內容目錄
At the 2022 Winter Olympics, the Chinese team ended with the best results in history with 9 golds, 4 silvers and 2 bronzes. Among them, Xu Mengtao won my country’s 5th gold medal in the women’s freestyle skiing aerial skills competition, while Qi Guangpu won my country’s 7th gold medal in the freestyle skiing men’s aerial skills competition. With the exception of some duos and mixed events, most Olympic events feature separate women’s and men’s divisions, for obvious reasons – there are huge biological differences between men and women.
In fact, this difference is not only reflected in the physical fitness and strength of sports. Research has found that in the treatment of tumors, the difference between men and women cannot be ignored.
Chemotherapy: more toxic in women
As early as 2005, studies showed that chemotherapy drugs are more toxic in women[1]. The study collected data from four Southwest Oncology Group (SWOG) colorectal cancer trials, including a total of 1074 eligible colorectal cancer patients receiving 5-fluorouracil treatment, of which 505 patients were used for exploration A sex analysis was used to determine which drug toxicities differed in severity or frequency between men and women, and an additional 569 patients served as a validation group to test the results from the first 505 patient analyses.
Overall, women experienced more high-grade toxicity events than men, with 45% of women experiencing ≥1 grade 3 and The above toxic events accounted for only 28% in men. Women also tended to experience more types of toxicities, with ≥2 grade 3 or higher toxic events occurring in 21% of women, compared with 8% in men, which was significantly higher in women than in men (p = 0.0001).
The greatest differences between men and women were in gastrointestinal and hematological toxicity. The above results were confirmed in the validation set.
Figure 1 Validation set chemotherapy toxicity data[1]
Immune or Targeted Therapy: Equally Pride in Women
Although the “female preference” trend of chemotherapy adverse reactions has been uncovered, few studies have looked at gender differences in immune or targeted therapy. Recently, an article from the United States The study investigated gender differences in the adverse reactions of tumor treatment modalities including chemotherapy, immunotherapy and targeted therapy, and the results were published in the Journal of Clinical Oncology (IF=44) [2] .
The study included eligibility evaluable in Phase II and Phase III clinical trials of the SWOG Cancer Research Network for a total of 30 years from July 1, 1989 to June 30, 2019 The patient’s data, adverse reactions are based on the 4th edition of the Common Terminology Criteria for Adverse Events (CTCAE) as a reference, and are divided into 0 to 5 according to the grade, 0 means no toxicity, 1 means mild toxicity, 2 means Moderate toxicity, 3 for severe toxicity, 4 for life-threatening, and 5 for death, the primary endpoint of the study was the occurrence of 1 or more treatment-related serious or higher-grade (≥3) adverse reactions. Among them, adverse reactions that show symptoms are called symptomatic adverse events, and reactions based on laboratory tests or objectively measurable are called objective adverse events. Some adverse event categories include both symptomatic adverse events and objective adverse events. Events (such as cardiovascular, cutaneous, gastrointestinal, neurological, respiratory and visual related adverse events).
A total of 23 296 patients (women: 8838, men: 14458) from 202 clinical trials experienced a total of 274,688 adverse events in 27 categories, including 17,417 patients Received chemotherapy, 2319 patients received immunotherapy, and 3560 patients received targeted therapy.
Of all patients, 64.6% (15,051) experienced one or more serious adverse events, and women had a 34% increased risk of serious adverse events compared with men, Among them, immunotherapy has the greatest increased risk. Women had a 25% increased risk of experiencing 5 or more serious adverse events across all combined treatment regimens.
Figure 2 Patient gender and adverse reactions[2]
Women experienced symptomatic (33.3% vs. 27.9%) and objective-hematologic (45.2% vs. 39.1%), objective-non-hematologic (30.9% vs. 29%) adverse events risk is higher than that of men.
Figure 3 Effects of adverse event categories on the incidence of serious adverse events
Further analysis of immunotherapy subgroups found that women receiving immune checkpoint inhibitors and immunomodulators were at risk of symptomatic adverse eventshigher, which was not observed for asymptomatic adverse events.
Among symptomatic adverse events, women receiving chemotherapy had significantly increased rates of skin and oral-related adverse events, and women experienced symptomatic gastrointestinal events across each treatment modality risks are increased. Women had an increased likelihood of sleep-related adverse events in patients receiving chemotherapy and immunotherapy.
Among objective adverse events, women receiving chemotherapy, immunotherapy, and targeted therapy had an increased chance of hematologic adverse events, and among patients receiving chemotherapy or immunotherapy, women with objective The risk of cardiovascular primary adverse events was significantly increased.
In conclusion, the study suggests that women are at a significantly increased risk of serious adverse events across a variety of treatment modalities.
Source: Figureworm Creative
It’s not a blessing: women have overall survival or better
But does this phenomenon mean that women have worse clinical outcomes than men? The conclusion may be the opposite, with research showing that increased risk of adverse reactions may be associated with longer survival.
A study of 1157 eligible patients with advanced non-small cell lung cancer (NSCLC) [3], including 431 women, 726 male. There were no statistically significant differences in performance status, weight loss >10%, tumor stage, and incidence of brain metastases between men and women, and women had a median survival time of 9.2 with similar efficacy rates of drug therapy. Months, significantly longer than men’s 7.3 months, the study also noted that women received chemotherapy drugs more toxic than men. Another study[4] evaluated the effect of gender and age on subsequent chemotherapy in patients with esophagogastric junction cancer who underwent radical surgery. The study conducted a survival analysis of 2668 male patients and 597 female patients and found that Compared with men, although the probability of certain adverse reactions in female patients was significantly higher than that in male patients, overall survival (OS) and disease-specific survival (DSS) were significantly improved in female patients.
In general, although female cancer patients face a higher risk of adverse events when receiving drug therapy, this may not be a bad thing for the final clinical outcome.
Author: Yin Qilei
Source: Cancer Frontline in Health
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