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Case Reports
. 2025 Jun:204:108587.
doi: 10.1016/j.lungcan.2025.108587. Epub 2025 May 18.

Unusual relapse dynamics in EGFR-mutated lung adenocarcinoma uncovered by genomic profiling: Insights from a case report

Luca Roma  1 , Obinna Chijioke  1 , Dominik Valentin Flury  2 , Gregor Jan Kocher  2 , Sebastian Ott  2 , Martin Buess  3 , Spasenija Savic Prince  1 , Lukas Bubendorf  4
Affiliations
Case Reports

Unusual relapse dynamics in EGFR-mutated lung adenocarcinoma uncovered by genomic profiling: Insights from a case report

Luca Roma et al. Lung Cancer. 2025 Jun.

Abstract

Synchronous or metachronous multiple NSCLCs challenge clinical practice, particularly in distinguishing multiple separate primary lung cancers (SPLC) from intrapulmonary metastasis (IPM) for accurate staging and management. Here, we present a unique case of three resected lung adenocarcinomas (LUAD) from a single patient collected at different time points, all harboring the same EGFR p.L858R somatic driver mutation but exhibiting distinct clonal trajectories. Whole exome sequencing (WES) analysis revealed that the first tumor was an independent primary tumor, while the latter two tumors were clonally related. Our findings highlight the complexity of tumor progression and provide insights into clonal heterogeneity. This report underscores the importance of genomic profiling for discriminating SPLC from IPM and emphasizes that the detection of a single shared driver mutation is not sufficient to prove metastasis.

Keywords: Case report; Clonal evolution; EGFR mutation; Lung adenocarcinoma; Multiple tumors.

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Conflict of interest statement

Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Dr. Chijioke received personal grants from Sassella-Stiftung and Cancer Research Switzerland; and personal fees from Eli Lilly and ImmunOs Therapeutics. Dr. Savic Prince received personal grants from Gilead Sciences Switzerland and Huggenberger-Bischoff Stiftung. Dr. Bubendorf received personal grants and fees from System Oncology; grants from Roche, Novartis, Boehringer Ingelheim, Thermo Fisher, and Astra Zeneca; fees from Janssen, MSD, Takeda, Amgen, Bayer, Eli Lilly and BMS. The remaining authors declare no conflict of interest.

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