Wood-Smoke Exposure as a Response and Survival Predictor in Erlotinib-treated Non-small Cell Lung Cancer Patients: An Open Label Phase II Study

Abstract

WSE is associated with better response to Erlotinib and improved progression-free survival in patients with NSCLC. Additional studies in epidermal growth factor receptor signaling pathway in WSE-associated NSCLC are warranted.

Clinical and Pathological Characteristics, Outcome and Mutational Profiles Regarding Non–Small-Cell Lung Cancer Related to Wood-Smoke Exposure

“…Nonetheless, after adjusting for sex, ECOG status, and histological type, it was found that a background of WSE was the most important independent factor associated with longer survival and response, having 83.3% overall response and 17.6 months PFS. 15 Similar studies have reported that WSE is a predictor of gefitinib responsiveness. 20 It has already become well established that EGFR gene mutations confer special sensitivity on TKIs such as gefitinib, erlotinib, and afatinib, 12 leading to 60% to 80% objective response and 8 to 16.5 month PFS rates.…”

“…13,14 Our group conducted a clinical trial using EGFR-TKIs as treatment for patients having progression to first-or second-line chemotherapy; 28% of the patients in our group had a history of WSE and were associated with better EGFR-TKI response rate (RR) (83.3%) and improved progression-free survival (PFS) of 17.6 months. 15 The clinical and pathological characteristics, genotype (EGFR and KRAS), and response to chemotherapy, EGFR-TKIs, and clinical outcomes were investigated regarding lung cancer patients at our institution.…”

Lung Cancer Mutations and Use of Targeted Agents in Hispanics

“…Environmental exposures specifically associated with lung cancer in H/L include exposure to wood-smoke, asbestos, asphalt and tar [68, 69]. For example, heating and cooking with open fires in poorly ventilated places, can cause high indoor smoke levels.…”

Comparative chemistry and toxicity of diesel and biomass combustion emissions

“…Besides the known effects of inorganic gases (e.g., NOx and CO), cilia-toxic respiratory irritants (e.g., phenols, cresols, acrolein, and acetaldehyde) and carcinogenic or mutagenic organic compounds (e.g., benzene, formaldehyde, 1,3-butadiene, PAH, and quinones) in biomass smoke are also known to pose health hazards [26]. As mentioned, numerous epidemiology and occupational studies have confirmed that biomass smoke exposure is associated with adverse respiratory and cardiovascular outcomes [26][27][28] and increased risk of lung cancer [29,30]. However, toxicology studies are still needed to fully explain the key component(s) of the biomass smoke responsible for adverse health outcomes and how these constituents differ depending on fuel and combustion conditions [26,31].…”