Early Application of Next-Generation Sequencing Identifies Pancreatic Mass as Metastasis From an EGFR-Mutated Lung Adenocarcinoma

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Luxi ChenDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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John DavelaarDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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Srinivas GaddamDepartment of Medicine, Gastroenterology, Cedars-Sinai Medical Center, Los Angeles, California

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Kambiz KosariDepartment of Hepatobiliary and Pancreatic Surgery, Cedars-Sinai Medical Center, Los Angeles, California

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Nicholas NissenDepartment of Hepatobiliary and Pancreatic Surgery, Cedars-Sinai Medical Center, Los Angeles, California

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George ChauxDepartment of Medicine, Pulmonary and Lung Transplant Program, Cedars-Sinai Medical Center, Los Angeles, California

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Christopher LeeDepartment of Radiology, Cedars-Sinai Medical Center, Los Angeles, California

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Eric VailDepartment of Pathology, Cedars-Sinai Medical Center, Los Angeles, California

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Andrew HendifarDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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Jun GongDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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Karen ReckampDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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Arsen OsipovDepartment of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California

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Pancreatic metastasis of primary lung adenocarcinoma is a rare occurrence, accounting for <0.3% of all pancreatic malignancies. Given that the prognosis and treatment options for primary pancreatic cancer differ greatly from pancreatic metastases from a primary site, an accurate diagnosis is critical. This report presents a unique case of a 65-year-old man who was admitted with significant unintentional weight loss, fatigue, abdominal pain, and jaundice, and found to have a pancreatic mass initially thought to be primary pancreatic adenocarcinoma and subsequently diagnosed as an EGFR-mutated lung adenocarcinoma with metastases to the pancreas via early application of next-generation sequencing (NGS). The use of NGS early in the patient’s clinical course not only changed the treatment strategy but also drastically altered the prognosis. Although metastatic pancreatic adenocarcinoma has a poor prognosis and survival rate, treatment of EGFR-mutated non–small cell lung cancer with EGFR tyrosine kinase inhibitors is associated with high response rates. Importantly, our case demonstrates that timely application of NGS very early in the disease course is paramount to the diagnosis, management, and prognosis of solid malignancies.

Submitted May 16, 2022; final revision received July 7, 2022; accepted for publication July 7, 2022. Published online November 17, 2022.

Disclosures: Dr. Reckamp has disclosed serving as a principle investigator for Genentech, Blueprint, Calithera, Daiichi Sankyo, Elevation Oncology, and Janssen; and serving as a consultant for Amgen, AstraZeneca, Blueprint, Daiichi Sankyo, EMD Soreno, Genentech, GlaxoSmithKline, Janssen, Lilly, Merck KGaA, Mirati, Seattle Genetics, Takeda, and Tesaro. The remaining authors have disclosed that they have no financial interests, arrangements, or affiliations with the manufacturers of any products discussed in this article or their competitors.

Correspondence: Arsen Osipov, MD, Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Lower Level, AC1044, Los Angeles, CA 90048. Email: arsen.osipov@cshs.org
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