{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T13:33:58Z","timestamp":1789220038747,"version":"build-2803163510"},"reference-count":11,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":5,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82303643"],"award-info":[{"award-number":["82303643"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Thoracic Cancer"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Targeted therapy is the standard treatment for driver\u2010mutated lung cancer, but its efficacy in multiple primary lung cancers (MPLCs) remains limited due to significant inter\u2010lesional molecular heterogeneity. We present a case of synchronous MPLC with 34 bilateral pulmonary nodules. The dominant right upper lobe lesion was an\n                    <jats:italic>EGFR<\/jats:italic>\n                    L858R\u2010mutated adenocarcinoma that responded to osimertinib, while other nodules progressed. Switching to chemoimmunotherapy induced regression of all lesions, enabling surgical resection. Postoperative pathological analysis revealed two resected lesions with discordant molecular profiles\u2014one\n                    <jats:italic>EGFR<\/jats:italic>\n                    \u2010mutated and one driver\u2010negative. Despite adjuvant therapy, the patient developed early recurrence as non\u2010small cell lung carcinoma\u2010not otherwise specified with no driver mutation and died within 6\u2009months post\u2010radiotherapy. This case highlights the limitations of single\u2010agent targeted therapy in MPLC, challenges the assumption that driver\u2010negative lesions typically follow an indolent course, and supports early chemotherapy\u2010based systemic combination strategies to address the significant molecular heterogeneity in MPLC.\n                  <\/jats:p>","DOI":"10.1111\/1759-7714.70215","type":"journal-article","created":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T06:17:56Z","timestamp":1767766676000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Multiple Primary Lung Cancer With Driver Gene Mutations: Is Targeted Therapy Always the Optimal Choice?\u2014A Case Report"],"prefix":"10.1111","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-6502-9380","authenticated-orcid":false,"given":"Zi\u2010Rui","family":"Ren","sequence":"first","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lv","family":"Wu","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chang","family":"Lu","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fen","family":"Wang","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"},{"name":"Department of Oncology Peking University Shenzhen Hospital  Shenzhen Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7162-4422","authenticated-orcid":false,"given":"Ying\u2010Long","family":"Peng","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"},{"name":"School of Medicine South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4609-7031","authenticated-orcid":false,"given":"Dong\u2010Xuan","family":"Cai","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4870-4408","authenticated-orcid":false,"given":"Li\u2010Bo","family":"Tang","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"},{"name":"School of Medicine South China University of Technology  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia\u2010Ting","family":"Li","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"},{"name":"Shantou University Medical College  Shantou Guangdong China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5796-1185","authenticated-orcid":false,"given":"Zhi","family":"Guo","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhi\u2010Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yu","family":"Deng","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Pathology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue\u2010Wu","family":"Wei","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian\u2010Lin","family":"Huang","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3474-2809","authenticated-orcid":false,"given":"Chong\u2010Rui","family":"Xu","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qing","family":"Zhou","sequence":"additional","affiliation":[{"name":"Guangdong Lung Cancer Institute, Guangdong Provincial Key Laboratory of Translational Medicine in Lung Cancer, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences Southern Medical University  Guangzhou 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