Even Smokers May Benefit from Targeted Lung Cancer Treatments


“Smokers are less likely than non-smokers to have lung cancers caused by targetable genetic changes. But a study published this week in the journal Clinical Cancer Research shows that when they do, smokers benefit just as much as non-smokers from targeted treatments.

” ‘A smoker or former smoker with a targetable alteration has the same probability of benefitting from targeted therapy as a never-smoker with a targetable alteration,’ says Dara Aisner, PhD, investigator at the University of Colorado Cancer Center and molecular pathologist at CU School of Medicine.”

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Increasing Trend of NSCLC Among Never-Smokers Prompts New Research Efforts

“Twenty percent of lung cancer cases in the United States are diagnosed in people who never smoked.

“This translates to between16,000 and 24,000 Americans annually, according to the American Cancer Society.  The majority of these cases are non–small cell lung cancer.

“Although the exact cause for increased proportion of lung cancer cases among never-smokers has not been established, researchers suggest environmental factors may to be blame.

“However, they emphasize more data are needed to identify the factors that are driving the increase ― and determine the most appropriate treatment options for never-smokers ― before changing practice.”

For Breast Cancer Patients, Never Too Late to Quit Smoking

“Documenting that it’s never too late to quit smoking, a large study of breast cancer survivors has found that those who quit smoking after their diagnosis had a 33 percent lower risk of death as a result of breast cancer than those who continued to smoke.

“The study involved more than 20,600  with breast cancer, and is one of the largest studies of survival outcomes according to  habits in women with a history of breast cancer, and the first study to assess smoking habits both before and after diagnosis.

“The paper was published in the Journal of Clinical Oncology on January 25, 2016.”

NSCLC Emerging as a Growing Problem Among Never-Smokers

“Lung cancers account for more than one-quarter of cancer deaths in the United States, and the disease is expected to kill nearly 160,000 Americans in 2016 alone. Early detection, which occurs in just 15% of cases, remains the best avenue to longterm survival; about half of patients found to have an early-stage lung cancer are alive 5 years after diagnosis, compared with fewer than 5% of patients whose cancers are detected after metastasis.

“The National Lung Screening Trial studied more than 53,000 patients and demonstrated that low-dose helical computed tomography (CT) is more effective at lung cancer early detection than standard chest X-rays, yielding—over an observation period of about 7 years—a 20% lower risk of dying from the disease. The trial enrolled only symptomless current or former smokers ages 55 to 74 who had a smoking history of 30 packyears (that is, a pack a day for 30 years, or 2 packs a day for 15 years) and who had been smokers within the prior 15 years.”

COPD Heightens Deadly Lung Cancer Risk in Smokers

“Smokers who have chronic obstructive pulmonary disorder (COPD) may face nearly twice the risk of getting small cell lung cancer (SCLC)—the deadliest form of lung cancer—than smokers who don’t have COPD, according to a large worldwide study led by researchers at the Harvard T.H. Chan School of Public Health.

“The study was published online September 24, 2015 in EBioMedicine.

“The new study—the largest-ever epidemiologic study of SCLC—is the first to look at how much COPD, a progressive disease that makes it hard to breathe, increases smokers‘ risk of getting SCLC. Although it’s long been known that smoking is a major risk factor for lung cancer, the new study estimates the risk more precisely than before.”

Incidence of NSCLC Has More than Doubled Among Nonsmokers

“The incidence of non–small cell lung cancer has more than doubled among individuals who have never smoked, according to research presented at the World Conference on Lung Cancer.

“The incidence of never-smokers diagnosed with NSCLC increased from 13% in 2007 to almost 28% in 2013, according to researchers. Further, many of these never-smokers presented with advanced-stage disease.

“Eric Lim, MD, MSc, a thoracic surgeon at Royal Brompton Harefield NHS Foundation Trust in London, and colleagues sought to define the incidence of NSCLC in never-smokers. In addition, researchers used data from the prospectively collected database of patients at Royal Brompton to evaluate clinical features of never-smokers who presented early with NSCLC and underwent surgery.

“The analysis included data from 2,170 patients who underwent lung cancer surgery between March 2008 and Nov. 2014.”

Smoking Cessation Near Time of Lung Cancer Diagnosis May Improve Survival

“Tobacco cessation provided a significant survival benefit for patients with lung cancer who quit smoking shortly before or after diagnosis, despite the severity of the disease. Results of this Roswell Park Cancer Institute–led study were published by Dobson Amato et al in the Journal of Thoracic Oncology.

“Roswell Park has a unique Tobacco Assessment and Cessation Service (TACS) that conducts a standardized tobacco use assessment for patients with lung cancer treated in the Thoracic Center and automatically refers patients who smoke to a dedicated tobacco cessation counseling service.

“Using data from TACS, 250 patients participated in the study. Those who had recently stopped smoking (50 patients) or quit after their first contact with TACS (71 patients) had reduced mortality rates compared with patients who continued to use tobacco. The median survival for patients who reported they had stopped smoking was 28 months, compared with 18 months for those who continued to use tobacco. The survival advantage for those who stopped smoking was adjusted for demographics, disease stage, and other health characteristics.”

Smoking a Significant Predictor of Lung Cancer Recurrence in Survivors

“In 2015, an estimated 158,040 Americans are expected to die from lung cancer, making it the leading cause of cancer death in in this country. Lung cancer screening with low-dose CT scans in high risk smokers has recently been approved to help detect lung cancer in its early stages when no symptoms are noticeable. The hope is that by detecting lung cancer in the early, more treatable stages, doctors may be able to improve the outcomes of patients with lung cancer. However, in addition to screening high risk smokers, close follow-up and monitoring of lung cancer survivors is also extremely important.

“A new study has shown that many lung cancer survivors are at high risk for developing another lung cancer or having their cancer return after completing treatment. Conducted by researchers in the U.S., the study specifically looked at lung cancer survivors from three different institutions who had shown no further evidence of having the disease after completing the required treatment for lung cancer.”

Smokers at Twice Risk of Prostate Cancer Recurring after Surgery

“Current smokers, and those who have quit smoking less than 10 years previously, have twice the risk of a recurrence of prostate cancer after surgery, according to new research presented at the European Association of Urology conference in Madrid.

“Prostate cancer is the third most common male cancer in Europe, accounting for over 92,000 deaths in 2012 (9% of male deaths). Around 30% of all prostate cancer patients treated with radical prostatectomy experience biochemical recurrence (defined by an increase in PSA, prostate specific antigen) within 10 years after surgery

“An international group of scientists and clinicians from the USA and Europe retrospectively looked at biochemical prostate cancer recurrence – in 7191 men who had had their prostate removed by radical prostatectomy. Of these men, roughly a third were never smokers (2513, or 34.9%), a third were former smokers (2269, or 31.6%) and a third were current smokers (3409, or 33.5%). These patients were followed up for an average of 28 months.

“The results showed that after a median of 28 months, current smokers had around double (HR 2.26) the chance of the cancer recurring than did patients who had never smoked (see abstract below for full results). Even those who had quit smoking within the last 10 years still had a significantly higher risk of cancer recurrence, at about the same level (HR 2.03) as that for current smokers. It wasn’t until 10 years after a patient had quit smoking that the risk of cancer recurrence dropped significantly.”