Anatomy and Cell Biology, Faculty of Science, McGill University, Montreal, QC H3A 0C7, Canada.
Anna and Peter Brojde Lung Cancer Centre, Jewish General Hospital, Montreal, QC H3T 1E2, Canada.
Curr Oncol. 2024 Nov 20;31(11):7379-7389. doi: 10.3390/curroncol31110544.
Immunotherapy with ICIs has revolutionized the treatment for NSCLC. The impact of sex on treatment outcomes remains unclear. The aim of this study was to evaluate sex-related differences in immunotherapy outcomes in a real-world population of NSCLC patients.
Demographics, clinical, pathological characteristics, and treatment-related variables were analyzed to understand the differences in efficacy and safety outcomes in relation to sex.
174 advanced NSCLC patients receiving first-line ICIs, either alone or in conjunction with chemotherapy, were included. No differences based on gender were observed in PFS and OS. Prognostic factors for OS and PFS included liver metastases and CRP levels at treatment discontinuation (TD). IrAE-related TD occurred at a significantly higher rate in females. GI toxicity, including hepatitis and colitis, was predominantly observed in females, whereas pneumonitis was the most frequent irAE leading to TD in males.
Despite no significant differences based on gender being observed in survival outcomes, our study showed that female patients with advanced NSCLC receiving ICIs are at a substantially greater risk of severe symptomatic irAEs and TD. This finding indicates that broad-based sex differences could potentially exist and emphasizes the need for further investigations into the role played by gender in immunity and cancer immunotherapy treatment.
免疫检查点抑制剂（ICI）的免疫疗法彻底改变了非小细胞肺癌（NSCLC）的治疗方法。性别对治疗结果的影响尚不清楚。本研究旨在评估真实世界 NSCLC 患者群体中免疫疗法结果的性别相关差异。
分析了人口统计学、临床、病理特征和与治疗相关的变量，以了解与性别相关的疗效和安全性结果的差异。
共纳入 174 例接受一线 ICI 治疗（单独或联合化疗）的晚期 NSCLC 患者。未观察到性别与无进展生存期（PFS）和总生存期（OS）之间存在差异。OS 和 PFS 的预后因素包括肝转移和治疗终止（TD）时的 CRP 水平。女性发生免疫相关不良事件（irAE）相关 TD 的比例显著更高。女性中主要观察到胃肠道毒性，包括肝炎和结肠炎，而男性中最常见的 irAE 导致 TD 的是肺炎。
尽管在生存结果方面未观察到性别差异，但本研究表明，接受 ICI 治疗的晚期 NSCLC 女性患者发生严重症状性 irAE 和 TD 的风险显著更高。这一发现表明，可能存在广泛的性别差异，并强调需要进一步研究性别在免疫和癌症免疫治疗中的作用。
