Potential effects of nicotine on glioblastoma and chemoradiotherapy: a review

ABSTRACT

Introduction: Glioblastoma multiforme (GBM) has a poor prognosis despite maximal surgical resection with subsequent multi-modal radiation and chemotherapy. Use of tobacco products following diagnosis and during the period of treatment for non-neural tumors detrimentally affects treatment and prognosis. Approximately, 16–28% of patients with glioblastoma continue to smoke after diagnosis and during treatment. The literature is sparse for information-pertaining effects of smoking and nicotine on GBM treatment and prognosis.

Areas covered: This review discusses cellular pathways involved in GBM progression that might be affected by nicotine, as well as how nicotine may contribute to resistance to treatment. Similarities of GBM pathways to those in non-neural tumors are investigated for potential effects by nicotine. English language papers were identified using PubMed, Medline and Scopus databases using a combination of keywords including but not limited to the following: nicotine, vaping, tobacco, e-cigarettes, smoking, vaping AND glioblastoma or brain cancer OR/AND temozolomide, carmustine, methotrexate, procarbazine, lomustine, vincristine, and neural tumor cell lines.

Expert opinion: Understanding the impact of nicotine on treatment and resistance to chemotherapeutics should allow physicians to educate their patients with GBM with evidence-based recommendations about the effects of continuing to use nicotine-containing products after diagnosis and during treatment.

KEYWORDS:

• Glioblastoma
• nicotine
• chemoresistance
• temozolomide
• radiotherapy
• procarbazine
• carmustine
• vincristine
• methotrexate

Article Highlights

• Many patients with glioblastoma continue to smoke tobacco or use e-cigarettes during treatment; nicotine can affect those treatments.

• Nicotine increases neural tumor cell proliferation, likely through EGFR and/or CY2B1 pathways.

• Nicotine also increases tumor growth, angiogenesis, migration, invasion, and inhibition of apoptosis of cancer cells, and could exert similar effects on glioblastoma

• Nicotine probably does not affect temozolamide metabolism, but may affect cytochrome-P450-metabolized agents, including BCNU

• Nicotine could contribute to chemotherapy drug resistance in glioblastoma

• Nicotine can contribute to resistance to radiotherapy

Declaration of interest

The authors were supported by the University of Missouri Division of Neurological Surgery scholarship funds. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer Disclosures

Peer reviewers on this manuscript have no relevant financial relationships or otherwise to disclose.

Additional information

Funding

This paper was not funded.