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Nonsmall cell lung cancer in never smokers

Scagliotti, Giorgio V; Longo, Marina; Novello, Silvia

doi: 10.1097/CCO.0b013e328321049e
Lung and mediastinum: Edited by Cesare Gridelli

Purpose of review To summarize the available knowledge about nonsmall cell lung cancer (NSCLC) in never smokers in terms of biological and clinical–pathological findings.

Recent findings Overall in newly diagnosed NSCLC, 10% of men and 20% of women, with a much higher proportion among Asiatic women, are never smokers and among them an overwhelming proportion have adenocarcinoma. Several environmental, genetic, hormonal and viral factors have been associated with an increased risk of NSCLC in never smokers, but for none of them there is definitive evidence. The incidence of epidermal growth factor receptor mutations is higher in never smokers, whereas K-ras mutations are rarely detected in this group of never smoking patients. The role of never smoking status in NSCLC as a positive prognostic factor or predictive of a better chemosensitivity to systemic treatments is still undefined.

Summary Epidemiological, molecular and clinical–pathological features indicate NSCLC in never smokers as a distinct entity. Future preclinical studies should address more deeply the biological differences between NSCLC in smokers and never smokers and, to avoid biased results due to differences in survival outcomes, smoking status should be considered among stratification factors in future clinical studies.

Department of Clinical and Biological Sciences, University of Turin, Turin, Italy

Correspondence to Giorgio V. Scagliotti, MD, University of Turin, Department of Clinical and Biological Sciences, S. Luigi Hospital, Regione Gonzole, 10, Orbassano, Turin 10043, Italy Tel: +39 011 9026414; fax: +39 011 9038616; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.