are found in adults vs the pediatric population include a higher frequency of some rare tumors in kids or infants like congenital fibrosarcoma, for example. While there are other, more common cancers where the frequency of an entrapped fusion is lower, such as lung cancer, gastrointestinal tumors, or non-secretory breast cancers, where those cancers cluster largely in the adult population. There is a difference in the profile of the tumor types that we see in infants and kids, adolescents, vs adults.

Alexander Drilon, MD, discusses the differences in how TRK fusions manifest in older patients vs younger patients.

Differentiating TRK Proteins in Adults and Adolescents With Solid Tumors 

Alexander E. Drilon, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the next steps for LOXO-292 in 2 subsets of patients: those with RET fusion-positive cancers and

Alexander E. Drilon, MD, discusses the next steps for LOXO-292 in 2 subsets of patients: those with RET fusion-positive cancers and <em>RET</em>-mutant medullary thyroid cancers.

Next Steps for LOXO-292 in RET-Mutant Medullary Thyroid Cancer

Alexander E. Drilon, MD, a medical oncologist at Memorial Sloan Kettering Cancer Center, discusses the prevalence of

fusions and mutations in patients with cancer, including lung and thyroid cancers.

In lung cancer, or more specifically nonsmall cell lung cancer, where there are about 200,000 cases every year,

mutations affect up to 2% of the population. In papillary thyroid cancer,

mutations are found in 10% to 20% of patients.

Alexander E. Drilon, MD, discusses the prevalence of <em>RET</em> fusions and mutations in patients with cancer, including lung and thyroid cancers.

Alexander E. Drilon, MD | Authors

Articles

Testing for NTRK Gene Fusions in the Community Setting

Differentiating TRK Proteins in Adults and Adolescents With Solid Tumors

Next Steps for LOXO-292 in RET-Mutant Medullary Thyroid Cancer

Prevalence of RET Mutations in Lung and Thyroid Cancers