YAFI Online Programming // Disease State Management and Drug Therapy

Cancer in Non-Smokers

Who, What, Why and How to Treat

Educational Objectives

After participating in this activity pharmacists will be able to:

  • DESCRIBE NSCLC’s pathogenesis in nonsmokers
  • LIST the abnormalities in growth stimulatory signaling pathways in NSCLC
  • DESCRIBE the components of individualized treatment plans for EGFR mutation positive NSCLC
  • REVIEW new and emerging treatment options in EGFR T790M mutation positive patients
  • MAXIMIZE the pharmacist’s contribution in improving treatment adherence and ongoing monitoring to attain therapeutic treatment goals

After participating in this activity pharmacy technicians will be able to:

  • LIST the basic characteristics of NSCLC in nonsmokers
  • RECALL oral TKIs used in EGFR mutation positive NSCLC
  • IDENTIFY when to refer patients to the pharmacists for recommendations or referrals

Lung Cancer

Session Offered

Release Date: June 15, 2020

Expiration Date: June 15, 2022

Course Fee


Session Codes

20YC45-XFY43 Pharmacist

20YC45-TKJ86 Pharmacy Technician

Accreditation Hours

2.0 hours of CE


Lung cancer includes many different diseases in the pulmonary space. Increasing, oncologists are diagnosing lung cancer in non- or never-smokers. Those lung cancers are often associated with a specific set of mutations. The tyrosine kinase inhibitors (TKIs) target mutations that are more likely to occur in lung cancer in non-smokers. Available in three generations, the reversible TKIs are often used as first line treatments. If patients develop resistance, TKIs from the second and third generations can be used. These drugs have unique adverse effect profiles. Pharmacy teams need to be aware of management strategies for the most common adverse effects, including cutaneous reactions and diarrhea.

In addition, all TKIs have drug-drug interactions, and pharmacy teams need to screen carefully to ensure that patients avoid some medications, or have dose modifications if they need to take others. Informed pharmacists and pharmacy technicians can help patients manage adverse effects, understand their therapies, and avoid medical misadventure.

Accreditation Statements

The University of Connecticut School of Pharmacy is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education.

Pharmacists and pharmacy technicians are eligible to participate in this application-based activity and will receive up to 0.2 CEU (2 contact hours) for completing the activity, passing the quiz with a grade of 70% or better, and completing an online evaluation. Statements of credit are available via the CPE Monitor on- line system and your participation will be recorded with CPE Monitor within 72 hours of submission


Grant funding: AstraZeneca Pharmaceuticals

Cost: Free

Initial Release Date: June 15, 2020
Expiration Date: June 15, 2022

To obtain CPE credit, visit the UConn Online CE Center

Use your NABP E-profile ID and the session code 20YC45-XFY43 for pharmacists or 20YC45-TKJ86 for pharmacy technicians to access the online quiz and evaluation.

First- time users must pre-register in the Online CE Center. Test results will be displayed immediately and your participation will be recorded with CPE Mon- itor within 72 hours of completing the requirements.

For questions concerning the online CPE activities, email joanne.nault@uconn.edu


Bisni Narayanan, Pharm D, MS, Clinical Specialty Pharmacist, Yale New Haven Health Systems, Outpatient pharmacy services, Hamden, CT

Faculty Disclosure

Dr. Narayanan has no actual or potential conflicts of interest associated with this article.

Disclosure of Discussions of Off-label and Investigational Drug Use

This activity may contain discussion of off label/unapproved use of drugs. The content and views presented in this educational program are those of the faculty and do not necessarily represent those of the University of Connecticut School of Pharmacy. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.



Often, when people hear that a friend or relative has lung cancer, their first question is, “Does he smoke?” Increasingly, the answer is, “No.” This answer often surprises and confuses healthcare providers and lay people. Yet lung cancer includes many different diseases in the pulmonary space. Medical researchers consider patients who have smoked fewer than 100 cigarettes during their lifetime “never-smokers,” while people who have smoked more than 100 as “eversmokers.”1 Non-small cell lung cancer (NSCLC) accounts for 85% of lung cancers.2 Patients are often diagnosed at advanced stages, and median survival time is less than a year when oncologists use conventional chemotherapy. NSCLC occurs in two common subtypes: pulmonary adenocarcinoma and pulmonary squamous cell carcinoma.3 Committed smoking cessation efforts have led to decreased lung cancer incidence in the US over the last several decades.4 But the proportion of never-smokers with lung cancer (LUNS) has grown at an alarming rate. Experts estimate roughly 25% of all lung cancers are unrelated to tobacco use, accounting for more than 300,000 deaths each year.5 LUNS ranges from 10% of lung cancers in men in Western countries to up to 40% of lung cancers in Asian women.1,2 LUNS is a distinct entity with a different tumorigenic pattern, pathology, and natural history than smoking-related lung cancer. Adenocarcinoma is the most common histology observed in never-smokers.3 Smoking is strongly associated with squamous cell carcinoma and small cell lung cancer.

LUNS is more common in women and in East Asian countries.3 Never-smokers exposed to secondhand smoke, pollution, occupational carcinogens, and those who have inherited genetic susceptibility are at increased risk. Molecular profiling has shown a higher frequency of epidermal growth factor receptor (EGFR) mutations and echinoderm microtubule associated protein-like 4 (EML4) with anaplastic lymphoma kinase (ALK) translocations in this patient population. These unique mutations are biomarkers to classify the lung cancer and choose the most appropriate therapy. Pharmacy teams can actively help patients manage adverse effects, prevent drug interactions, and improve treatment adherence. To understand how treatment targets LUNS, one has to drill down to the molecular level and the lengthy sidebar to the right explains the science. Although the science may seem heavy, reading slowly and making note of the abbreviations can help.


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