Loading
The first drug approved for a gene fusion regardless of where the cancer started; it works in about 75% of NTRK-fusion cancers, from infant fibrosarcoma to salivary and thyroid cancers.
Drilon (NEJM 2018): 75% response across 17 tumour types; approved November 2018 as the second tumour-agnostic approval (after pembrolizumab MSI-H). Long durability (median DOR >40 months in updates); resistance via NTRK solvent-front mutations (G595R) addressed by repotrectinib and next-generation TRK inhibitors. Paediatric formulation.
Highly selective ATP-competitive inhibitor of TRKA/B/C (NTRK1/2/3) fusion kinases. Connects to NTRK.
1.Larotrectinib slips into a pocket on NTRK.
Background: ADC sequencing, Antigen escape (antigen loss, lineage switch), BCG-unresponsive, Castration-resistant prostate cancer (CRPC), Circulating tumour DNA (ctDNA). Also on OnCo: Resistance: how tumours escape each drug class · Lines of therapy.
Oral, self-administered, so it is a Part D drug: covered through a stand-alone Part D plan or Medicare Advantage drug benefit, usually on the specialty tier with 25 to 33% coinsurance until the annual cap ($2,000 in 2025, $2,100 in 2026).
Covered for FDA-labelled and NCCN-listed uses, but almost always behind prior authorisation confirming diagnosis, biomarker and line of therapy; dispensed through a specialty pharmacy. NTRK fusion by an approved test.
Part D out-of-pocket capped at $2,000 (2025) / $2,100 (2026). Medicare patients cannot use manufacturer co-pay cards; charity funds (PAN, HealthWell, CancerCare) and the Extra Help subsidy are the routes.
Sources: Medicare.gov: Drug coverage (Part D) · Medicare.gov: Costs for Medicare drug coverage (annual out-of-pocket cap). Not medical or financial advice; verify with your plan.
Sources: NICE TA630 · NHS England Cancer Drugs Fund list · SMC advice: larotrectinib. Funding decisions are indication-specific and change monthly; verify with NICE and your treating team.
Treatment of adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation; are metastatic or where surgical resection is likely to result in severe morbidity; and have no satisfactory alternative treatments or that have progressed following treatment
Accelerated approval on a surrogate endpoint, with a confirmatory trial required. source
Formation: Treatment of adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation; are metastatic or where surgical resection is likely to result in severe morbidity; and have no satisfactory alternative treatments or that have progressed following treatment
Accelerated approval on a surrogate endpoint, with a confirmatory trial required. source
Treatment of adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation; are metastatic or where surgical resection is likely to result in severe morbidity; and have no satisfactory alternative treatments or that have progressed following treatment
Confirmed: the accelerated approval of 2018 converted to traditional approval 6.4 years after it was granted. source
Formation: Treatment of adult and pediatric patients with solid tumors that have a neurotrophic receptor tyrosine kinase (NTRK) gene fusion without a known acquired resistance mutation; are metastatic or where surgical resection is likely to result in severe morbidity; and have no satisfactory alternative treatments or that have progressed following treatment
Confirmed: the accelerated approval of 2018 converted to traditional approval 6.4 years after it was granted. source
| Region | Year | Indication |
|---|---|---|
| US | 2018 | Solid tumours with NTRK gene fusion without known acquired resistance mutation, metastatic or unresectable, adults and children |
| EU | 2019 | Same |
| UK | 2020 | NTRK fusion-positive solid tumours in adults and children, locally advanced or metastatic or where surgery would cause severe morbidity, with no satisfactory treatment options: NICE TA630 (27 May 2020) recommends it within the Cancer Drugs Fund under a managed access agreement · https://www.nice.org.uk/guidance/ta630 |
| England (NICE) | 2020 | NTRK fusion-positive solid tumours, including colorectal cancer · TA630, published 27 May 2020: recommended for use within the Cancer Drugs Fund only, under a managed access agreement, where there is no satisfactory treatment option. |
Country and place are remembered in this browser only. A postcode is sent to OpenStreetMap's Nominatim service to find coordinates when you press the button; nothing else leaves your device.
The document that made biomarker testing part of routine pancreatic cancer care in the United States; the 2018 version it built on fixed the second-line chemotherapy sequence still used in most guidelines.
NTRK fusions are under 0.5% of pancreatic cancers but carry a tumour-agnostic approval; this case is the published proof that the label applies here.
NTRK fusion testing is now recommended in lung and other cancers without a common driver, and larotrectinib or entrectinib is the standard treatment when a fusion is found.
Query for this drug: (TITLE:"Larotrectinib" OR ABSTRACT:"Larotrectinib" OR TITLE:"Vitrakvi" OR ABSTRACT:"Vitrakvi") AND (cancer OR tumor OR tumour OR oncology OR carcinoma OR lymphoma OR leukemia OR leukaemia OR myeloma OR sarcoma OR melanoma OR glioma). Results are unfiltered search hits about Larotrectinib, not a curated reading list.
Shares Secretory carcinoma of the breast, Colorectal cancer drugs in England: what NICE has recommended, University of Colorado Cancer Center, Metastatic Pancreatic Cancer: ASCO Guideline Update.
Shares TruSight Oncology Comprehensive, NTRK1/2/3 gene fusion, Papillary thyroid cancer, Tumour-agnostic (tissue-agnostic) approval.
Shares Thyroid cancer (KEGG map), NTRK1/2/3 gene fusion, Inflammatory myofibroblastic tumour (IMT), NTRK fusion-positive non-small-cell lung cancer.
Shares Thyroid cancer (KEGG map), RACE for Children Act, Papillary thyroid cancer, NCI-COG Pediatric MATCH (APEC1621).
Shares RACE for Children Act, Paediatric high-grade glioma (excluding diffuse midline glioma), Ampullary cancer (ampulla of Vater), KRAS wild-type pancreatic ductal adenocarcinoma.
Shares University of Colorado Cancer Center, Inflammatory myofibroblastic tumour (IMT), NTRK fusion-positive non-small-cell lung cancer, Paediatric high-grade glioma (excluding diffuse midline glioma).
Shares NTRK1/2/3 gene fusion, Tumour-agnostic (tissue-agnostic) approval, Gene fusion, Receptor tyrosine kinase activation.
Shares University of Colorado Cancer Center, Study to Investigate Outcome of Individualized Treatment in Patients With Metastatic Colorectal Cancer, Inflammatory myofibroblastic tumour (IMT), Uterine sarcoma.