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Adult Sarcomas with NTRK Fusions: Clinicopathologic and Genomic Heterogeneity
Michael Schwartz1,2, Kieran Sweeney3, Steven C Smith4
1Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA.
Adult sarcomas with NTRK gene fusions are rare and diverse. Understanding their genomic context is crucial for effective TRK inhibitor therapy, as fusion status alone may not predict oncogenic dependence.
Area of Science:
- Oncology
- Genomics
- Molecular Pathology
Background:
- Neurotrophic tyrosine receptor kinase (NTRK) gene fusions drive various cancers, but their role in adult sarcomas is less understood.
- NTRK fusions are more commonly associated with pediatric cancers, necessitating further characterization in adult mesenchymal neoplasms.
Purpose of the Study:
- To investigate the clinicopathologic features, genomic landscape, and treatment response of NTRK-rearranged sarcomas in adult patients.
- To compare the characteristics of adult NTRK-rearranged sarcomas with fusion-negative sarcomas and non-sarcoma NTRK-rearranged tumors.
Main Methods:
- Retrospective analysis of a national genomics database for adult sarcomas (age >18) with pathogenic NTRK1, NTRK2, or NTRK3 fusions.
- Whole-transcriptome and exome sequencing for fusion identification and co-occurring alterations; insurance claims data for real-world survival and TRK inhibitor therapy duration.
Main Results:
- Nineteen adult NTRK-fusion sarcomas were identified, predominantly high-grade and advanced-stage, with heterogeneous histology.
- Common fusion partners included TPM3, EML4, and TFG; additional genomic alterations were frequent (72%), involving TERT promoter, NF1, and RB1.
- NTRK fusion activation and increased MAPK pathway activity were observed; TRK inhibitor therapy showed variable duration.
Conclusions:
- Adult NTRK-fusion sarcomas are rare, morphologically varied, and genetically diverse.
- NTRK fusion status requires interpretation alongside comprehensive clinicopathologic and genomic data for treatment decisions.
- Further research is needed to fully elucidate the oncogenic dependence and therapeutic strategies for these rare tumors.
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