ArticleThe oncologist2026
Minimal residual disease assessment through ctDNA facilitates tailored immunotherapy in MSI-high, NTRK1-fusion pancreatic adenocarcinoma.
Article in The oncologist, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Pancreatic cancer remains one of the most lethal malignancies, with limited integration of precision oncology into routine clinical care. We present a unique case of a RAS wild-type, MSI-H, TMB-H pancreatic ductal adenocarcinoma harboring a TPM3-NTRK1 fusion, monitored through 13 serial liquid biopsies over 3 years. Dynamic changes in NTRK1-fusion allele frequency, tumor mutational burden, and the emergence of an NTRK1 resistance mutation guided finely tuned, situation-adapted therapeutic adjustments: rapid disease control with targeted NTRK inhibition followed by durable remission under immune checkpoint blockade. This case highlights the power of comprehensive molecular profiling and high-frequency ctDNA monitoring to capture tumor evolution and minimal residual disease. Importantly, it further demonstrates how MRD-guided surveillance enables a precise balance between fast-acting targeted therapy and the sustained effects of immunotherapy, providing a blueprint for individualized, context-driven treatment strategies in rare molecular subtypes of pancreatic cancer.
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