Lung Cancer in Smokers vs. Non-Smokers

“Did you smoke?” is a common, and not always easy question, which people are asked when they get lung cancer. It may not be a nice question, but it is increasingly important for deciding your treatment.

Smoking is, of course, the primary cause of lung cancer, but non-smokers can, and do, develop this disease. Researchers are beginning to understand the differences between lung cancer in smokers versus non-smokers, says Dr. Ronald Natale, a medical oncologist at Cedars-Sinai Medical Center, and they’re getting closer to developing targeted treatments that will be able to address the genetic drivers of lung cancer in non-smokers.

Targeted cancer therapy attacks very specific molecules within a tumor that are involved in its growth and spread. As it stands, doctors can target a genetic mutation that drives lung cancer in as many as 70 percent of non- or very light smokers with an approved drug, leaving around 30 percent for whom there is a target but no viable treatment yet.

One new drug that’s being used in these cases, pembrolizumab (Keytruda), is approved for treating lung cancers that express PD-L1 or Programmed death-ligand 1. This therapy blocks a protein called PD-L1, which hides and protects the tumor from the immune system. Sometimes drugs like this one work best alone, but other times they are more powerful in combination. Researchers are now taking a deep dive into data on Keytruda when combined with other immunotherapy drugs to see if a subgroup of people with lung cancer such as non-smokers derive an even greater benefit.

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