Multiple lung cancers including squamous cell carcinoma with strong PD-L1 expression and adenocarcinoma with EGFR exon 19 deletion: A case report

Next-Generation Sequencing of Synchronous Multiple Primary Lung Cancers in a Patient with Squamous Cell Carcinoma and Small Cell Lung Cancer

The incidence of synchronous multiple primary malignancies is low. The presence of different lung tumor types in one patient is rare. Here, we report a rare case of synchronous lung squamous cell cancer and small cell lung cancer in a 60-year-old man. Because of the presence of two different tumor types, the proper treatment must be determined. To identify treatment targets, the genetic features of primary tumor tissues from the lungs were analyzed by next-generation sequencing (NGS). The objective was to analyze the origin and evolution of multiple primary lung cancers. NGS can find the genetic mutation sites of patients to guide treatment and promote the advancement of precision medicine. The effects of standard treatments were evaluated by response evaluation criteria in solid tumors. The results suggest that early treatment of synchronous multiple primary malignancies is a favorable outcome.

Multiple Primary Lung Cancers: A New Challenge in the Era of Precision Medicine

With the widespread implementation of lung cancer screening, more and more patients are being diagnosed with multiple primary lung cancers (MPLCs). In the era of precision medicine, many controversies remain in differentiating MPLCs from intrapulmonary metastasis and the optimum treatment choice, especially in patients exhibiting similar histology. In this review, we summarize common diagnostic criteria and novel discrimination methods with a special emphasis on the emerging value of broad panel next-generation sequencing (NGS) for the diagnosis of MPLCs. We then discuss current advances regarding therapeutic approaches for MPLCs. Radical surgery is the main treatment modality, while stereotactic body radiotherapy (SBRT) is safe and feasible for early-stage MPLC patients with inoperable tumors. In addition, immunotherapy and targeted therapy, particularly epidermal growth factor receptor-tyrosine kinase inhibitors, are emerging therapeutic strategies that are still in their infancy. Characteristics of both genomic profiles and tumor microenvironment are currently being evaluated but warrant further exploration to facilitate the application of targeted systematic therapies in MPLC patients.