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Promise and Progress - Lung Cancer In Never Smokers A Different Disease with Different Treatments

Leading the Way Fall 2009 Winter 2010

Lung Cancer In Never Smokers A Different Disease with Different Treatments

By: Valerie Mehl
Date: December 1, 2009

Clinical Cancer Research, September 15, 2009

We usually think of lung cancer as a smoker’s disease, but about 15 percent of cases occur in people who never smoked, and researchers are finding there is more than just the smoking component that sets them apart.

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“It’s becoming increasingly clear that the genetic, cellular, and molecular nature of lung cancer in people who have never smoked is different from smoking related lung cancers,”
says Charles Rudin, M.D., P.h.D. “Now there is good evidence that the treatment and prevention strategies should be different as well.”

Rudin, a lung cancer expert and associate director of clinical research at the Kimmel Cancer Center is part of a scientific committee that recently published a guide on the biology, diagnosis, and treatment of lung cancer in people who have never smoked.
The group met in 2007 and reviewed data from several hundred studies published by experts in public health, population science, molecular biology, pathology, and oncology to identify the distinct characteristics of lung cancer in people who have smoked less than
100 cigarettes in their lifetimes.

Rudin and team found lung cancers in people who never smoked more often had mutations of the EFGR gene than those of smokers. As a result, never-smokers benefitted
most from drugs that block or inhibit EGFR signaling. Other gene alterations more prevalent among never smokers also were identified, and Rudin says a genomewide study of this population could reveal still more. The group’s guide calls for lung cancer clinical
trial participants to be classified by smoking status so scientists can better evaluate the success of therapies among smokers and never smokers.

“Second-hand smoke exposure remains the most easily preventable cause of lung cancer,” says Rudin. “Efforts to continue to reduce workplace, home, and public space
exposure are very important.”

Radon gas exposure also was found to be a leading cause of non-smoking related lung cancers in the U.S. (Radon results from the natural decay of uranium contained in nearly all soils. It makes its way into homes through cracks and holes in the foundation.)
Asbestos, indoor wood-burning stoves, and tiny airborne oil particles created when cooking food also were identified as risk factors. However, a specific risk factor has not been found to explain at least half of all lung cancers in never-smokers. The team recommends further research focused on this unique subset of lung cancers.

The research and guide were funded by the Flight Attendant Medical Research Institute.