神经营养性酪氨酸受体激酶(NTRK)基因融合在多种肿瘤类型中的出现为使用原肌球蛋白受体激酶(TRK)抑制剂作为癌症治疗提供了有吸引力的机会。最近的临床研究表明,与使用TRK抑制剂相关的高度有效的结果。例如拉罗列替尼和恩列替尼在NTRK融合癌症中的应用,在成人和儿科人群中。虽然NTRK基因融合常见于一些罕见的成人和儿童恶性肿瘤,他们也被发现,虽然很少,在广泛的更常见的恶性肿瘤中。在几乎所有晚期恶性肿瘤中测试NTRK基因融合的潜在价值由TRK抑制剂提供的显着治疗结果支持。这一要求提出了现实世界肿瘤实践中的实际和财务挑战。此外,存在不同的测试平台来检测NTRK基因融合,每个都有其优点和缺点。是的,因此,必须制定NTRK基因融合检测策略,以优化有限组织标本和财政资源的使用,并尽量减少周转时间。2020年底,由新加坡公共和私营部门的医学专家组成的多学科工作组召集,提出了成人结直肠肿瘤的测试算法。肉瘤,非小细胞肺癌,和儿科癌症,特别适应新加坡的肿瘤学实践。这里提出的建议强调了NTRK融合阳性癌症的异质性,并强调需要针对每种肿瘤类型定制测试方法以优化工作流程。
The occurrence of neurotrophic tyrosine receptor kinase (NTRK) gene fusions in a wide range of tumor types presents an attractive opportunity for using a tropomyosin receptor kinase (TRK) inhibitor as cancer therapy. Recent clinical studies have demonstrated highly efficacious outcomes associated with the use of TRK inhibitors, such as larotrectinib and entrectinib in NTRK fusion-bearing cancers, in both adult and pediatric populations. While NTRK gene fusions are commonly found in some uncommon adult and pediatric malignancies, they are also found, albeit rarely, in a wide range of more common malignancies. The potential value of testing for NTRK gene fusions in practically all advanced malignancies is underpinned by the remarkable therapeutic outcomes that TRK inhibitors offer. This requirement presents practical and financial challenges in real-world oncological practice. Furthermore, different testing platforms exist to detect NTRK gene fusions, each with its advantages and disadvantages. It is, therefore, imperative to develop strategies for NTRK gene fusion testing in an attempt to optimize the use of limited tissue specimen and financial resources, and to minimize the turnaround time. A multidisciplinary task force of Singapore medical experts in both public and private sectors was convened in late 2020 to propose testing algorithms for adult colorectal tumors, sarcomas, non-small cell lung cancer, and pediatric cancers, with particular adaptation to the Singapore oncological practice. The recommendations presented here highlight the heterogeneity of NTRK-fusion positive cancers, and emphasize the need to customize the testing methods to each tumor type to optimize the workflow.