title: Impact of active smoking on survival of patients with metastatic lung adenocarcinoma harboring an epidermal growth factor receptor (EGFR) mutation.
abstract: Lung cancer in smokers and non-smokers demonstrates distinct genetic profiles, and cigarette smoking affects epidermal growth factor receptor (EGFR) function and causes secondary EGFR tyrosine kinase resistance. We evaluated the effect of active smoking in patients with metastatic lung adenocarcinoma. A total of 132 metastatic lung adenocarcinoma patients, diagnosed between 2008 and 2013, with known EGFR mutation status, were evaluated retrospectively. Among these patients, 40 had an activating EGFR mutation. Patients who continued smoking during the treatment were defined as active smokers. Former smokers and never smokers were together defined as non-smokers. The outcomes of the treatment in relation to the EGFR mutation and smoking status were evaluated. The median follow-up time was 10.5 months. The overall response rate for the first-line therapy was significantly higher among the EGFR-mutant patients (p = 0.01), however, smoking status had no impact on the response rate (p = 0.1). The EGFR-mutant active smokers progressed earlier than the non-smokers (p < 0.01). The overall survival (OS) of the non-smokers and patients treated with erlotinib was significantly longer (p = 0.02 and p = 0.01, respectively). Smoking status did not affect the OS in EGFR wild type tumors (p = 0.49) but EGFR-mutant non-smokers had a longer OS than the active smokers (p = 0.01).The active smokers treated with erlotinib had poorer survival than the non-smokers (p = 0.03). Multivariate analysis of EGFR-mutant patients showed that erlotinib treatment at any line and non-smoking were independent prognostic factors for the OS (p = 0.04 and p = 0.01, respectively). Smoking during treatment is a negative prognostic factor in metastatic lung adenocarcinoma with an EGFR mutation.
authors.affiliation: Department of Medical Oncology, Faculty of Medicine, Trakya University, Edirne, Turkey. berdoga@hotmail.com.
authors.forename: Bulent
authors.initials: B
authors.lastname: Erdogan
authors.forename: Hilmi
authors.initials: H
authors.lastname: Kodaz
authors.forename: Senem
authors.initials: S
authors.lastname: Karabulut
authors.forename: Ahmet
authors.initials: A
authors.lastname: Cinkaya
authors.forename: Hilmi
authors.initials: H
authors.lastname: Tozkir
authors.forename: Ozgur
authors.initials: O
authors.lastname: Tanriverdi
authors.forename: Devrim
authors.initials: D
authors.lastname: Cabuk
authors.forename: Muhammed Bekir
authors.initials: MB
authors.lastname: Hacioglu
authors.forename: Esma
authors.initials: E
authors.lastname: Turkmen
authors.forename: Ilhan
authors.initials: I
authors.lastname: Hacibekiroglu
authors.forename: Sernaz
authors.initials: S
authors.lastname: Uzunoglu
authors.forename: Irfan
authors.initials: I
authors.lastname: Cicin
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality*; D000077192:Adenocarcinoma of Lung; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018572:Disease-Free Survival; D066246:ErbB Receptors / Q000235:genetics*; D000069347:Erlotinib Hydrochloride / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000235:genetics* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D011379:Prognosis; D012189:Retrospective Studies; D012907:Smoking / Q000009:adverse effects* / Q000401:mortality*; D016019:Survival Analysis
chemical_list: D000970:Antineoplastic Agents; D000069347:Erlotinib Hydrochloride; C512478:EGFR protein, human; D066246:ErbB Receptors