Smoking affects treatment outcome in patients with advanced nonsmall cell lung cancer

Abstract

BACKGROUND.The purpose of the current study was to determine whether smoking during chemotherapy or chemoradiation therapy for nonsmall cell lung cancer (NSCLC) affects treatment outcome. METHODS.The authors reviewed the medical records of patients with NSCLC (AJCC Stage III or IV) who were treated with frontline chemotherapy or chemoradiation therapy at the University of Texas M. D. Anderson Cancer Center between January 1993 and December 2002. Treatment type, response, progression-free survival, and overall survival (OS) were correlated with patient demographic characteristics, clinical features, and smoking habits at the time of diagnosis and during therapy. RESULTS.Of 1370 patients who were eligible for analysis, 497 received chemoradiation therapy and 873 received chemotherapy. In the chemoradiation group, 6% of patients were never-smokers, 45% were former smokers, and 49% were current smokers. Multivariate analysis demonstrated no prognostic effect of smoking status on treatment response or OS rates in the chemoradiation therapy group. In the chemotherapy group, 16% of patients were never-smokers, 42% were former smokers, and 42% were current smokers; 20% of patients continued to smoke during therapy. Never-smokers had higher response rates (19% vs. 8% vs. 12%; P ϭ .004) and lower rates of progressive disease (49% vs. 65% vs. 66%; P ϭ .002) than former and current smokers, respectively. The OS rates were found to be higher among never-smokers (P Ͻ.0001), women (P ϭ .002), and those with a better Eastern Cooperative Oncology Group (ECOG) performance status (P Ͻ.0001). The multivariate Cox model indicated that with adjustment for age, gender, stage of disease, and ECOG performance status, the hazard ratio was 1.47 for former smokers (P ϭ .003) and 1.55 for current smokers (P ϭ .0004). Active smoking during therapy did not appear to impact outcome. CONCLUSIONS.Never-smokers were found to have an improved outcome over smokers when treated with chemotherapy.

Alternative efficacy-predicting markers for paclitaxel instead of CHFR in non-small-cell lung cancer

“…Regarding smoking status, those authors found that never-smokers had higher response rates than former or current smokers. 21 In opposition to their report, we showed that only the sensitivity rate to PTX was significantly higher in smokers than in never-smokers (Fig. 3I).…”

“…The differences among the four groups are statistically significant (p < 0.05) by scheffe's test. Tsao et al analyzed 1,370 patients from the United States with stage III or IV NSCLC and found that responses to first-line chemotherapy were not associated with patient age, gender or histological subtype of tumors; 21 these results are all in accord with the present results. Regarding smoking status, those authors found that never-smokers had higher response rates than former or current smokers.…”

Survival among Never-Smokers with Lung Cancer in the Cancer Care Outcomes Research and Surveillance Study

“…Likewise, in an analysis of data from 883 patients with NSCLC, including 286 neversmokers (32%), Toh observed worse survival among smokers (HR, 1.30; 95% CI, 1.04-1.62) (19). Finally, Tsao and colleagues found worse survival among smokers (P , 0.0001) in an analysis of 1,370 patients with stage III and IV NSCLC treated with chemotherapy or chemoradiation (20). Two prior studies did not show an association between smoking status and survival.…”

Female Gender Is an Independent Prognostic Factor in Non-small-cell Lung Cancer: A Meta-analysis

“…In addition, survival was longer for women in multiple randomized clinical trials that included chemotherapy for unresectable stage IIIB-IV NSCLCs. 32,56,59) These results suggest that overall, advanced stage NSCLCs in women respond to chemotherapy better than those in men. Our combined studies including fewer than 30% stage I patients in the present meta-analysis also demonstrated that survival for women was significantly better, implying that women's survival benefits were not limited to earlier disease stages.…”