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. 2021 Jun;16(6):960-967.
doi: 10.1016/j.jtho.2020.12.017. Epub 2021 Feb 1.

Smoking Behavior in Patients With Early-Stage NSCLC: A Report From ECOG-ACRIN 1505 Trial

Conor E Steuer  1 , Opeyemi A Jegede  2 , Suzanne E Dahlberg  3 , Heather A Wakelee  4 , Steven M Keller  5 , William J Tester  6 , David R Gandara  7 , Stephen L Graziano  8 , Alex A Adjei  9 , Charles A Butts  10 , Suresh S Ramalingam  11 , Joan H Schiller  12 ; ECOG-ACRIN 1505 Investigators
Affiliations

Smoking Behavior in Patients With Early-Stage NSCLC: A Report From ECOG-ACRIN 1505 Trial

Conor E Steuer et al. J Thorac Oncol. 2021 Jun.

Abstract

Introduction: Smoking cessation has been reported to benefit patients even after a diagnosis of lung cancer. We studied the smoking behavior of patients who participated in a phase 3 trial of adjuvant therapy following resection of stages IB-IIIA NSCLC.

Methods: The ECOG-ACRIN 1505 was conducted to determine whether the addition of bevacizumab to adjuvant chemotherapy would improve overall survival (OS) for patients with early-stage NSCLC. Studying the association between smoking status and OS was a secondary end point. Patients completed a questionnaire on their smoking habits at baseline, 3, 6, 9, and 12 months.

Results: A total of 1501 patients were enrolled, and 99.8%, 95%, 94%, 93%, and 93% responded to the questionnaire at baseline, 3, 6, 9, and 12 months, respectively. A total of 90% reported a current or previous history of cigarette smoking. In addition, 60% of nonsmokers at enrollment reported smoking after diagnosis (before randomization); however, 1% of them reported smoking at 12 months. Furthermore, 94% of the respondents smoked none/fewer cigarettes daily at 12 months. The incidence of grades 3-5 toxicity on treatment was 68%, 76%, and 72% in never, former, and current smokers, respectively (p = 0.05). The disease-free survival for never-smokers relative to current and former smokers was (hazard ratio [HR] 0.93, p = 0.64 and HR 1.05, p = 0.72), and OS was (adjusted HR for death 0.54, p = 0.005 and adjusted HR for death 0.68, p = 0.03), respectively.

Conclusions: This is the first comprehensive, prospective report of smoking habits in patients with NSCLC patients from a phase III early-stage trial. There was a high rate of smoking reduction and cessation following study entry. The disease-free survival did not differ significantly between smokers and never smokers, though there were less grade 3-5 toxicities and more favorable OS in never-smokers.

Keywords: Chemotherapy; Clinical trial; Lung cancer; Outcomes; Smoking; Tobacco cessation.

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Conflict of interest statement

Conflict of Interest Statement:

Dr Gandara reports Consultant and honorarium from Roche-Genentech.

Dr Steuer reports advisory board honorarium from Abbvie, Lilly, Bergen Bio, Armo

Dr Wakelee reports grants form Gilead, Personal Fees from AztraZeneca, Xcovery, Janssen, Daiichi Sankyo, Helsinn, Mirat

Dr. Ramalingam reports grants and other from Amgen, other from Abbvie, grants and other from Astra Zeneca, grants and other from BMS, other from Genentech, other from Roche, grants and other from Merck, grants and other from Takeda, grants from Tesaro, grants from Advaxis

The other Authors report no relevant COI

Figures

Figure 1.
Figure 1.
Overall Survival by Baseline Smoking Status
Figure 2.
Figure 2.
Disease-Free Survival by Baseline Smoking Status
See this image and copyright information in PMC

Comment in

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