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Effects of cigarette smoking on metabolism and effectiveness of systemic therapy for lung cancer.
- Source :
-
Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer [J Thorac Oncol] 2014 Jul; Vol. 9 (7), pp. 917-926. - Publication Year :
- 2014
-
Abstract
- Introduction: Cigarette smoke associated polycyclic aromatic hydrocarbons can induce key drug-metabolizing enzymes of cytochrome P450 and isoforms of the glucuronyl transferases families. These enzymes metabolize several systemic therapies for lung cancer. Induction of these enzymes may lead to accelerated clearance with resultant impact on systemic therapy efficacy and toxicity in smokers compared with nonsmokers. This article reviews published literature regarding the influence of smoking as it relates to alteration of metabolism of systemic therapy in lung cancer.<br />Methods: A structured search of the National Library of Medicine's PubMed/MEDLINE identified relevant articles. Data were abstracted and analyzed to summarize the findings.<br />Results: Studies that analyzed pharmacokinetic data were prospective. Smokers receiving erlotinib exhibited rapid clearance, requiring a higher dose to reach equivalent systemic exposure compared with nonsmokers. Smokers receiving irinotecan also demonstrated increased clearance and lower systemic exposure. There was no difference in clearance of paclitaxel or docetaxel in smokers. Chemotherapy-associated neutropenia was worse in nonsmokers compared with smokers in patients treated with paclitaxel, docetaxel, irinotecan, and gemcitabine.<br />Conclusions: Systemic therapy for lung cancer has a narrow therapeutic index such that small changes in plasma concentrations or exposure in smokers may result in suboptimal therapy and poor outcomes. Smoking cessation must be emphasized at each clinical visit. However, prospective trials should take into consideration the effects of smoking history on drug pharmacokinetics and efficacy. The metabolizing enzyme phenotype in smokers may require individualized dose algorithms for specific agents.
- Subjects :
- Antineoplastic Agents therapeutic use
Camptothecin analogs & derivatives
Camptothecin pharmacokinetics
Camptothecin therapeutic use
Cytochrome P-450 CYP1A1 metabolism
Cytochrome P-450 CYP1A2 metabolism
Cytochrome P-450 CYP2D6 metabolism
Cytochrome P-450 CYP3A metabolism
Deoxycytidine analogs & derivatives
Deoxycytidine pharmacokinetics
Deoxycytidine therapeutic use
Docetaxel
Erlotinib Hydrochloride
Humans
Irinotecan
Lung Neoplasms enzymology
Neutropenia etiology
Paclitaxel pharmacokinetics
Paclitaxel therapeutic use
Polycyclic Aromatic Hydrocarbons metabolism
Quinazolines pharmacokinetics
Quinazolines therapeutic use
Smoking metabolism
Taxoids pharmacokinetics
Taxoids therapeutic use
Gemcitabine
Antineoplastic Agents pharmacokinetics
Enzyme Induction drug effects
Lung Neoplasms drug therapy
Nicotine metabolism
Smoking adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1556-1380
- Volume :
- 9
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Journal of thoracic oncology : official publication of the International Association for the Study of Lung Cancer
- Publication Type :
- Academic Journal
- Accession number :
- 24926542
- Full Text :
- https://doi.org/10.1097/JTO.0000000000000191