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Lung Cancers in Never-Smokers: A Different Disease?
Michelle C Salazar1, Aki Katarina Kobayashi2
1Department of Thoracic Surgery, Memorial Sloan Kettering Cancer Center, 160 East 53rd Street, New York, NY 10022, USA.
Surgical Oncology Clinics of North America
|October 19, 2025
Summary
Lung cancer in never-smokers is a unique disease, often adenocarcinoma driven by specific mutations. Targeted therapies are more effective than immunotherapy for this population.
Area of Science:
- Oncology
- Genetics
- Epidemiology
Background:
- Lung cancer in never-smokers represents a distinct clinical and molecular entity.
- The incidence of lung cancer among never-smokers is increasing as smoking rates decline.
- Women are disproportionately affected due to lower smoking prevalence.
Purpose of the Study:
- To highlight the unique characteristics of lung cancer in never-smokers.
- To emphasize the importance of molecular profiling in this patient group.
- To discuss risk factors and treatment implications for never-smokers.
Main Methods:
- Review of epidemiological data on lung cancer incidence in never-smokers.
- Analysis of tumor biology and common molecular alterations, such as EGFR mutations.
- Examination of treatment response data for immunotherapy and targeted therapies.
Main Results:
- Adenocarcinoma is the predominant subtype in never-smokers.
- Actionable mutations, like epidermal growth factor receptor, are frequently identified.
- Never-smokers show limited response to immunotherapy but significant benefit from targeted therapies.
Conclusions:
- Lung cancer in never-smokers is biologically distinct and requires tailored diagnostic and therapeutic approaches.
- Molecular profiling is crucial for identifying targetable mutations and guiding treatment decisions.
- Environmental, genetic, and hormonal factors warrant further investigation in risk assessment.
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