Investigating ROS1 and TRK Rearrangements in Lung Cancer

Benjamin P. Levy, MD, clinical director of Medical Oncology at John Hopkins Sidney Kimmel Cancer Center at Sibley Memorial Hospital, discusses genotyping in lung cancer, particularly focusing on ROS1 and TRK mutations. ROS1 rearrangements are highly actionable, according to Levy. Crizotinib (Xalkori) has been approved by the FDA for ROS1 rearrangements, but there are many new drugs coming down the pike that are also active, including entrectinib. The next step with these drugs is determining the best sequence, while also understanding the mechanisms of resistance to ROS1, Levy says. Currently, crizotinib is still the standard, though Levy argues that the data from the World Conference on Lung Cancer shows entrectinib may also be considered. Levy also discusses a recent tissue agnostic basket trial that investigated larotrectinib (LOXO-101) in patients with NTRK fusions. The response rate in this trial was almost 70%. This drug has been exceptionally well tolerated and is the poster child for precision medicine, Levy says. At this point in time, there are too many good drugs to continue only testing for EGFR and ALK. At Levy’s center, he and his peers do a 200 gene panel so that they are able to understand all the fusions that could drive their decision making. For more information on the agents currently being investigated for ROS1-, TRK-rearranged lung cancer: https://www.targetedonc.com/news/targ...