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Nonsmokers and Lung Cancer -- In-Depth Doctor's Interview

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http://www.ivanhoe.com/channels/p_chann ... ryid=11668

Reported July 11, 2005

Nonsmokers and Lung Cancer -- In-Depth Doctor's Interview

George Simon, M.D., explains what his researched on the small percentage of lung cancer patients who have never smoked in their lives.

Ivanhoe Broadcast News Transcript with

George Simon, M.D., Oncologist,

Moffitt Cancer Center, Tampa, Florida,

TOPIC: Nonsmokers and Lung Cancer

When people think lung cancer, their first thought is smoking, but there is a group of patients who you consider never-smokers. Can you explain this?

Dr. Simon: The majority of the lung cancers still occur in smokers, but a small minority of lung cancers occur in never-smokers. Technically, never-smokers are defined as smoking less than 100 cigarettes in their entire lifetime.

Are never-smokers getting lung cancer then as a consequence of secondhand smoke or pollution?

Dr. Simon: Well, there is a significant documented history of secondhand smoking, but those patients are typically not considered never-smokers.

How did it begin that you wanted to study the differences between smokers and never-smokers?

Dr. Simon: Some researchers started studying this topic that lung cancers in some people arose without being caused by the tobacco. So, we hypothesized that these cancers have a different origin or different genesis, and if they have a different genesis, then they have a different behavior. Consequently, they should have different clinical properties and maybe even clinical trials specifically tailored to this population of patients.

With your studies, what did you find about never-smokers?

Dr. Simon: We found that never-smokers were more likely to be female than male, and they were more likely to have a particular kind of non-small cell lung cancer called adenocarcinoma. We also found they tend to be older at diagnosis, and they also tend to live longer. All these differences were actually statistically significant.

There was a recent study that pointed to the hormones in females playing a role in lung cancer. Could hormones play a role with never-smokers as well?

Dr. Simon: Yes. In pre-clinical models, there have been suggestions that the estrogen receptors and progesterone receptors might be important in lung cancer carcinogenesis, though this has yet to be confirmed in the clinic and in humans.

Tell me about the registry of never-smokers with lung cancer.

Dr. Simon: Never-smoking patients with lung cancer still is a relatively rare entity. So if you develop a large national database of never-smokers with lung cancer, then researchers from around the country can access that database. So it gives them a wider access and also will help us start and finish studies quicker so that we can understand more about this disease faster. Once we know more, we can tailor chemotherapy treatments or other treatments specifically for this disease.

In the future, do you see never-smokers having their own specific standard of care vs. a smoker?

Dr. Simon: es. I think in the future that we may be seeing clinical trials specifically tailored to never-smoking patients with lung cancer. We may see treatment strategies specifically tailored to never-smoking patients with lung cancer, but it may take five, 10 years before that actually happens.

Do you know why the cancer is different in never-smokers?

Dr. Simon: We have some clues. Other investigators from Boston have shown that there are specific mutations in a particular receptor that is present in the lung cancers more commonly seen in never-smokers. The presence of these mutations makes these tumors exquisitely sensitive to a group of compounds called epidermal growth factor receptor inhibitors. Two compounds are already available on the market, they’re called Tarceva (erlotinib) and Iressa (gefitinib).

So in essence a never-smoker patient should be treated with these chemicals compounds vs. other treatments?

Dr. Simon: Well, we don’t know yet. Those studies are currently on the drawing board right now. But it is very likely that we may treat never-smoking patients with adenocarcinoma up front with these eight agents alone or in combination with chemotherapy.

For the never-smokers, how did the registry come about?

Dr. Simon: I can’t take any credit for that. It was after the publication of our article I got e-mails from never-smoking patients with adenocarcinoma asking whether such a database would be of use to researchers all over the country, and I thought it was a great idea. So, I encouraged them to develop this database.

For this subset of patients, how does the cancer hit them?

Dr. Simon: It can be extremely devastating. These are individuals who have lived good, clean lives and to be stricken with this disease which is usually diagnosed in advanced stages and is often incurable can be devastating psychologically, physically, and mentally.

So, never-smokers live longer?

Dr. Simon: Yes. In my opinion, never-smoking patients with lung cancer live longer. They tend to respond better to the specific compounds we mentioned. I believe the biology of this disease is different, and they tend to have a less aggressive course. So, they tend to live longer and that is the good news. Fortunately, we are getting better and better in treating lung cancer. We have more effective, less toxic chemotherapies, and we also have newer non-chemotherapy drugs to which we can treat lung cancer with. We even have monoclonal antibodies we can treat lung cancer with.

Is the lung cancer in never-smokers genetic?

Dr. Simon: A genetic link to lung cancer has never been proven. We have not yet identified a specific gene that predicts for inheritance of lung cancer.

What would you advise for these patients?

Dr. Simon: I would advise them to not lose hope. We are getting better and better in treating lung cancer. There are 300-plus newer drugs that are being evaluated in lung cancer in clinical trials all over the country. In the last one-year alone, we have seen three new drugs being approved for lung cancer. We just had a press release recently saying that combining Avastin with chemotherapy can improve survival in patients with stage IV non-small cell lung cancer. I think there is a lot of hope for lung cancer patients in general in the next few years. Even though this is a rare group of patients, it is still a significant group of people. It is still worth studying and evaluating because it can lead to many lives saved and prolonged.

How many lung cancer patients are nonsmokers?

Dr. Simon: The figures are still coming in, but up to 85 percent to 90 percent of lung cancers still occur in smokers. Five percent to 10 percent occur in never-smokers, though a proportion of those patients may actually have a significant secondhand exposure. Specifically, for those whose cancer is not caused by smoking at all, my estimate is it may be up to 5 percent.

Could there be different types of lung cancer?

Dr. Simon: Yes. Though we tend to broadly clump all lung cancer together, there could be distinct disease entities with their own specific behavior patterns.

This article was reported by Ivanhoe.com, who offers Medical Alerts by e-mail every day of the week. To subscribe, go to: http://www.ivanhoe.com/newsalert/.


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