Perlík František
Department of Pharmacology, First Faculty of Medicine, Charles University and General University Hospital, Prague, Czech Republic.
Institute for Postgraduate Medical Education, Prague, Czech Republic.
Cent Eur J Public Health. 2020 Mar;28(1):53-58. doi: 10.21101/cejph.a5620.
This article reviews the published studies dealing with the influence of cigarette smoking on metabolic changes and effectiveness of drugs used in the systemic chemotherapy of the lung cancer.
The literature search of interactions between cigarette smoking and drugs used for lung cancer was carried out. The abstracted data mostly involved some induction of key drug-metabolizing enzymes of cytochrome CYP1A1/2, CYP2D6, CYP3A4 and isoforms of UDP-glucuronosyltransferase.
Metabolic changes are important both in the non-chemotherapy and for the drugs used in the chemotherapy. They can change pharmacokinetic and pharmacodynamic effects of drugs. Primarily, we addressed potential differences in drug effects on smokers and non-smokers. The increased clearance of erlotinib and irinotecan may have impact on effectiveness of the lung cancer therapy. The effects of taxanes and gemcitabine are more complex.
The evaluated studies show that continued smoking after lung cancer diagnosis is related to poor prognosis, reduced survival, risk of second primary malignancies, and increased cancer recurrence. Of particular importance is the deterioration in the quality of life and an increased incidence of the adverse drug reactions in smokers. The patient's cigarette smoking history should be considered carefully and smoking cessation must be taken into account.
本文综述已发表的关于吸烟对代谢变化及肺癌全身化疗所用药物疗效影响的研究。
对吸烟与肺癌用药之间的相互作用进行文献检索。提取的数据大多涉及细胞色素CYP1A1/2、CYP2D6、CYP3A4以及尿苷二磷酸葡萄糖醛酸转移酶同工型等关键药物代谢酶的某些诱导作用。
代谢变化在非化疗及化疗用药方面均很重要。它们可改变药物的药代动力学和药效学效应。我们主要探讨了药物对吸烟者和非吸烟者作用的潜在差异。厄洛替尼和伊立替康清除率的增加可能会影响肺癌治疗的疗效。紫杉烷类和吉西他滨的作用更为复杂。
评估研究表明，肺癌诊断后继续吸烟与预后不良、生存率降低、发生第二原发性恶性肿瘤的风险以及癌症复发增加有关。尤其重要的是吸烟者生活质量下降以及药物不良反应发生率增加。应仔细考虑患者的吸烟史，且必须考虑戒烟。
