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Does patients’ gender play a role in the efficacy of cancer immunotherapy?
There is a gender-related dimorphism in immune system response; however, does patients’ gender play a role in the efficacy of immune checkpoint inhibitors as cancer treatments? A systematic review and meta-analysis published in The Lancet Oncology journal assessed the heterogeneity of immunotherapy efficacy between men and women.
Researchers searched PubMed, MEDLINE, Embase, and Scopus, from database inception to 30 November 2017, for randomised controlled trials of immune checkpoint inhibitors (inhibitors of PD-1, CTLA-4, or both). The primary endpoint was to assess the difference in efficacy of immune checkpoint inhibitors between men and women.
Of 7,133 studies identified, there were 20 eligible randomised controlled trials of immune checkpoint inhibitors (ipilimumab, tremelimumab, nivolumab, or pembrolizumab) that reported overall survival according to patients’ sex. Overall, 11,351 patients with advanced or metastatic cancers (7,646 men and 3,705 women) were included in the analysis. The most common types of cancer were melanoma (3,632) and non-small-cell lung cancer (3,482).
The pooled overall survival hazard ratio was 0·72 (95% CI 0·65–0·79) in male patients treated with immune checkpoint inhibitors, compared with men treated in control groups. In women treated with immune checkpoint inhibitors, the pooled overall survival hazard ratio compared with control groups was 0·86 (95% CI 0·79–0·93).
The difference in efficacy between men and women treated with immune checkpoint inhibitors was significant (p=0·0019).
Researchers concluded that immune checkpoint inhibitors can improve overall survival for patients with advanced cancers such as melanoma and non-small-cell lung cancer, but the magnitude of benefit is gender-dependent. They suggested that future research should guarantee greater inclusion of women in trials and focus on improving the effectiveness of immunotherapies in women, perhaps exploring different immunotherapeutic approaches in men and women.
Fabio Conforti, Laura Pala, Vincenzo Bagnardi, Tommaso De Pas, Marco Martinetti, Giuseppe Viale, Richard D Gelber, Aron Goldhirsch. 1 June, 2018. Cancer immunotherapy efficacy and patients’ sex: a systematic review and meta-analysis. The Lancet Oncology. Volume 19. Issue 6. P 737 – 746. DOI:https://doi.org/10.1016/S1470-2045(18)30261-4