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Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e3181ae2497
Letters to the Editor

Wood-Smoke Exposure as a Response and Survival Predictor in Erlotinib-Treated Nonsmall Cell Lung Cancer Patients

Arrieta, Oscar MD; Rios Trejo, Miguel Angel MD; Michel, Rosa M. MD

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Department of Medical Oncology, Experimental Oncology Laboratory, Instituto Nacional de Cancerología (INCan), Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico (Arrieta)

Rosa M. Michel, MD, Department of Medical Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico (Trejo, Michel)

Disclosure: The authors declare no potential conflicts of interest.

Address for correspondence: Oscar Arrieta, MD, Department of Medical Oncology, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Sección XVI, Delegación Tlalpan, 14080 Mexico City, Mexico. E-mail:

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To the Editor:

In relation to the letter to the editor written by Cardona et al.1 published in the Journal of Thoracic Oncology on January 2009 referring to our article entitled “Wood-Smoke Exposure as a Response and Survival Predictor in Erlotinib-treated Nonsmall Cell Lung Cancer Patients: An Open Label Phase II Study,”2 in which Cardona et al. concluded that the findings that we previously published are not supported by them, some statements should be made: their study is based exclusively on an experience-established treatment of 156 adenocarcinoma patients, not a prospective clinical trial. Of these 156 patients, only 23% (36 patients) received erlotinib. It does not mention attachment to treatment of the patients, which might be an issue, considering that those exposed to wood-smoke generally belong to lower socioeconomic status than those who have no history of exposure and depend on study inclusion to receive treatment.

Moreover, of the erlotinib-treated patients, just nine of them had wood-smoke exposure (WSE) history and seven of them also had smoking history for an average of 14 years. Our hypothesis about nonsmall cell lung cancer patients with WSE and their response to tyrosine kinase inhibitors treatment suggests that the pathways involved in carcinogenesis in WSE patients and smokers are different, reason for which nonsmall cell lung cancer development could be attributed solely to WSE in two patients of their series. Therefore, the sample is not representative.

Furthermore, there is a mistake in their statistical analysis. Cardona et al. states a 5% response rate to erlotinib in WSE patients with a sample size of merely nine patients, which corresponds to 0.45 patients, assuming that only one patient had shown response it would be equal to 11.11% of patients.

Also, their reported response rate in non-WSE patients, including smokers and nonsmokers, is of 47%, which is strikingly high and is different from data that have been previously reported by Shepherd et al.3 in a phase III study that included 731 patients with a response rate of 8.9% and, exclusively, 29% of patients in the adenocarcinoma subtype. Their rate of response is not comparable either with the TRUST4 study that investigated the extended use of erlotinib in 5448 patients with a reported response rate of 12%. However, this information is consistent with our finding of a response rate of 12.3% in non-WSE patients. We would welcome the authors’ clarification of their numbers in case we have misinterpreted them.

Oscar Arrieta, MD

Department of Medical Oncology

Experimental Oncology Laboratory

Instituto Nacional de Cancerología (INCan)

Universidad Nacional Autónoma de México (UNAM)

Mexico City, Mexico

Miguel Angel Rios Trejo, MD

Rosa M. Michel, MD

Department of Medical Oncology

Instituto Nacional de Cancerología (INCan)

Mexico City, Mexico

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1. Cardona AF, Reguart N, Reveiz L. Wood-smoke exposure (WSE) as a predictor of response and survival in erlotinib-treated non-small cell lung cancer (NSCLC) patients. J Thorac Oncol 2009;4:142–143.

2. Arrieta O, Martinez-Barrera L, Treviño S, et al. Wood-smoke exposure as a response and survival predictor in erlotinib-treated non-small cell lung cancer patients: an open label phase II study. J Thorac Oncol 2008;3:887–893.

3. Shepherd FA, Rodrigues Pereira J, Ciuleanu T, et al. Erlotinib in previously treated non-small-cell lung cancer. N Engl J Med 2005;353:123–132.

4. Groen H, Arrieta OG, Riska H, et al. The global TRUST study of erlotinib in advanced non-small-cell lung cancer (NSCLC). J Clin Oncol 2008;26(May 20 Suppl); abstr 19000.

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This article has been cited 1 time(s).

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Planning cancer control in Latin America and the Caribbean
Goss, PE; Lee, BL; Badovinac-Crnjevic, T; Strasser-Weippl, K; Chavarri-Guerra, Y; St Louis, J; Villarreal-Garza, C; Unger-Saldana, K; Ferreyra, M; Debiasi, M; Liedke, PER; Touya, D; Werutsky, G; Higgins, M; Fan, L; Vasconcelos, C; Cazap, E; Vallejos, C; Mohar, A; Knaul, F; Arreola, H; Batura, R; Luciani, S; Sullivan, R; Finkelstein, D; Simon, S; Barrios, C; Kightlinger, R; Gelrud, A; Bychkovsky, V; Lopes, G; Stefani, S; Blaya, M; Souza, FH; Santos, FS; Kaemmerer, A; de Azambuja, E; Zorilla, AFC; Murillo, R; Jeronimo, J; Tsu, V; Carvalho, A; Gil, CF; Sternberg, C; Duenas-Gonzalez, A; Sgroi, D; Cuello, M; Fresco, R; Reis, RM; Masera, G; Gabus, R; Ribeiro, R; Knust, R; Ismael, G; Rosenblatt, E; Roth, B; Villa, L; Solares, AL; Leon, MX; Torres-Vigil, I; Covarrubias-Gomez, A; Hernandez, A; Bertolino, M; Schwartsmann, G; Santillana, S; Esteva, F; Fein, L; Mano, M; Gomez, H; Hurlbert, M; Durstine, A; Azenha, G
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© 2009International Association for the Study of Lung Cancer


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