NTRK Gene Fusion Testing: FastTrk Update

FastTRK is a clinical testing program for the diagnosis of NTRK gene fusions. Sponsored by Bayer, this is a complimentary service for clinicians to determine whether their patients’ cancer has an NTRK gene fusion.

Eligibility criteria includes ALL patients with solid tumours that are metastatic or when surgical resection is likely to result in severe morbidity, and for whom no satisfactory treatment options are available.

Starting August 2021, physicians sending samples to FastTRK to determine whether their patients' cancer has an NTRK gene fusion will receive upfront NGS testing for the following adult and pediatric solid tumours (incidental findings included if requested)*:

• Colorectal carcinomas: Stage IV, dMMR, and BRAF wild-type^1,2
• Soft-tissue-sarcomas: locally advanced unresectable or metastatic^3,4
• Salivary carcinomas: locally advanced unresectable or metastatic^4,5
• Thyroid carcinomas: radioactive iodine refractory and TKI eligible^4,6
• Upfront NGS testing will continue for all primary CNS and pathognomonic tumour types**

* Other alterations that may be tested include: BRAF, KRAS, NRAS, RET, FGFR1-3, ALK, EGFR, MET, NRG1, ROS1

**Pathognomonic tumours includes infantile fibrosarcoma (IFS), congenital mesoblastic nephroma (CMN), secretory breast cancer (SBC), and mammary analogue secretory carcinoma (MASC)

For more information or to download a requisition form, please visit FastTRK.ca

References: 1. Chou A, et al. NTRK gene rearrangements are highly enriched in MLH1/PMS2 deficient, BRAF wild-type colorectal carcinomas—a study of 4569 cases. Mod Pathol. 2020, 33(5):924-932. Mod Pathol 2019. 2. E. Cocco et al. Colorectal Carcinomas Containing Hypermethylated MLH1 Promoter and Wild-Type BRAF/KRAS Are Enriched for Targetable Kinase Fusions. Cancer Res. 2019; 9(6):1047-1053. 3. Demetri GD, et al. Diagnosis and management of tropomyosin receptor kinase (TRK) fusion sarcomas: expert recommendations from the World Sarcoma Network. Ann Oncol .2020, 31(11):1506-1517. 4. Rosen EY, et al. TRK Fusions Are Enriched in Cancers with Uncommon Histologies and the Absence of Canonical Driver Mutations. 5. Cocco E, et al. NTRK fusion-positive cancers and TRK inhibitor therapy. Nature Reviews Clinical Oncology 2018;15: 731–747. 6. Chu Y.-H., et al. Clinicopathologic and molecular characterization of NTRK rearranged thyroid carcinoma (NRTC). Mod Pathol. 2020, 33(11):2186-2197.

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