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Cancer Prevention Research
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Special Collection: Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention

The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions

Scott D. Siegel, Caryn Lerman, Alex Flitter and Robert A. Schnoll
Scott D. Siegel
1Value Institute and Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, Delaware.
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  • ORCID record for Scott D. Siegel
  • For correspondence: ssiegel@christianacare.org
Caryn Lerman
2Department of Psychiatry and Norris Cancer Center, University of Southern California, Los Angeles, California.
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Alex Flitter
3Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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Robert A. Schnoll
3Department of Psychiatry and Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania.
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DOI: 10.1158/1940-6207.CAPR-19-0259 Published March 2020
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Abstract

The nicotine metabolite ratio (NMR), a genetically informed biomarker of rate of nicotine metabolism, has been validated as a tool to select the optimal treatment for individual smokers, thereby improving treatment outcomes. This review summarizes the evidence supporting the development of the NMR as a biomarker of individual differences in nicotine metabolism, the relationship between the NMR and smoking behavior, the clinical utility of using the NMR to personalize treatments for smoking cessation, and the potential mechanisms that underlie the relationship between NMR and smoking cessation. We conclude with a call for additional research necessary to determine the ultimate benefits of using the NMR to personalize treatments for smoking cessation. These future directions include measurement and other methodologic considerations, disseminating this approach to at-risk subpopulations, expanding the NMR to evaluate its efficacy in predicting treatment responses to e-cigarettes and other noncigarette forms of nicotine, and implementation science including cost-effectiveness analyses.

See all articles in this Special Collection Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention

Footnotes

  • Cancer Prev Res 2020;13:261–72

  • Received May 20, 2019.
  • Revision received June 20, 2019.
  • Accepted July 1, 2019.
  • Published first March 4, 2020.
  • ©2020 American Association for Cancer Research.
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Cancer Prevention Research: 13 (3)
March 2020
Volume 13, Issue 3
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The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions
Scott D. Siegel, Caryn Lerman, Alex Flitter and Robert A. Schnoll
Cancer Prev Res March 1 2020 (13) (3) 261-272; DOI: 10.1158/1940-6207.CAPR-19-0259

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The Use of the Nicotine Metabolite Ratio as a Biomarker to Personalize Smoking Cessation Treatment: Current Evidence and Future Directions
Scott D. Siegel, Caryn Lerman, Alex Flitter and Robert A. Schnoll
Cancer Prev Res March 1 2020 (13) (3) 261-272; DOI: 10.1158/1940-6207.CAPR-19-0259
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  • Article
    • Abstract
    • Introduction
    • The Development of the Nicotine Metabolite Ratio (T0)
    • Initial Assessment of the NMR and Its Relationship with Smoking Behavior (T1)
    • The NMR and Response to Treatments for Smoking Cessation (T2)
    • What are Potential Mechanisms Through Which the NMR may Operate to Personalize Smoking Cessation Treatments?
    • Challenges and Future Directions (T3 and T4)
    • Conclusions
    • Disclosure of Potential Conflicts of Interest
    • Acknowledgments
    • Footnotes
    • References
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Show more Special Collection: Honoring Paul F. Engstrom, MD, Champion of Cancer Prevention
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