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L2086F Mutant ROS1-Rearranged NSCLC Resistant to Repotrectinib Responds to Cabozantinib: A Case Report
Urs Weber1, Kurtis D Davies2, D Ross Camidge1
1Division of Medical Oncology, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Abstract:
Repotrectinib, licensed in November 2023, is a novel ROS1 tyrosine kinase inhibitor (TKI) with activity against G2032R, the most common resistance mutation to prior generations of ROS1 TKIs. Here, we report a case of a patient who was heavily pretreated, with advanced L1951R and L2026M mutated ROS1-rearranged NSCLC, who initially responded to repotrectinib but later developed further on-target resistance with the emergence of an L2086F mutation. The disease then responded to cabozantinib, a separate class of ROS1 TKI with preclinical activity against L2086F.
Insights
Repotrectinib shows promise for ROS1-rearranged NSCLC, but resistance can emerge. Cabozantinib offers a subsequent treatment option for patients with specific resistance mutations like L2086F.
Area of Science:
- Oncology
- Molecular Biology
- Pharmacology
Background:
- Repotrectinib is a novel ROS1 tyrosine kinase inhibitor (TKI) approved for ROS1-rearranged NSCLC.
- The G2032R mutation is a common resistance mechanism to earlier ROS1 TKIs.
- Emerging resistance mutations necessitate the exploration of alternative treatment strategies.
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