Histology Agnostic Gene Fusions

CE / CME

Seq and Ye Shall Find: Targeting Histology-Agnostic Gene Fusions to Improve Patient Outcomes

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

ABPath MOC: maximum of 1.00 Lifelong Learning point

Released: January 28, 2025

Expiration: August 05, 2025

Pretest

Progress
1 2 3
Course Completed
Please answer the questions below.
1.

Which testing assays are required to thoroughly test for all genomic biomarkers associated with therapies having a histology-agnostic indication?

2.

  • A 52-yr-old woman with no significant past medical history presents with back pain and increasing abdominal girth

  • Imaging shows 1 right upper lobe mass, diffuse lesions, numerous osseus lesions, and sub-cm brain lesions

  • Pathology reveals poorly differentiated carcinoma consistent with large-cell neuroendocrine carcinoma (LCNEC), with positive chromogranin staining

  • Tissue-based RNA NGS reveals KIF5B-RET fusion

Which of the following would you recommend for this patient with metastatic LCNEC harboring a KIF5B-RET gene fusion?

3.

  • A 76-yr-old woman presents with a persistent cough​

  • Extracranial imaging revealed innumerable bilateral pulmonary nodules; hilar and mediastinal adenopathy; and hepatic, adrenal, and osseous metastases​

  • MRI scan of the brain, obtained in the absence of symptoms, identified ​ >10 sub-cm supratentorial-enhancing brain metastases; endobronchial biopsy showed adenocarcinoma consistent with a lung primary​

  • DNA NGS was negative for KRAS, EGFR, BRAF, MET, and HER2 mutations and ALK, ROS1, and RET rearrangements

  • RNA NGS was performed and identified a novel activating NTRK fusion (in-frame fusion between EPS15 exon 21 and NTRK1 exon 10)

Based on available evidence of efficacy and safety, which of the following targeted agents would be most appropriate for this patient?