The second part of my conversation with Drs. Tom Hensing from North Shore Health System in Chicago and David Jackman from Dana Farber Cancer Institute in Boston covered a case of a relatively young, generally healthy woman diagnosed with a lung adenocarcinoma that turned out to be stage IV.

It's been two and a half years since I described a phase IIB trial of Fotolyn (pralatrexate), a relatively new chemotherapy agent, being compared to Tarceva (erlotinib) in current or ex-smokers with previously treated advanced NSCLC.

It seems obvious: environmental tobacco smoke (ETS)/passive smoke exposure from being around smokers, can be harmful and may cause cancer in never-smokers. A new paper in the Journal of Clinical Oncology by Lee and colleagues from Korea actually offers some evidence that highlights this, showing that never-smokers in Korea were less likely to have an EGFR mutation if they were exposed to ETS.

For the last several years, we've known that never-smokers are more likely to have a significant and long-lasting response to EGFR inhibitors. Since then, we've learned that EGFR mutation status is quite correlated with smoking status and is the more important, likely driving factor, but all of this work has led to a new focus on never-smokers and smoking history in general.

As more and more oncologists become aware of the importance of testing for at least the EGFR mutation in tumor, and soon, perhaps, in blood, it seems likely that more patients will have their first systemic treatment for advanced non-small cell lung cancer (NSCLC) be an epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI), usually Tarceva (erlotinib), until Iressa (gefitinib) is re-approved (perhaps).

Here's a video presentation on never-smokers with lung cancer, a population that has been a subject of great interest to me for the past several years. Ten years ago, we really didn't focus on smoking status as a relevant issue and didn't break out never-smokers as a group within our lung cancer trials.