Home > Oncology > Women experience more, and more severe, toxicities from many types of cancer treatment

Women experience more, and more severe, toxicities from many types of cancer treatment

Journal of Clinical Oncology
Reuters Health - 22/02/2022 - Across cancer treatment modalities, women experience more severe symptomatic and hematologic adverse events (AEs) than men, especially from immunotherapy, a retrospective analysis found.

"Prior studies had shown that there were notable sex differences in toxicity from chemotherapy treatments. But almost no research has examined whether these differences were still evident for newer, modern treatments," Dr. Joseph Unger of the Fred Hutchinson Cancer Research Center in Seattle told Reuters Health by email. "We found that sex differences in toxicity persisted for the newer treatments too, especially for immune therapies, with women having a nearly 50% increased risk of severe toxicity compared to men."

"If confirmed by others," he said, "these findings would indicate that the sex of patients with cancer would be one variable to consider when assessing treatment risks."

As reported in the Journal of Clinical Oncology, Dr. Unger and colleagues analyzed treatment-related AEs by sex in SWOG phase II and III clinical trials conducted between1980 and 2019, excluding sex-specific cancers. The most common cancers were gastrointestinal (26.1%), lung (20.5%), and leukemia (12.1%).

More than 23,000 patients (38%, women; 9%, Black; 26%, obese) from 202 trials experiencing 274,688 AEs were included; 17,417 received chemotherapy, 2,319 received immunotherapy, and 3,560 received targeted therapy.

Overall, 64.6% experienced one or more severe (grade 3 or higher) AEs.

Women had a 34% increased risk of severe AEs compared with men. The odds ratios of severe toxicity for each treatment type were 1.25 for targeted therapy; 1.36 for chemotherapy and 1.49 for immunotherapy.

Women experienced an increased risk of severe symptomatic AEs among all treatments, especially immunotherapy (OR 1.66), and women receiving chemotherapy or immunotherapy experienced higher rates of severe hematologic AEs.

No statistically significant sex differences were found in risk of nonhematologic AEs.

The authors suggest that the observed between-sex differences "could be due to differences in AEs reported, pharmacogenomics of drug metabolism/disposition, total dose received, and/or adherence to therapy."

"Particularly large sex differences were observed for patients receiving immunotherapy, suggesting that studying AEs from these agents is a priority," they conclude.

Dr. Unger said, "Our findings were based on toxicity outcomes reported by the physicians. We would like to examine whether these differences are also apparent in terms of patient-reported quality of life, which very immediately and directly gets at patients' sense of wellbeing, so sex differences in that domain would be critical to understand."

Dr. Chadi Nabhan of the University of South Carolina Department of Clinical Pharmacy and Outcomes Sciences commented on the study in an email to Reuters Health.

"It's not unusual in clinic to observe that women and men might experience different side effects or even responses to therapy, but these observations were never studied comprehensively and their underlying causes were never fully explained," he said. "We have learned in the past decade how pharmacogenomics impact efficacy and adverse events, and I suspect that this is a major reason for the observations published in this paper."

"One important caveat is that the patients...were all enrolled on clinical trials that may not properly represent patients treated in the real world," he noted. "It's important to study this question in a real-world setting. Moreover, the publication spanned SWOG studies over four decades, and we know that other advances in supportive measures and how we recognize new side effects and manage them have evolved and improved."

"Also," he added, "this is a retrospective series that requires prospective validation."

SOURCE: https://bit.ly/3vdMKOu Journal of Clinical Oncology, online February 4, 2022.

By Marilynn Larkin

© 2023 The Author(s). Published by Medicom Medical Publishers.
User license: Creative Commons Attribution – NonCommercial (CC BY-NC 4.0)

Posted on