Effects of Cigarette Smoking on Metabolism and Effectiveness of Systemic Therapy for Lung Cancer
| Autor: | Vicki L. Ellingrod, Amanda N. King, Nithya Ramnath, Meaghan O’Malley, Marisa Conte |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Oncology
Pulmonary and Respiratory Medicine medicine.medical_specialty Nicotine Lung Neoplasms Neutropenia Paclitaxel medicine.medical_treatment Chemotherapy metabolism Antineoplastic Agents Docetaxel Pharmacology Irinotecan Deoxycytidine Erlotinib Hydrochloride Therapeutic index Cytochrome P-450 CYP1A2 Internal medicine Cytochrome P-450 CYP1A1 medicine Cytochrome P-450 CYP3A Humans Pharmacokinetics Polycyclic Aromatic Hydrocarbons Lung cancer business.industry Smoking Response medicine.disease Gemcitabine Cytochrome P-450 CYP2D6 Pharmacodynamics Enzyme Induction Quinazolines Toxicities Smoking cessation Camptothecin Taxoids Erlotinib business medicine.drug |
| Zdroj: | Journal of Thoracic Oncology. 9(7):917-926 |
| ISSN: | 1556-0864 |
| DOI: | 10.1097/jto.0000000000000191 |
| Popis: | 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. 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. 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. 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. |
| Databáze: | OpenAIRE |
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