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Letter to the Editor| Volume 160, P279-281, January 2022

Smoking and immunotherapy efficacy in lung cancer by PDL1 subgroups: An individual participant data meta-analysis of atezolizumab clinical trials

Smoking and immunotherapy efficacy in lung cancer
Published:November 30, 2021DOI:https://doi.org/10.1016/j.ejca.2021.10.020
Smoking and immunotherapy efficacy in lung cancer by PDL1 subgroups: An individual participant data meta-analysis of atezolizumab clinical trials
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      Immune checkpoint inhibitors (ICIs) are now a cornerstone of advanced non-small cell lung cancer (NSCLC) treatment. However, heterogeneity in ICI benefit is significant, and it is increasingly apparent that resistance is likely multifactorial. As cigarette smoking is associated with increased tumour mutation burden (TMB) [
      • Gainor J.F.
      • Rizvi H.
      • Jimenez Aguilar E.
      • Skoulidis F.
      • Yeap B.Y.
      • Naidoo J.
      • et al.
      Clinical activity of programmed cell death 1 (PD-1) blockade in never, light, and heavy smokers with non-small-cell lung cancer and PD-L1 expression ≥50.
      Ann Oncol. 2020; 31: 404-411
      ,
      • Wang X.
      • Ricciuti B.
      • Alessi J.V.
      • Nguyen T.
      • Awad M.M.
      • Lin X.
      • et al.
      Smoking history as a potential predictor of immune checkpoint inhibitor efficacy in metastatic non-small cell lung cancer.
      J Natl Cancer Inst. 2021; (Online only at this stage. Online issue)https://doi.org/10.1093/jnci/djab116
      ], it is possible that ‘never smokers’ could obtain less ICI benefit. Recent study-level meta-analyses report that never smokers may obtain less effect from ICIs than previous/current smokers [
      • Mo J.
      • Hu X.
      • Gu L.
      • Chen B.
      • Khadaroo P.A.
      • Shen Z.
      • et al.
      Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis.
      World J Surg Oncol. 2020; 18: 15
      ,
      • Dai L.
      • Jin B.
      • Liu T.
      • Chen J.
      • Li G.
      • Dang J.
      The effect of smoking status on efficacy of immune checkpoint inhibitors in metastatic non-small cell lung cancer: a systematic review and meta-analysis.
      EClinicalMedicine. 2021; 38
      ], while small cohort studies report prognosis may be poorer in never smokers compared to previous/current smokers [
      • Gainor J.F.
      • Rizvi H.
      • Jimenez Aguilar E.
      • Skoulidis F.
      • Yeap B.Y.
      • Naidoo J.
      • et al.
      Clinical activity of programmed cell death 1 (PD-1) blockade in never, light, and heavy smokers with non-small-cell lung cancer and PD-L1 expression ≥50.
      Ann Oncol. 2020; 31: 404-411
      ,
      • Wang X.
      • Ricciuti B.
      • Alessi J.V.
      • Nguyen T.
      • Awad M.M.
      • Lin X.
      • et al.
      Smoking history as a potential predictor of immune checkpoint inhibitor efficacy in metastatic non-small cell lung cancer.
      J Natl Cancer Inst. 2021; (Online only at this stage. Online issue)https://doi.org/10.1093/jnci/djab116
      ]. However, these studies (1) used small cohorts, (2) failed to recognise previous and current smokers have different TMBs, and (3) have not reported according to PDL1 expression.

      Keywords

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      References

        • Gainor J.F.
        • Rizvi H.
        • Jimenez Aguilar E.
        • Skoulidis F.
        • Yeap B.Y.
        • Naidoo J.
        • et al.
        Clinical activity of programmed cell death 1 (PD-1) blockade in never, light, and heavy smokers with non-small-cell lung cancer and PD-L1 expression ≥50.
        Ann Oncol. 2020; 31: 404-411
        View in Article
        • Wang X.
        • Ricciuti B.
        • Alessi J.V.
        • Nguyen T.
        • Awad M.M.
        • Lin X.
        • et al.
        Smoking history as a potential predictor of immune checkpoint inhibitor efficacy in metastatic non-small cell lung cancer.
        J Natl Cancer Inst. 2021; (Online only at this stage. Online issue)https://doi.org/10.1093/jnci/djab116
        View in Article
        • Mo J.
        • Hu X.
        • Gu L.
        • Chen B.
        • Khadaroo P.A.
        • Shen Z.
        • et al.
        Smokers or non-smokers: who benefits more from immune checkpoint inhibitors in treatment of malignancies? An up-to-date meta-analysis.
        World J Surg Oncol. 2020; 18: 15
        View in Article
        • Dai L.
        • Jin B.
        • Liu T.
        • Chen J.
        • Li G.
        • Dang J.
        The effect of smoking status on efficacy of immune checkpoint inhibitors in metastatic non-small cell lung cancer: a systematic review and meta-analysis.
        EClinicalMedicine. 2021; 38
        View in Article

      Article info

      Publication history

      Published online: November 30, 2021
      Accepted: October 18, 2021
      Received: October 11, 2021

      Identification

      DOI: https://doi.org/10.1016/j.ejca.2021.10.020

      Copyright

      © 2021 Elsevier Ltd. All rights reserved.

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