We wrote this clinical protocol this year. This was reviewed in the Concept and full protocol reviews by the Medical Oncology Branch and Affiliates'clinical protocol review process. Finally this was approved by the IRB couple of months back. We have identified couple of patients who are on home hospice now. We have initiated discussions with those patients and family members to explain this protocol. Tissue procurement by rapid autopsies provides an effective way to investigate tumor biology of primary and a broad range of metastatic sites in a manner not possible by any other means. In addition to tumor heterogeneity, tissue obtained at autopsy could yield important biologic insights into frequency and nature of secondary mutations associated with tumor progression, novel biomarkers and mechanisms of resistance to treatment. The full extent and consequences of tumor heterogeneity can be evaluated by deep sequencing and global analysis of genetic alterations at the protein level of simultaneous core biopsies from several areas of the primary tumor and metastases and correlation with clinical outcome. To our knowledge, no such studies have been done in NSCLC. We intend to collect tumor tissue from up to ten different sites of metastatic disease to study inter-tumor heterogeneity. Up to six different cores from each site will be stored properly to interrogate intra-tumor heterogeneity. Next generation sequencing and in-depth mass spectrometry-based proteomics analyses will be performed on these samples to assay tumor heterogenety. We will also attempt to generate cell lines from several sites from a patient that are expected to be unique reagents to study tumor heterogenety and tumor biology.
