Dr Hilary Tindle Discusses NMR and Precision Approaches in Cancer Care

Hilary Tinde, MD, MPH, associate professor of medicine at Vanderbilt University spoke about previous trials using the nicotine metabolite ratio (NMR) and precision medicine approaches to improve outcomes in patients with lung cancer.

What are some effective treatments for quitting smoking and why are they being underutilized? How can precision approaches improve treatment?

Precision approaches stand to improve treatment in a variety of ways. But first, I can give you a sense of what's available for treating smoking. The most important things to do when a patient wants to quit smoking is to combine counseling, behavioral techniques like from a quit line, or a health care provider, and FDA-approved medication. And the FDA-approved medications are things like nicotine replacement, like the patch, gum, or lozenge; those are available over the counter.

And there are also prescription medications such as arenicline, which is also known as Chantix, that a doctor or prescribing health care provider can write a prescription for, and a patient can go pick that up at the pharmacy.

Combining these 2 things, counseling and medication, is the best way to quit smoking because it grandly, greatly increases chances of quitting for good, as opposed to when people don't use these quit aids, these proven aids, about 95 out of 100 quit attempts fail.

When you think about the bigger picture, there are about 30 million Americans now who smoke cigarettes, American adults. And over half are trying to quit every year. But only 5% of those individuals, so over 15 million people trying to quit, only about 5% use counseling and medication. And that's why most people keep smoking and are unsuccessful in quitting. There are lots of reasons you might ask why are these proven aids, these proven medications not used. And a lot of it has to do with historical context. In the past our nation, just our health care system, didn't necessarily think of smoking as a chronic disease that needed, like diabetes, to be treated with behavioral intervention, such as counseling plus medication.

We know better now, but it takes a while to undo some of those myths. Patients might not think that they need meds, and their health care providers might or might not think that they need to provide them. But precision medicine and precision approaches can really improve things, potentially. And that's one reason I'm so excited about using them and developing them, because patients have something to be excited about when we can tailor a medication to a patient's genetics.

For example, we can boost the efficacy or the effectiveness of that medication, and even double quit rates. So that's one example. That might make health care providers more excited to or enthusiastic to prescribe those medications. Those are just a couple examples of how precision approaches could help.