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Test Your Knowledge: NTRK Fusions in Head and Neck Cancers

  • Authors: Jessica Bauman, MD
  • CME / ABIM MOC Released: 8/4/2021
  • Valid for credit through: 8/4/2022, 11:59 PM EST
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Target Audience and Goal Statement

This activity is intended for hematology/oncology specialists, endocrinologists, and otolaryngologists.

The goal of this activity is to improve clinicians' ability to manage patients with head and neck cancers that harbor NTRK gene fusions.

Upon completion of this activity, participants will:

  • Have increased knowledge regarding the
    • Clinical trial data evaluating TRK inhibitors in cancers of the head and neck
    • Characteristics that guide eligibility for treatment with a TRK inhibitor
  • Have greater competence related to
    • Selecting an evidence-based treatment regimen for a patient with NTRK fusion-positive head and neck cancer
    • Mitigating treatment-related adverse events in patients receiving therapy with a TRK inhibitor


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  • Jessica Bauman, MD

    Assistant Professor, Department of Hematology/Oncology
    Chief, Division of Head and Neck Medical Oncology
    Fox Chase Cancer Center
    Temple Health
    Philadelphia, Pennsylvania


    Disclosure: Jessica Bauman, MD, has the following relevant financial relationships:
    Advisor or consultant for: Beigene; Blueprint Medicine; Janssen; Lilly; Merck; Turning Point


  • Charlotte Warren

    Senior Director of Content Development, Medscape, LLC


    Disclosure: Charlotte Warren has disclosed no relevant financial relationships.

  • Tristin Abair, PhD

    Senior Medical Writer, Medscape, LLC


    Disclosure: Tristin Abair, PhD, has disclosed no relevant financial relationships.

CME Reviewer

  • Robert Morris, PharmD

    Associate Director, Accreditation and Compliance, Medscape, LLC


    Disclosure: Robert Morris, PharmD, has disclosed the following relevant financial relationships:
    Served as an advisor or consultant for: ViiV Healthcare
    Owns stock, stock options, or bonds from: GlaxoSmithKline

None of the nonfaculty planners for this educational activity have relevant financial relationship(s) to disclose with ineligible companies whose primary business is producing, marketing, selling, reselling, or distributing healthcare products used by or on patients.

Peer Reviewer

This activity has been peer reviewed and the reviewer has disclosed no relevant financial relationships.

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Interprofessional Continuing Education

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    For Physicians

  • Medscape, LLC designates this enduring material for a maximum of 1.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Test Your Knowledge: NTRK Fusions in Head and Neck Cancers

Authors: Jessica Bauman, MDFaculty and Disclosures

CME / ABIM MOC Released: 8/4/2021

Valid for credit through: 8/4/2022, 11:59 PM EST


The following cases are modeled on the interactive grand rounds approach. The questions within the activity are designed to test your current knowledge. After each question, you will be able to see whether you answered correctly and read evidence-based information that supports the most appropriate answer choice. The questions are designed to challenge you; you will not be penalized for answering the questions incorrectly. At the end of the activity, there will be a short post-test assessment based on the material presented.


Elizabeth is a 67-year-old retired dance teacher who stays active with her children and grandchildren. She was diagnosed with thyroid cancer 15 years ago and underwent a total thyroidectomy. Final pathology showed a 3.1-cm papillary thyroid tumor with extrathyroidal extension and 2 involved lateral cervical lymph nodes. She received adjuvant radioactive iodine (RAI) and was then monitored closely by her endocrinologist.

Three years ago, during a routine surveillance appointment, her thyroglobulin (Tg) levels had increased and she underwent ultrasound and computed tomography (CT) with contrast of her neck and chest. Small nodules in her chest were observed and RAI imaging was performed, showing the new nodules were RAI avid. She was again treated with RAI, and the post-treatment scans showed modest uptake. Initially, her Tg levels decreased, but then within 6 months, her Tg levels began to increase. Initial imaging showed stability of the pulmonary nodules, but then after a year, they started to grow. Six months ago, her Tg doubling time became < 6 months and the nodules were increasing further.

Elizabeth was referred to a medical oncologist and a needle biopsy of one of the pulmonary lesions was performed, confirming metastatic papillary thyroid carcinoma. She is asymptomatic and otherwise healthy, with no major comorbidities. Her history and initial workup are summarized in Table 1.

Table 1. Elizabeth's Medical History and Workup

Demographics/ patient Information
  • 67 years old, female
  • Height: 5'5"; weight: 140 lb; BMI: 23.3
  • No major comorbidities, ECOG PS 0
  • Nonsmoker, non-drinker
  • No drug allergies or current medications
Medical history
  • November 2006: Diagnosed with papillary thyroid carcinoma
    • Total thyroidectomy and RAI
  • February 2018: Rising Tg levels; multiple RAI-avid pulmonary nodules < 0.5 cm
    • Received RAI; post-therapy imaging showed modest uptake
  • 2018-2020: Tg levels increasing, but doubling time > 6 months and CT scans showed minimally growing nodules
  • 2021: Tg doubling time now < 6 months and nodules growing
  • August 2021: referred to medical oncology
Initial workup
  • CT with contrast of neck/chest: > 10 pulmonary nodules; several are > 1 cm
  • Needle biopsy of largest pulmonary nodule: papillary thyroid carcinoma
  • TSH: 0.01 mU/L
  • Tg: 325 ng/mL
  • Anti-Tg antibody: < 0.1 IU/mL
BMI = body mass index; ECOG PS = Eastern Cooperative Oncology Group performance status; TSH = thyroid stimulating hormone.
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