Is it better to use PD-1 in lung cancer patients with a history of smoking?

Release date: 2017-02-23

The relationship between smoking and lung cancer is a well-known and self-evident topic. Indeed, as early as the 1950s, epidemiological evidence suggests that smoking can greatly increase the risk of lung cancer. In early Western cancer statistics, 85% to 90% of lung cancer was attributed to smoking. In the Asian population, 60-70% of patients with non-small cell lung cancer have a history of smoking.

However, do you know? Smoking and lung cancer have another layer of unknown and “unbelievable” relationships. The latest in a series of clinical trials and biological studies have shown that patients with non-small cell lung cancer who have a history of smoking may be more effective with PD-1 antibody than patients without a history of smoking!

A clinical trial of a combination of Nivolumab and ipilimumab has shown that it is more effective in patients with non-small cell lung cancer who have a history of smoking. The investigators treated 77 patients with non-small cell lung cancer at a dose of ipilimumab (1 mg/kg) once every 2 weeks for Nivolumab (3 mg/kg) plus every 6 weeks (or every 12 weeks). Among them, the objective response rate of patients with smoking history was 46% (30 of 65 patients were effective), while the objective response rate of patients without smoking history was only 27% (3 of 11 patients were effective).

So, what is the cause of this "inconceivable" phenomenon? A number of biological experiments have shown that cancer patients have higher rates of cancer cell mutations than non-smokers. A genomic analysis of 17 patients with non-small cell lung cancer showed that cancer patients had a 10-fold higher mutation rate than non-smokers. In terms of point mutation alone, the number of median mutations in 11 smokers was 15,659 (from 7,424 to 26,202), while the number of median mutations in 6 non-smokers was 888 (from 842 to 1,268). .

Patients with high mutations in cancer cells generally have better efficacy. A clinical trial using pembrolizumab in patients with non-small cell lung cancer showed that patients with high mutations in the cancer group had a higher objective response rate of 63% (lower mutation group 0%); no progression-free survival time, no median progression The survival time was 14.5 months (3.7 months in the low mutation group). The researchers also pointed out that in the process of genetic testing, the traces of smoking in patients (high mutations in cancer cells) can be found. The objective response rate of patients with obvious smoking marks reached 56%. The study did not reach the median progression-free survival time, and the patients with insignificant smoking were only 17% objectively relieved, with a median progression-free survival time of 3.5 months.

The amount of information is a bit large, let's summarize it: smoking will increase the risk of lung cancer; and once you have lung cancer, smoking patients will be better than non-smokers, which means that the face of lung cancer is a reality, smoking Instead, it becomes a "additional item." This conclusion may sound overwhelming, but in fact it is not difficult to choose. After all, no one will first put himself at risk in order to make himself more comfortable in dealing with the uncertain risks in the future.

Finally, it is also important to emphasize that PD-1 drugs are not currently available in the country, and various factors such as quality, safety, price and distance are considered. Patients are advised to visit the Taihe International Cancer Hospital in Singapore. Experienced doctors will develop the most appropriate treatment plan based on the actual situation of the patient and the progress of new drug application, and the patient can safely take medication under the supervision of the doctor. You can also use the contact information at the bottom of the screen to communicate with the referral office established in Singapore by Taihe International Cancer Hospital in China.

Source: Tumor Information CCH Singapore

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