New Targeted Therapy Option for Lung Cancer

A novel tyrosine kinase inhibitor, Repotrectinib, has emerged as a promising treatment for various tumor types driven by specific mutations. Notably, this drug is particularly effective for patients with ROS1-positive lung cancer.

Repotrectinib (marketed as Augtyro® in 40 mg and 160 mg capsules by Bristol Myers Squibb) is indicated for adults suffering from advanced ROS1-positive non-small cell lung cancer (NSCLC). Additionally, it can be administered to patients aged 12 years and older who have advanced solid tumors with NTRK gene fusions and have previously received an NTRK inhibitor or where non-targeted therapeutic options have proven limited or ineffective. Prior to starting treatment, the presence of the ROS1 oncogene or NTRK gene fusion must be confirmed.

This new tyrosine kinase inhibitor is taken orally as a monotherapy. The recommended dosage begins at 160 mg once daily for 14 days, followed by 160 mg taken twice daily until disease progression or intolerable side effects occur. Should side effects arise, the treatment may be paused, discontinued, or the dosage adjusted accordingly.

The capsules should be taken consistently at the same time each day, with or without food, and should not be consumed alongside grapefruit or bitter orange.

Repotrectinib exhibits broad kinase inhibition, targeting the proto-oncogene tyrosine-protein kinase ROS1, as well as tropomyosin receptor kinases (TRK) A, B, and C, and anaplastic lymphoma kinase (ALK). The NTRK genes encode the TRK proteins (A, B, and C). When an NTRK gene is damaged and fuses with another damaged gene, it can become oncogenic, resulting in a continuously active fusion gene that produces its corresponding kinase. These fusion proteins, containing ROS1 or TRK domains, can hyperactivate subsequent signaling pathways, leading to uncontrolled cell proliferation.

NTRK gene fusions can occur across all tumor types, allowing for Repotrectinib's application irrespective of the tumor's location. This expansive indication is not entirely new; the TRK inhibitor Entrectinib (Rozlytrek®) is approved for patients from one month of age with NTRK-positive solid tumors and for adults with ROS1-positive NSCLC. Similarly, Larotrectinib (Vitrakvi®) is used for NTRK-positive solid tumors regardless of tissue type, while Crizotinib (Xalkori®) is approved for adults with ROS1- or ALK-positive NSCLC.