Immunotherapy equally effective in men, women with advanced cancer

  • Wallis CJD & al.
  • JAMA Oncol
  • 3 Jan 2019

  • curated by Yael Waknine
  • Clinical Essentials
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Takeaway

  • Men and women derive equal survival benefit from immune checkpoint inhibitors in advanced solid cancers.

Why this matters

  • A prior meta-analysis suggested that men derive greater benefit from immunotherapy for advanced solid cancers, but the methodology was flawed and subsequent studies have cast doubt on the findings.

Study design

  • Meta-analysis of 23 randomized clinical trials (RCTs) involving 9322 men (67.9%) and 4399 women (32.1%); most used a programmed cell death protein 1 (PD-1) or PD-ligand 1 (PD-L1) inhibitor (74%).
  • Most focused on lung cancer (NSCLC, 48%; small-cell lung cancer, 9%), melanoma (17%), or clear-cell renal carcinoma (9%); 48% involved front-line settings.
  • Median age was typically in the 70’s.
  • Funding: None.

Key results

  • Immunotherapy yielded survival benefit in men (HR=0.75; P<.001 and women p=".002)," with no os advantage between the sexes i>2=38%).
  • Statistically significant heterogeneity found in both men (τ2=0.02; х2=51.67; P=.003; I2=57%) and women (τ2=0.07; х2=62.29; P<.001 i>2=65%).
  • Men and women showed similar survival benefit in subgroup analysis by disease site, line of therapy, immunotherapy class, trial methodology, and proportion of women included.

Limitations

  • Only 3 trials had ≥24-month follow-up.
  • Efficacy-effectiveness gap.

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