• Bo-Hua Kuang, Bi-Cheng Wang, Fan Tong, Jin-Song Yang, Yu-Lan Zeng, Ru-Bo Cao, and Li Liu.
• Cancer Center, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan.
• Medicine (Baltimore). 2018 Dec 1; 97 (51): e13192.

RationaleAlthough lung cancer is the leading cause of cancer-related death in the world, targeted therapy plays an essential role in improving the survival of lung cancer. Next-generation sequencing (NGS) technology can dynamically monitor the genomic profiles of tumors and assist cancer diagnosis and treatment.Patient ConcernsWe reported on a 55-year-old man who presented with chest tightness and wheezing for 1 month.DiagnosesThe patient was diagnosed with stage cT4N2M1a non-small cell lung cancer (NSCLC) and was found to have wild-type EGFR by pleural effusion cytology.InterventionsThe patient received systemic treatments, including chemotherapy, targeted therapy, and radiotherapy. During the cancer development, sequential DNA sequencing data that used circulating cell-free tumor DNA, and NGS revealed EGFR L858R and T790M mutations, MYC amplification, and other gene variations.OutcomesThe patient died of brain and lung metastases, and had an overall survival as long as 37 months.LessonsThe dynamic monitoring of tumor genomic profiles has important implications for NSCLC diagnosis, treatment, and prognosis.

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