At the 2022 Winter Olympics, the Chinese team ended perfectly with the best results in the history of 9 gold, 4 silver and 2 bronze. Among them, Xu Mengtao won the fifth gold medal for the mainland in the freestyle ski women's aerial skills, while Qi Guangpu won the mainland's seventh gold medal in the freestyle skiing men's aerial skills competition. With the exception of some doubles and mixed events, most of the Olympic events will have a women's and men's team, for obvious reasons , of course – there are huge physiological differences between men and women.
In fact, this difference is not only reflected in the physical strength and strength of exercise, the study found that in the treatment of tumors, the difference between male and female sexes can not be ignored.
Chemotherapy: more toxic to women
As early as 2005, studies showed that chemotherapy drugs were more toxic to women [1]. The study collected data from four colorectal cancer trials in the Southwest Oncology Group (SWOG) and included a total of 1,074 eligible colorectal cancer patients treated with 5-fluorouracil, of which 505 patients were used for exploratory analysis to determine which drug toxicity severity or frequency differed between men and women, and another 569 patients were used as a validation group to test the results of the analysis of the first 505 patients.
Overall, women experienced more high-level toxic events than men, with 45% of women experiencing a grade 3 or higher toxicity event ≥ 1 compared to only 28% of men. And women tend to experience more types of toxicity, with 21% of women experiencing ≥ 2 grade 3 and above toxic events, 8% of men, and women are significantly higher than men (p = 0.0001).
The biggest difference between men and women is manifested in gastrointestinal toxicity and hematotoxicity. The above results were confirmed in the verification set.
Figure 1 Validation set of chemotherapy toxicity data[1]
Immune or targeted therapy: equally female over male
Although the "preference for women over men" in the adverse effects of chemotherapy has been uncovered, few studies have looked at sex differences in immunity or targeted therapy, and a recent study from the United States examined the sex differences in adverse effects of tumor treatment modalities, including chemotherapy, immunotherapy, and targeted therapy, and published in the Journal of Clinical Oncology (IF=44) [2].
The study included data on eligible patients who could be assessed in phase II and PHASE III clinical trials of the SWOG Cancer Research Network over a total period of 30 years from July 1, 1989 to June 30, 2019, with adverse reactions referred to the 4th Edition of the Common Terminology Criteria for Adverse Events (CTCAE) and graded on a scale of 0 to 5, with 0 indicating non-toxicity and 1 indicating mild toxicity, 2 indicated moderate toxicity, 3 indicated severe toxicity, 4 indicated life-threatening, 5 represented death, and the primary endpoint of the study was the occurrence of 1 or more treatment-related adverse reactions of severe or higher grade (≥3). Among them, adverse reactions that show symptoms are called symptomatic adverse events, reactions based on laboratory tests or objectively measurable are called objective adverse events, and some adverse event categories include both symptomatic adverse events and objective adverse events (such as cardiovascular, skin, gastrointestinal, neurological, respiratory and visual related adverse events).
A total of 23 296 patients (women: 8838 and men: 14458) were included in the study, who came from 202 clinical trials and experienced a total of 274688 27 categories of adverse events, of which 17417 patients received chemotherapy, 2319 patients received immunotherapy, and 3560 patients received targeted therapy.
Of all patients, 64.6% (15,051 patients) experienced 1 or more serious adverse reactions, and compared with men, women had a 34% increased risk of serious adverse events, with the risk of immunotherapy being the most significant. Across all combination regimens, women experienced a 25% increased risk of experiencing 5 or more times of serious adverse reactions.
Figure 2 Patient sex and adverse reactions[2]
Women were at higher risk of symptomatic (33.3% vs. 27.9%) and objective-haematology (45.2% vs. 39.1%), and objective-non-hematologic (30.9% vs. 29%) adverse events than men.
Figure 3 Effect of adverse event categories on the incidence of serious adverse events
Further analysis of the immunotherapy subgroup found that women receiving immune checkpoint inhibitors and immunomodulators were at higher risk of symptomatic adverse events, while asymptomatic adverse events were not observed.
Among symptomatic adverse events, women receiving chemotherapy had a significantly increased probability of skin- and oral-related adverse events, and in each treatment modality, women were at increased risk of developing symptomatic gastrointestinal events. For patients receiving chemotherapy and immunotherapy, women increased the likelihood of sleep-related adverse events.
Among objective adverse events, women receiving chemotherapy, immunotherapy, and targeted therapy have an increased chance of haematological adverse reactions, and in patients receiving chemotherapy or immunotherapy, women have a significantly higher risk of objective primary cardiovascular adverse events.
Taken together, the study suggests that women are at a much higher risk of serious adverse events across multiple treatment modalities.
Source: Figureworm Creative
Knowing that it is not blessed: the overall survival of women may be higher
But does this phenomenon mean that the clinical outcomes are worse for women than for men? The conclusion may be the opposite, and studies suggest that an increased risk of adverse effects may be associated with longer survival.
Studies have conducted 1157 eligible patients with advanced non-small cell lung cancer (NSCLC) [3], including 431 women and 726 men. There were no statistically significant differences in performance status, weight loss>10%, tumor staging, and incidence of brain metastases among the included men and women, and the median survival time for women was 9.2 months, significantly longer than the men's, with similar rates of efficacy, and the study also noted that women treated with chemotherapy drugs were more toxic than men. Another study[4] evaluating the effects of sex and age on subsequent chemotherapy in patients with esophageal gastric junction cancer who underwent radical surgery, analyzed the survival of 2668 male patients and 597 female patients and found that although female patients had a significantly higher probability of certain adverse reactions than men, the overall survival rate (OS) and disease-specific survival rate (DSS) of female patients improved significantly compared with men.
Overall, while women oncology patients are at higher risk of adverse events when they receive medication, this is a good thing for the final clinical outcome.
Author: Yin Qilei
Source: Frontline of Cancer in the Health Community