The Impact of Smoking Status on the Behavior and Survival Outcome of Patients With Advanced Non-small Cell Lung Cancer

Toh, Chee-Keong; Wong, Ee-Hwee; Lim, Darren Wan-Teck; Leong, S. S.; Fong, Kok‐Yong; Wee, Joseph; Tan, Eng‐Huat

doi:10.1378/chest.126.6.1750

Cited by 121 publications

(115 citation statements)

References 26 publications

(25 reference statements)

Supporting

Mentioning

101

Contrasting

Unclassified

Order By: Relevance

“…Based on the relatively higher incidence of never-smokers diagnosed with lung cancer especially among women in Asia, it does suggest that a higher proportion of patients in this part of the world may benefit from treatment with gefitinib (MacLennan et al, 1977;Koo et al, 1985;Gao et al, 1987;Han et al, 1990). Our previous study revealed that 36% of patients referred to our department were never-smokers (Toh et al, 2004). Despite the negative results from the INTACT studies, it is still worthwhile exploring the use of chemotherapy with gefitinib in never-smoking patients with advanced NSCLC.…”

Section: Discussionmentioning

confidence: 92%

“…We looked for possible differences in outcome between smokers and nonsmokers in patients with advanced NSCLC treated with platinum-based chemotherapy in our previous study (Toh et al, 2004). In that study that included 317 patients (115 patients were nonsmokers), no differences were observed in terms of response to cytotoxics and survival outcome between smokers and nonsmokers despite distinct differences in age at diagnosis, and histology, and gender distribution.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Gefitinib is more effective in never-smokers with non-small-cell lung cancer: experience among Asian patients

Wong

et al. 2005

Br J Cancer

View full text Add to dashboard Cite

We retrospectively analysed the results of patients with advanced non-small-cell lung cancer treated with gefitinib to derive clinical factors predictive of response and a favourable survival outcome. Patients were treated with gefitinib 250 mg per day and reevaluated 4 -8 weeks later with repeat CT scan and every 8 weeks thereafter to assess response and the duration of response. Pathology review by a histopathologist was conducted, in particular to confirm a recently published result of bronchioloalveolar carcinoma histology or its components as predictive of response to gefitinib. Logistic regression and Cox regression analytical methods were applied to determine factors that could predict for response and improved overall survival. A total of 110 patients were treated. The overall response rate was 32% partial responses (PRs). Only never-smoking status was predictive of response in the logistic regression analysis, adjusted OR ¼ 6.1, 95% CI ¼ 1.7, 21.5. The presence of a PR and good performance status were predictive of a favourable survival outcome from the Cox regression modelling. Responders had an adjusted HR of 3.0, 95% CI ¼ 1.5 -5.8 compared to nonresponders, while patients with ECOG status 0 -1 had an adjusted HR of 0.42, 95% CI ¼ 0.25 -0.72, compared with patients with ECOG status 2 -4. Bronchioloalveolar carcinoma or its components were distinctly absent on pathology review. In conclusions, Never-smoking status is an important clinical predictor of a favourable response to gefitinib.

show abstract

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Gefitinib is more effective in never-smokers with non-small-cell lung cancer: experience among Asian patients

Wong

et al. 2005

Br J Cancer

View full text Add to dashboard Cite

show abstract

“…A retrospective study from Singapore [24] observed no differences in response rates between current and former smokers, finding respective median survival times of 18.5 and 13.6 months (p = .14). In another study, Nordquist et al [25] reported a 5-year survival rate of 23% for patients with adenocarcinoma of the lung who had never smoked (neversmokers), compared with 16% for smokers (p = .004).…”

Section: Thementioning

confidence: 91%

Clinical Evidence for Second- and Third-Line Treatment Options in Advanced Non-Small Cell Lung Cancer

Marinis

Grossi²

2008

The Oncologist

View full text Add to dashboard Cite

In the U.S. and Europe, the current options for the second-and third-line treatment of advanced non-small cell lung cancer (NSCLC) are cytotoxic drugs and targeted agents. Docetaxel was the first drug approved for second-line treatment after two phase III trials demonstrated its superiority over best supportive care (BSC) alone and single-agent chemotherapy. Pemetrexed was also registered for use as second-line therapy after it was demonstrated to have activity comparable with, and a more favorable toxicity profile than, docetaxel. Erlotinib, an epidermal growth factor receptor inhibitor, is the only biological agent to have been approved in the U.S. and Europe for lung cancer treatment after a study showed its superiority over BSC in recurrent (second-/third-line) NSCLC patients. This review focuses on these drugs, dealing with the results supporting the choice among docetaxel, pemetrexed, and erlotinib in second-and/or third-line treatment. The Oncologist 2008;13(suppl 1):14-20

show abstract

“…[1][2][3][4] The development of lung cancer in never-smokers (LCINS) is of great concern in East Asian countries, and some estimates suggest that up to 70% of these cancers in women may be unrelated to tobacco smoking. 1,[5][6][7] Currently, LCINS is regarded as a distinct disease entity with a unique tumorigenic pattern, clinicopathologic features, and natural history. LCINS is more likely to be addicted to signaling from a single oncogene rather than widespread genetic and epigenetic changes, like those observed in lung cancers observed in smokers.…”

Section: Introductionmentioning

confidence: 99%

Distinct clinical features and outcomes in never‐smokers with nonsmall cell lung cancer who harbor EGFR or KRAS mutations or ALK rearrangement

Kim

Shim

Chung

et al. 2011

Cancer

133

View full text Add to dashboard Cite

BACKGROUND:The objectives of this study were to determine the proportions of major oncogenic alterations and to examine survival in genotype-specific subsets of never-smokers with nonsmall cell lung cancer (NSCLC). METHODS:The authors concurrently analyzed mutations in the epidermal growth factor receptor (EGFR) and v-Ki-ras2 Kirsten rat sarcoma viral oncogene homolog (KRAS) genes and investigated anaplastic lymphoma kinase (ALK) gene rearrangements in samples from 229 never-smokers with NSCLC. ALK rearrangements were identified by fluorescent in situ hybridization and were confirmed by immunohistochemistry. Mutations in EGFR (exons 18 to 21) and KRAS (codons 12 and 13) were determined by direct sequencing. RESULTS: Of 229 tumors, the frequency of EGFR mutations, ALK rearrangements, KRAS mutations, and no mutations (wild type [WT]) in any of the 3 genes (WT/WT/WT) was 48%, 8.3%, 3.5%, and 40.2%, respectively. All genetic alterations were mutually exclusive. The median progression-free survival after treatment with EGFR tyrosine kinase inhibitors (TKIs) was 12.8 months, 6.3 months, 2.1 months, and 1.6 months in patients with EGFR mutations, the WT/WT/WT genotype, KRAS mutations, and ALK rearrangements, respectively. In a Cox regression model, the adjusted hazard ratio for the risk of disease progression after treatment with EGFR TKIs was 0.59 (95% confidence interval [CI], 0.40-0.87; P ¼ .008) for patients with EGFR mutations, 4.58 (95% CI, 2.07-10.15; P < .001) for patients with ALK rearrangements, and 4.23 (95% CI, 1.65-10.8; P ¼ .003) for patients with KRAS mutations. Overall survival also differed significantly among genotypes. CONCLUSIONS: To the authors' knowledge, this was the largest comprehensive and concurrent analysis to date of 3 major oncogenic alterations in a cohort of East Asian never-smokers with NSCLC. Because survival outcomes differed among genotypes, and drugs that target specific alterations currently are available, genetic profiling to identify genotype-specific subsets can lead to successful treatment with appropriate kinase inhibitors. Cancer 2012;118:729

show abstract

The Impact of Smoking Status on the Behavior and Survival Outcome of Patients With Advanced Non-small Cell Lung Cancer

Cited by 121 publications

References 26 publications

Gefitinib is more effective in never-smokers with non-small-cell lung cancer: experience among Asian patients

Gefitinib is more effective in never-smokers with non-small-cell lung cancer: experience among Asian patients

Clinical Evidence for Second- and Third-Line Treatment Options in Advanced Non-Small Cell Lung Cancer

Distinct clinical features and outcomes in never‐smokers with nonsmall cell lung cancer who harbor EGFR or KRAS mutations or ALK rearrangement

Contact Info

Product

Resources

About