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10-01-2019 | Oncology | News | Article

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Survival after immunotherapy for advanced cancer not affected by sex

medwireNews: Men and women derive similar survival benefits from immunotherapy when undergoing treatment for advanced solid-organ cancer, results of an updated meta-analysis show.

“Contrary to findings of a previous analysis, we found no evidence that sex should be considered when deciding whether to offer immunotherapy to patients with advanced cancers”, Christopher Wallis (University of Toronto, Ontario, Canada) and co-authors remark.

The researchers explain that the previous meta-analysis they describe, which included 16 studies, indicated that the overall survival advantage seen with immune checkpoint inhibitors versus standard care was greater among men than women.

“However, methodologic concerns and subsequent trials have placed these results in doubt”, they write. The inclusion of a limited subset of approved immunotherapeutic agents (ipilimumab, tremelimumab, nivolumab and pembrolizumab) and studies with a low proportion of women were some such concerns.

To address this, the team “used a more contemporary and comprehensive literature search strategy” and ultimately reviewed data from 23 randomised clinical trials, including the 16 reviewed in the previous meta-analysis, that compared immunotherapy with standard care (nonimmunotherapy) in the treatment of 9322 (68%) men and 4399 (32%) women with advanced solid-organ malignant neoplasms. Treatment agents included those in the earlier study plus atezolizumab, durvalumab and avelumab.

Wallis et al found that immunotherapy was associated with a significantly reduced risk of death in both men and women compared with standard care, at hazard ratios of 0.75 and 0.77, respectively, with no significant difference between the sexes.

Furthermore subgroup analyses showed similar results when the patients were stratified according to disease site, line of therapy, class of immunotherapy, study methodology and proportion of women included.

The majority of trials (n=11) included in the meta-analysis were among patients with non-small-cell lung cancer, four included patients with melanoma, two each included those with clear cell renal cell carcinoma and small-cell lung cancer, while there was one trial each for urothelial carcinoma, head and neck squamous carcinoma, mesothelioma and gastric or gastroesophageal carcinoma.

Just over half (52%) of the trials assessed immunotherapy after previous systemic therapy failure, with the remainder assessing immunotherapy in the first-line setting, and most (74%) used an inhibitor of the programmed cell death protein 1 or its ligand as the immunotherapy agent.

The study findings are published in JAMA Oncology.

By Laura Cowen

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