Practical Application of Next-Generation Sequencing. Identification of STK11 and KEAP1 Mutations Determine Use of First-Line Chemoimmunotherapy

Limited targeted lung panel is the standard of care in Australia.The use of next-generation sequencing (NGS) outside major centres and clinical trials is limited.We present a case wherein a regional cancer centre NGS was obtained and identified negative prognostic somatic mutations.These mutations are not routinely investigated, but their detection consequently altered management, and most likely improved our patient's outcome.Our patient is a septuagenarian with Stage IV, driver-negative lung adenocarcinoma, with high PD-L1 score.Standard management would warrant single-agent immunotherapy.The identification of STK11 and KEAP1 mutations through NGS alerted the clinicians of a potentially poorer response.An offer of combination chemoimmunotherapy was made which we believe has resulted in better-than-expected outcomes for this patient to date.We advocate for greater use of comprehensive molecular profiling for oncology treatment and more creative, cost-effective solutions to overcome the tyranny of distance in the practice of regional oncology.