Consultancy Corner: ‘Risk of tumours higher for smokers’

If you ever remind a smoker of its impending risks of lung cancer, you would often be scoffed at with a comment like, “There are so many non-smokers, who get lung cancer…I might as well smoke.” Well! they aren’t completely wrong. A non-smoker may also get lung cancer due to second hand smoke, pollution and carcinogens (eg. asbestos) at the work place. 

So, is the smoker really correct when he ridicules your advice? Not really. Firstly, people who smoke cigarettes are 15 to 30 times more likely to get lung cancer or die from lung cancer than people who do not smoke. Secondly, lung cancer of a smoker and that of a non-smoker are not exactly similar.

From 2009 onwards, newer drugs with targeted therapies proved themselves to be better than chemotherapy in terms of increased overall survival and reduced side effects in lung cancer patients. These were pills one could pop orally and do not have to go for chemotherapy. 

Various targeted therapies for lung cancer are currently approved by US FDA: Erlotinib (Tarceva), Afatinib (Gilotrif), Gefitinib (Iressa), Osimertinib (Tagrisso), Necitumumab (Newer and more effective targeted therapies are made every year. However, each targeted therapy acts against a specific mutation(s).

Interestingly smoker’s and non-smoker’s tumour DNA look very different.

Even for an untrained eye, it would be quite evident that a smoker and that with a non-smoker’s scans look very different. Smokers are usually associated with a subtype of lung cancer called squamous cell carcinoma while non-smokers are typically associated with adenocarcinoma. A smoker will more often than not have a tumour that can’t be treated by a targeted therapy, hence may end up getting treated by platinum based chemotherapy such as Cisplatin.

Thus, here we see that smoking not only increases the risk of getting lung cancer by 15 to 30 times, but it may frequently lead to a tumour that can’t be treated by even the new generation of targeted therapies.

At Neuberg Center of Genomic Medicine, Ahmedabad, we perform state of the art test called OncoCEPT solid (CEPT: Comprehensive Evaluation for Personalized Treatment). This single test analyses all possible targetable mutation in any lung tumour and helps oncologists choose the best course of treatment. OncoCEPT solid is based on state of the art Next Generation Sequencing (NGS) platform.