Choosing Larotrectinib vs Entrectinib to Treat NTRK Fusion+ Lung Cancer

David Hong, MD, deputy chair, Department of Investigational Cancer Therapeutics, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, explains why larotrectinib (Vitrakvi) may be chosen over other TRK inhibitors for the treatment of NTRK fusion-positive lung cancer.

Larotrectinib is 1 of 2 FDA-approved treatment options for TRK fusion-positive lung cancer. Findings from the phase 2 NAVIGATE (NCT02576431), phase 1 LOXO-TRK-14001 trial (NCT02122913), and phase 1/2 SCOUT trial (NCT02637687) supported the FDA approval. The other approved NTRK inhibitor, entrectinib (Rozlytrek) was supported by data from the phase II STARTRK-2 trial, the phase I STARTRK-1 trial, and the phase I ALKA-372-001 trial, anddata from the phase I/II STARTRK-NG trial.

According to Hong, although both NTRK inhibitors have a place in the field, larotrectinib appears to have more robust data.

0:08 | I think larotrectinib has the most robust data at this point, number of patients etc. and tracking it was different than the sense it's less of a nonspecific inhibitor it also targets ROS and those who are developing and larotrectinib and involved with larotrectinib will tell you that may be an advantage. But you know, what’s interesting is that the majority of patients who have NTRK fusions rarely have any other alterations. They just have NTRK fusions.

0:41 | My bias, given the fact that I also helped develop this drug is that patients who have NTRK fusions should be getting an NTRK of some sort, in my opinion. And larotrectinib, given the robustness of the data, and the number of patients, the response rates are a little bit better with larotrectinib. Right now, it's not clear whether progression-free survival overall survival are any better, but that's why I would consider larotrectinib.