Alternative tobacco and nicotine products during anticancer therapy: a systematic review of mechanistic toxicology evidence, treatment-resistance signals, and potential hazards

However, multi-center replication study failed to validate such findings, concluded that e-cigarette aerosols do not significantly increase cisplatin resistance in head and neck squamous cell carcinoma cell lines. Finally, there is some evidence that alternative products affects cancer cells proliferation, growth, epithelial-to-mesenchymal transition, oxidative stress, which may influence survival and metastasis of cancer cells.

Due to limited evidence, we are unable to clearly determine effects of using alternative tobacco/nicotine products on patients’ response to chemotherapy, cancer progression, metastasis and risk of cancer-related death. The evidence supports cautious interpretation of findings and highlights the need for standardized, reproducible methods and further <i>in vivo</i> preclinical and clinical data before drawing conclusions about the use of alternative products during chemotherapy.

Therefore, well-designed prospective cohort studies, real-world evidence studies and cancer patient registries are critical to fully understand potential risks associated with their use during anticancer therapy.</p>