Results: Patient with mesothelioma and a somatic (tumour) NTRK rearrangement

A 77-year-old man has mesothelioma and has progressed through available treatment options. Somatic (tumour) testing via a multi-target massively parallel sequencing (sometimes called next-generation sequencing) panel has revealed an NTRK rearrangement.

• The NTRK genes NTRK1, NTRK2 and NTRK3 encode neurotrophin receptors TRKA, TRKB and TRKC respectively.
• NTRK fusion genes are formed when rearrangements – such as translocations or inversions – occur between or within chromosomes in such a way that an NTRK gene is brought into contact and fuses with a partner, such as ETV6, LMNA or TPM3. This NTRK-partner gene fusion results in a fusion protein product that constitutively activates downstream signalling pathways, such as MAPK, PI3K and PKC.
• NTRK fusion genes are oncogenic drivers of various adult and paediatric tumours.
• NTRK fusion genes are found in about 1% of all solid tumours, but frequency varies significantly between different tumour types.
• NTRK fusions are present in <1% of pleural mesotheliomas.
• NTRK inhibitors are targeted therapies associated with high response rates in NTRK-fusion positive cancers, regardless of the tumour histology.

• Patients with mesothelioma and an NTRK rearrangement who have no satisfactory treatment options are eligible for treatment with the NTRK inhibitor drugs entrectinib or larotrectinib.
• These drugs are currently made available via the Cancer Drugs Fund.
• Overall, data are limited for the efficacy of NTRK inhibitors in treating mesothelioma owing to the low frequency of eligible patients. However, these drugs offer a further choice of therapy in a tumour type in which options are limited.
• For information about how to arrange testing in Wales, Scotland or Northern Ireland, see our dedicated Knowledge Hub resource.
• Information about patient eligibility and test indications was correct at the time of writing. When requesting a test, please refer to the National Genomic Test Directory to confirm the right test for your patient.

For clinicians

• European Society for Medical Oncology: Epidemiology of cancers with NTRK gene fusion
• NHS England: National Genomic Test Directory
• NICE: Entrectinib for treating NTRK fusion-positive solid tumours
• NICE: Larotrectinib for treating NTRK fusion-positive solid tumours

References:

• Leal JL, Peters G, Szaumkessel M and others. ‘NTRK and ALK rearrangements in malignant pleural mesothelioma, pulmonary neuroendocrine tumours and non-small cell lung cancer‘. Lung Cancer 2020: volume 146, pages 154–159. DOI: 10.1016/j.lungcan.2020.05.019

For patients

• Macmillan Cancer Support: Histology independent therapies (HITs)
• Macmillan Cancer Support: Entrectinib (Rozlytrek®)
• Macmillan Cancer Support: Larotrectinib (Vitrakvi®)