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NTRK Fusion CRC — SCE Medical Oncology MCQ

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ModerateGI CancersNTRK Fusion CRCSCE Medical Oncology

A 55-year-old woman with metastatic CRC develops an unexpected NTRK fusion on comprehensive molecular profiling. This is found in <1% of CRC. What is the significance?

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Correct answer: B — NTRK fusions are tumour-agnostic therapeutic targets — larotrectinib or entrectinib achieve response rates >75% regardless of tumour type; this patient should receive TRK inhibitor therapy

NTRK fusions are rare in CRC (<1%) but highly actionable — larotrectinib (NICE TA863) and entrectinib are tumour-agnostic TRK inhibitors with remarkable response rates (>75%) and durable benefit across tumour types. This exemplifies the power of comprehensive molecular profiling in identifying rare but druggable alterations. In CRC specifically, NTRK fusions are enriched in MSI-H tumours and right-sided primaries. Testing should be part of comprehensive NGS panels rather than standalone NTRK testing.

Reference: NICE TA863 Larotrectinib; ESMO 2024 Precision Medicine/mCRC