Larotrectinib in TRK fusion-positive, metastatic non-small cell lung cancer (NSCLC) after treatment with entrectinib in a patient with a history of coronary artery disease

Here, we describe a patient with advanced metastatic non-small cell lung cancer (NSCLC) who harbors a neurotrophic tyrosine receptor kinase (NTRK) gene fusion, identified by liquid biopsy, and has a known history of heart disease. Patient evaluation showed primary left upper lobe (LUL) lung adenocarcinoma and stage IV disease metastases. Entrectinib was prescribed initially, but after 6 days, the patient experienced congestive heart failure (CHF). After considering the patient's medical history and adverse event profiles, larotrectinib was initiated and tumor shrinkage was observed after 6 weeks. Since his last follow-up at 20 weeks, this patient is still responding well to the medication. This case is a rare example of a patient being treated with 2 tropomyosin receptor kinase (TRK) inhibitors, thus highlighting that entrectinib and larotrectinib should be considered as separate entities, based on their safety profiles, to achieve successful clinical outcomes.