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WCLC 2025 | Investigating lung cancer outcomes in smokers receiving immunotherapy
Abhishek Shankar, MD, All India Institute of Medical Sciences, Delhi, India, discusses the complex relationship between tobacco status, smoking status, and immunotherapy outcomes in lung cancer. Smokers tend to have better overall response rates and overall survival on immunotherapy, but promoting smoking is not the right approach, as it may not translate to better outcomes. Further research and stratification trials are needed to understand the relationship between smoking cessation efforts and immunotherapy response. This interview took place at 2025 World Conference on Lung Cancer (WCLC) in Barcelona, Spain.
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Transcript
I think there are now growing evidences and there are many trials which show that the relationship between the tobacco status and smoking status and outcomes related to immunotherapy is very complex and very much undiscovered. Many trials, like CheckMate and Keynote, have discovered that people on immunotherapy who are smokers are doing well in terms of overall response rate and overall survival...
I think there are now growing evidences and there are many trials which show that the relationship between the tobacco status and smoking status and outcomes related to immunotherapy is very complex and very much undiscovered. Many trials, like CheckMate and Keynote, have discovered that people on immunotherapy who are smokers are doing well in terms of overall response rate and overall survival. And we always advocate that during any course of treatment, you have to quit tobacco. We don’t advocate it. And there is a question now, if it is increasing the response to immunotherapy, is this the right approach to promote smoking? The answer is no. The reason is that whenever a smoker has a very high mutation burden and they have an expression of PD-L1 and PD-1, so they respond better to immunotherapy, but still, we need to wait for it and where there is a need for a stratification trial which can tell about what are the smoking and efforts related to smoking cessation needs to be placed in between to come to a conclusion whether this better response to immunotherapy is how useful and maybe we, as oncologists, can’t promote smoking to just get a better outcome in terms of immunotherapy. So, this is very complex, but yes, this is a truth and this is backed by the evidence that smokers do better with immunotherapy.
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