title: 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: BACKGROUND
  Erlotinib, a tyrosine kinase inhibitor, has improved survival and quality of life in patients with non-small cell lung cancer (NSCLC) after first- or second-line chemotherapy. Asian origin, adenocarcinoma histology, female gender, lack of tobacco use, and expression of epidermal growth factor receptor are significant independent predictors of response to Erlotinib. Although tobacco use is considered a major cause of NSCLC, other risk factors such as wood-smoke exposure (WSE) are associated. Almost 3 billion people worldwide rely on solid fuels as their primary source of domestic energy for cooking and heating.
  
  
  METHODS
  In this study, 150 consecutive unselected patients with histologically proven NSCLC with progression after prior first- or second-line chemotherapy and/or poor performance status were treated with Erlotinib 150 mg/d. Clinical and pathologic characteristics were associated with response.
  
  
  RESULTS
  Overall response to Erlotinib was observed in 51 patients [34%; 95% confidence interval {95% CI}, 29.9-37.6]. In multivariate analysis, clinical features associated with response to Erlotinib were adenocarcinoma (35 versus 20%; p = 0.05) and WSE (83 versus 13%; p < 0.001). Factors associated with longer progression-free survival in Cox analysis included adenocarcinoma (7.9 versus 2.3 months; p = 0.009), female gender (8.4 versus 5.3 months; p = 0.04), and WSE (17.6 versus 5.3 months; p = 0.006).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medical Oncology, Instituto Nacional de Cancerología (INCAN), Tlalpan, 14080, México, DF. ogar@servidor.unam.mx
authors.forename: Oscar
authors.initials: O
authors.lastname: Arrieta
authors.forename: Luis
authors.initials: L
authors.lastname: Martinez-Barrera
authors.forename: Sergio
authors.initials: S
authors.lastname: Treviño
authors.forename: Enrique
authors.initials: E
authors.lastname: Guzman
authors.forename: Patricia
authors.initials: P
authors.lastname: Castillo-Gonzalez
authors.forename: Miguel Angel
authors.initials: MA
authors.lastname: Rios-Trejo
authors.forename: Diana
authors.initials: D
authors.lastname: Flores-Estrada
authors.forename: Eduardo
authors.initials: E
authors.lastname: Téllez
authors.forename: Cesar
authors.initials: C
authors.lastname: Gonzalez
authors.forename: Johny
authors.initials: J
authors.lastname: de la Cruz Vargas
authors.forename: Claudia Haydee
authors.initials: CH
authors.lastname: Gonzalez-De la Rosa
authors.forename: Norma
authors.initials: N
authors.lastname: Hernandez-Pedro
authors.forename: Rafael
authors.initials: R
authors.lastname: Morales-Barrera
authors.forename: Jaime
authors.initials: J
authors.lastname: De la Garza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002289:Carcinoma, Non-Small-Cell Lung / Q000188:drug therapy* / Q000209:etiology / Q000401:mortality; D004781:Environmental Exposure / Q000009:adverse effects*; D066246:ErbB Receptors / Q000037:antagonists & inhibitors; D000069347:Erlotinib Hydrochloride; D005260:Female; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000209:etiology / Q000401:mortality; D008875:Middle Aged; D009367:Neoplasm Staging; D052638:Particulate Matter / Q000009:adverse effects*; D011379:Prognosis; D011446:Prospective Studies; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use*; D011799:Quinazolines / Q000627:therapeutic use*; D012906:Smoke; D015996:Survival Rate; D014934:Wood
chemical_list: D052638:Particulate Matter; D047428:Protein Kinase Inhibitors; D011799:Quinazolines; D012906:Smoke; D000069347:Erlotinib Hydrochloride; D066246:ErbB Receptors