Application of whole exome sequencing in metachronous lung cancers evaluation

Abstract

Multiplicity and metachronous tumours are recurrent management problems. Morphological resemblance, in-situ carcinoma, cancer driver mutations, etc. have been used to distinguish intrapulmonary metastasis and metachronous primary lung cancers but these criteria are often insufficient. Next generation sequencing promises to advance personalized cancer management but finding a practicable approach remains a problem. We explored the utility of whole exome sequencing for cancer nature determination in a 74 year-old female non-smoker with 2 sequential lung cancers of unknown relation. Initially, she had an EGFR-L858R adenocarcinoma (Tumour-A) treated by excision and adjuvant gefitinib for metastatic pleural tumours. Two years later while ...