School of Pharmacy, West Virginia University, Morgantown, West Virginia 26506, USA.
Pharmacotherapy. 2012 Oct;32(10):920-31. doi: 10.1002/j.1875-9114.2012.01117.
A substantial number of the world's population continues to smoke tobacco, even in the setting of a cancer diagnosis. Studies have shown that patients with cancer who have a history of smoking have a worse prognosis than nonsmokers. Modulation of several physiologic processes involved in drug disposition has been associated with long-term exposure to tobacco smoke. The most common of these processes can be categorized into the effects of smoking on cytochrome P450-mediated metabolism, glucuronidation, and protein binding. Perturbation in the pharmacokinetics of anticancer drugs could result in clinically significant consequences, as these drugs are among the most toxic, but potentially beneficial, pharmaceuticals prescribed. Unfortunately, the effect of tobacco smoking on drug disposition has been explored for only a few marketed anticancer drugs; thus, little prescribing information is available to guide clinicians on the vast majority of these agents. The carcinogenic properties of several compounds found in tobacco smoke have been well studied; however, relatively little attention has been given to the effects of nicotine itself on cancer growth. Data that identify nicotine's effect on cancer cell apoptosis, tumor angiogenesis, invasion, and metastasis are emerging. The implications of these data are still unclear but may lead to important questions regarding approaches to smoking cessation in patients with cancer.
尽管已经确诊癌症，世界上仍有大量人群继续吸烟，甚至包括一些癌症患者。研究表明，与不吸烟者相比，有吸烟史的癌症患者预后更差。长期接触烟草烟雾会影响多种参与药物处置的生理过程，其中最常见的过程可分为吸烟对细胞色素 P450 介导的代谢、葡萄糖醛酸化和蛋白结合的影响。由于这些药物是最具毒性但又可能有益的处方药物，因此抗癌药物药代动力学的改变可能会导致临床显著后果。不幸的是，仅对少数已上市的抗癌药物进行了关于烟草吸烟对药物处置影响的研究；因此，几乎没有相关的用药信息可指导临床医生对大多数此类药物进行用药。尽管烟草烟雾中几种化合物的致癌特性已经得到了充分研究，但尼古丁本身对癌症生长的影响相对较少受到关注。目前正在出现一些确定尼古丁对癌细胞凋亡、肿瘤血管生成、侵袭和转移影响的数据。这些数据的含义尚不清楚，但可能会引发有关癌症患者戒烟方法的重要问题。
