NRG1 fusions: Biology to therapy

NRG1 fusions are rare oncogenic drivers that exist at low frequencies across multiple tumor types. They are uncommon in lung cancer with an estimated incidence of 0.2 %. NRG1 fusions have a unique biology and are challenging to detect, due to large intronic regions of the gene, but they do represent possible therapeutic targets. Several agents targeting the ErbB signaling pathway have shown early evidence of efficacy including pan-ErbB kinase inhibitors, monoclonal antibodies, and bispecific antibodies. Supporting data are limited to case reports and small series for now, but prospective trials are underway. While our understanding of these fusions is still evolving, it is clear that NRG1 will be a clinically relevant finding in the years to come.