We were very interested in the article ‘Better chemotherapeutic response of small cell lung cancer in never smokers than in smokers’ [1]. Since small cell lung cancer (SCLC) is strongly linked to smoking, the study examines rarely studied subgroup never smokers with SCLC and highlights their unique clinical features, which are often overlooked. Key treatment outcomes, such as overall survival, progression- free survival, and objective response rate, were evaluated by the authors. This comparison between smokers and never smokers provides important insights into variations in long-term prognosis and chemotherapy response. The findings gain credibility through the use of appropriate and varied statistical tools such as multivariate logistic regression, t-tests, Fisher’s exact test, and Kaplan-Meier survival analysis. However we would like to point out limitations in the study design. Patients were classified simply as ‘never smokers’ or ‘smokers’ without considering low-level tobacco use or exposure to passive (secondhand) smoke. The article notes that secondhand smoke increases the risk of lung cancer for both smokers and non-smokers and that there is evidence of a multiplicative relationship between secondhand smoke exposure and active smoking [2]. Taking this factor into account during the analysis could enhance the accuracy and interpretation of the results. Additionally, there was no biochemical validation or standardized threshold— such as fewer than 100 lifetime cigarettes—to differentiate never smokers from light or occasional smokers; instead, the definition of a never-smoker relied solely on self-reporting. This reliance on self-reporting may jeopardize the accuracy of patient classification due to the potential for recall [3]. Moreover, we would like to highlight a related 2020 study that provided comprehensive information on the types and severity of treatment-related toxicities in patients with SCLC. This study found that during treatment, 433 patients (76.1%) experienced severe toxicity, 176 patients (30.9%) experienced non-hematologic toxicity, and 397 patients (69.8%) experienced hematologic toxicity. Among the 433 patients with severe toxicity, 249 (43.8%), 237 (45.5%), 245 (51.5%), and 174 (40.7%) experienced grade 3-5 toxicity following the first, second, and third cycles, respectively. Standardized toxicity grading systems allow for meaningful comparisons between studies, treatment plans, and patient subgroups, such as smokers and never-smokers [4]. In conclusion, we commend the authors for addressing a significant and under-researched topic. Future research would benefit from using more precise definitions of smoking exposure and standardized assessment instrument for toxicity to improve the validity and generalizability of the results.