Beyond monotherapy: Integrating immunotherapy into current treatment regimens

Abstract

While we have shown that these urinary metabolites are risk biomarkers for lung cancer in these studies, they are not fully predictive. This is because these biomarkers are mainly measuring exposure but do not take into account the critical metabolic activation step leading to the formation of DNA adducts which cause the multiple mutations observed in lung cancer. Quantitation of DNA adducts is challenging because of their low levels, typically less than 1 adduct per 10 normal bases, and the small amounts of DNA available for studies in living humans. To address this question, we are developing high resolution mass spectrometric methods for quantifying oral cell DNA adducts as a surrogate for DNA adduct formation in the lung. In one recent study, we found remarkably high levels of DNA adducts of tobaccospecific compounds in in the oral mucosa cells of smokers compared to non-smokers. We are also able to quantify formaldehyde-DNA adducts in oral mucosa cells. As mass spectrometric methods for analysis of carcinogen-DNA adducts become increasingly more sensitive and specific, it appears likely that quantitation of a panel of tobacco carcinogen DNA adducts in smokers, leading to identification of susceptible individuals, may be feasible.