EGFR mutation, smoking, and gender in advanced lung adenocarcinoma

Abstract

PurposeIn the current targeted therapy era, information on the effect of smoking in epidermal growth factor receptor (EGFR)-mutant lung cancer patients is scarce.ResultsIn total, 11,678 adenocarcinoma patients were enrolled. Of these, 33.3% and 91.8% of male and female patients were non-smokers, respectively. An increased amount of smoking (P < 0.001 for trend), fewer smoke-free years (P < 0.001 for trend), and younger age of smoking initiation (P = 0.034 for trend) were all associated with significantly lower EGFR mutation rates. Smokers had a shorter median overall survival (OS) among both EGFR-mutant and EGFR-wild type patients (17.8 vs. 21.1 months, and 7.9 vs. 11.4 months respectively; both P < 0.001). Among patients with EGFR-mutant adenocarcinoma, younger smokers were associated with shorter OS (P = 0.047). In multivariate analysis, female gender was an independent prognostic factor for OS (hazard ratio: 0.86 [95% confidence interval {CI}: 0.80–0.93]; P < 0.001 in the EGFR-mutant group and 0.88 [95% CI: 0.81–0.96]; P = 0.004 in the EGFR-wild type group).Materials and MethodsWe reviewed the National Lung Cancer database (Taiwan) to assess the impact of smoking on the EGFR mutation rate and survival in advanced lung adenocarcinoma patients during 2011 and 2014 retrospectively.ConclusionsSmoking was associated with lower incidence of EGFR mutation rate and reduced OS of advanced lung adenocarcinoma patients in a dose-dependent manner. In addition to EGFR mutation and smoking, gender also plays an important role in survival among these patients.

Characteristics of non-small cell lung cancer: Differences by sex and hormonal status in a Mexican population

“…Previously it had been reported that wood-smoke exposure was an important risk factor to develop lung cancer in non-smoking Mexican women, 27,28 we observed that this factor remains relevant in the etiology of lung cancer in women to this day. In addition EGFR-mutations have also been associated with patients who are never smokers and women, 29 which was also confirmed by our results. Nowadays patients with lung adenocarcinomas that exhibit EGFR sensitizing mutation are treated with targeted therapy based on Tyrosine Kinase Inhibitors (TKIs) which produce a high response rate as a first-line treatment.…”

Prevalence of EGFR Mutations and Clinico-Pathological Characteristics of Chilean Lung Cancer Patients

“…Then, we calculated OS according to gender ( Figure 1B). As expected (Tseng et al, 2017), median OS in females was 18 months compared to 12 months among males (Log Rank p=0.0392). Figure 1C shows that median OS for patients with exon-19 deletions was 17 months compared with 12 months for other mutations (Log Rank p=0.1274).…”

“…A summary of clinico-pathological characteristics of these patients is presented in Table 1. In general, activating EGFR mutations are significantly more frequent in females and non-smokers (Jänne et al, 2005;Tseng et al, 2017). As expected, EGFR mutants were predominantly female (64%) and classified as non-smokers or light smokers (93.1%).…”

Disparities in Systemic Treatment Use in Advanced-stage Non–Small Cell Lung Cancer by Source of Health Insurance

“…Smoking prevalence is higher among those in the military and those with low SES (37). There is evidence that smoking is associated with a lower incidence of EGFR mutations (38), so our findings of decreased likelihood of TKI use among those with military-related or Medicaid/other public insurance compared with the privately insured could reflect more smokers with fewer TKI actionable mutations in these categories.…”