Case Report: A Bilateral Synchronous Primary Non-Small Cell Lung Cancer Patient With Two Different EGFR Mutations

Background

Non-small cell lung cancer (NSCLC) represents the majority of lung cancer cases, with epidermal growth factor receptor (EGFR) mutations playing a crucial role in disease prognosis and treatment. Around half of Asian patients with NSCLC, particularly non-smoking women, have EGFR mutations. These patients with NSCLC typically exhibit a single EGFR mutation in exon 18, 19, 20, or 21. It is extremely rare for patients with bilateral primary NSCLC to harbor two different EGFR mutations.

Case

We report a case of 70-year-old non-smoking Vietnamese female patient diagnosed with synchronous bilateral primary NSCLC, each harboring different EGFR mutations—G719C in exon 18 in the right lung and an exon 19 deletion in the left lung. The patient underwent surgical resection of the left lung lesion, followed by targeted therapy with afatinib for the right lung lesion, which resulted in tumor reduction and disease stability for 1 year before disease progression.

Conclusion

Our study underscores the complexity of diagnosing and managing synchronous bilateral NSCLC with distinct genetic profiles. This report also highlights the importance of comprehensive molecular profiling to select an optimal treatment strategy to improve patient outcomes.