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Int J Clin Oncol. 2020 Mar;25(3):403-417. doi: 10.1007/s10147-019-01610-y. Epub 2020 Jan 24.

Japan society of clinical oncology/Japanese society of medical oncology-led clinical recommendations on the diagnosis and use of tropomyosin receptor kinase inhibitors in adult and pediatric patients with neurotrophic receptor tyrosine kinase fusion-positive advanced solid tumors, cooperated by the Japanese society of pediatric hematology/oncology.

Author information

1
Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan. ynaito@east.ncc.go.jp.
2
Japanese Society of Medical Oncology (JSMO), Tokyo, Japan. ynaito@east.ncc.go.jp.
3
Department of Breast and Medical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
4
Japan Society of Clinical Oncology (JSCO), Tokyo, Japan.
5
Saitama Cancer Center, Saitama, Japan.
6
Japanese Society of Medical Oncology (JSMO), Tokyo, Japan.
7
Yokohama City University School of Medicine, Yokohama, Japan.
8
Juntendo University, Tokyo, Japan.
9
Tohoku University, Sendai, Japan.
10
National Center for Child Health and Development, Tokyo, Japan.
11
Keio University, Tokyo, Japan.
12
Tsukuba University, Ibaraki, Japan.
13
Hiroshima University Hospital, Hiroshima, Japan.
14
Okayama University, Okayama, Japan.
15
Kyoto Prefectural University of Medicine, Kyoto, Japan.
16
Hokkaido University Hospital, Sapporo, Japan.
17
Nagoya University Hospital, Nagoy, Japan.
18
National Cancer Center Hospital, Tokyo, Japan.
19
Jichi Medical University, Tochigi, Japan.
20
Japanese Society of Pediatric Hematology/Oncology (JSPHO), Tokyo, Japan.
21
Kyorin University Faculty of Medicine, Tokyo, Japan.

Abstract

BACKGROUND:

The development of novel antitumor agents and accompanying biomarkers has improved survival across several tumor types. Previously, we published provisional clinical opinion for the diagnosis and use of immunotherapy in patients with deficient DNA mismatch repair tumors. Recently, efficacy of tropomyosin receptor kinase inhibitors against neurotrophic receptor tyrosine kinase (NTRK) fusion gene-positive advanced solid tumors have been established as the second tumor-agnostic treatment, making it necessary to develop the guideline prioritized for these patients.

METHODS:

Clinical questions regarding medical care were formulated for patients with NTRK-positive advanced solid tumors. Relevant publications were searched by PubMed and Cochrane Database. Critical publications and conference reports were added manually. Systematic reviews were performed for each clinical question for the purpose of developing clinical recommendations. The committee members identified by Japan Society of Clinical Oncology (JSCO) and Japanese Society of Medical Oncology (JSMO) voted to determine the level of each recommendation considering the strength of evidence, expected risks and benefits to patients, and other related factors. Thereafter, a peer review by experts nominated from JSCO, JSMO, and Japanese Society of Pediatric Hematology/Oncology, and the public comments among all Societies' members was done.

RESULTS:

The current guideline describes 3 clinical questions and 15 recommendations for whom, when, and how NTRK fusion should be tested, and what is recommended for patients with NTRK fusion-positive advanced solid tumors.

CONCLUSION:

In the NTRK guideline, the committee proposed 15 recommendations for performing NTRK testing properly to select patients who are likely to benefit from tropomyosin receptor kinase inhibitors.

KEYWORDS:

Advanced solid tumor; Clinical practice guideline; Neurotrophic receptor tyrosine kinase (NTRK) fusion; Tropomyosin receptor kinase (TRK) inhibitor; Tumor-agnostic treatment

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