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NTRK2 Fusion Driven Pediatric Glioblastoma: Identification of key molecular drivers by personalized oncology

Published online by Cambridge University Press:  05 September 2019

Levine
Affiliation:
Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
Y Shen
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
K Mungall
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
J Serrano
Affiliation:
Department of Pathology, New York University School of Medicine, New York, NY, USA
M Snuderl
Affiliation:
Department of Pathology, New York University School of Medicine, New York, NY, USA
E Pleasance
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
SJM Jones
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
J Laskin
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada Department of Medical Oncology, BC Cancer Agency; Vancouver, BC, Canada
MA Marra
Affiliation:
Canada’s Michael Smith Genome Sciences Centre, BC Cancer, Vancouver, BC, Canada
R Rassekh
Affiliation:
Division of Pediatric Hematology/Oncology, BC Children’s Hospital, Vancouver, BC, Canada
R Deyell
Affiliation:
Division of Pediatric Hematology/Oncology, BC Children’s Hospital, Vancouver, BC, Canada
S Yip
Affiliation:
Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
S Cheng
Affiliation:
Division of Pediatric Hematology/Oncology, BC Children’s Hospital, Vancouver, BC, Canada
C Dunham
Affiliation:
Division of Anatomic Pathology, Children’s and Women’s Health Centre of BC, Vancouver, BC, Canada
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Abstract

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We describe the case of an 11-month-old girl with a rare cerebellar glioblastoma driven by a NACC2-NTRK2 (Nucleus Accumbens Associated Protein 2-Neurotrophic Receptor Tyrosine Kinase 2) fusion. Initial workup of our case demonstrated homozygous CDKN2A deletion, but immunohistochemistry for other driver mutations, including IDH1 R132H, BRAF V600E, and H3F3A K27M were negative, and ATRX was retained. Tissue was subsequently submitted for personalized oncogenomic analysis, including whole genome and whole transcriptome sequencing, which demonstrated an activating NTRK2 fusion, as well as high PD-L1 expression, which was subsequently confirmed by immunohistochemistry. Furthermore, H3 and IDH demonstrated wildtype status. These findings suggested the possibility of treatment with either NTRK- or immune checkpoint- inhibitors through active clinical trials. Ultimately, the family pursued standard treatment that involved Head Start III chemotherapy and proton radiotherapy. Notably, at most recent follow upapproximately two years from initial diagnosis, the patient is in disease remission and thriving, suggesting favorable biology despite histologic malignancy. This case illustrates the value of personalized oncogenomics, as the molecular profiling revealed two actionable changes that would not have been apparent through routine diagnostics. NTRK fusions are known oncogenic drivers in a range of cancer types, but this is the first report of a NACC2-NTRK2 fusion in a glioblastoma.

LEARNING OBJECTIVES

This presentation will enable the learner to:

  1. 1. Explore the current molecular landscape of pediatric high grade gliomas

  2. 2. Recognize the value of personalized oncogenomic analysis, particularly in rare and/or aggressive tumors

  3. 3. Discuss the current status of NTRK inhibitor clinical trials

Type
Abstracts
Copyright
© The Canadian Journal of Neurological Sciences Inc. 2019