Efficacy of Immunotherapy for Lung Cancer: Does Gender Matter?
Posted: Friday, June 8, 2018
Men receiving immune checkpoint inhibitor therapy for advanced cancers, including non–small cell lung cancer (NSCLC), had an overall survival benefit significantly greater than that of women, according to a systematic review and meta-analysis of 20 randomized controlled trials reported through November 2017. The review, published in The Lancet Oncology, was conducted by Fabio Conforti, MD, of the European Institute of Oncology, Milan, Italy, and colleagues.
The reviewed trials needed to include hazard ratios that indicated death according to patient sex. The pooled overall survival hazard ratios were 0.72 and 0.86 for men and women, respectively, for immune checkpoint inhibitor therapy versus control treatment. The difference in efficacy between men and women was significant (P = .0019).
A total of 11,351 patients with advanced or metastatic cancer received control treatments or ipilimumab (n = 2,881), tremelimumab (n = 1,226), nivolumab (n = 3,893), or pembrolizumab (n = 3,209); all are inhibitors of PD-1, CTLA-4, or both. A nivolumab-plus-ipilimumab trial enrolled 142 patients. About one-third of the total patients (n = 3,482; 31%) had NSCLC, whereas another one-third had melanoma (n = 3,632; 32%). The total population included 7,646 men and 3,705 women.
Previously, little was “known about the effect of patients’ sex on the efficacy of immune checkpoint inhibitors as cancer treatments,” wrote Dr. Conforti and colleagues. Although immunotherapy may improve overall survival, “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,” they concluded.