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Women more prone to selected chemotherapy side-effects
Provide insight for conducting future clinical trials; stratifying patients according to their gender to evaluate the efficacy and tolerance of treatments

Men and women may need to be treated differently – at least when it comes to some types of cancer.

In an analysis to be presented at the ESMO 2018 Congress in Munich, data was pooled from four UK randomised controlled clinical trials (RCTs) of first line chemotherapy in oesophagogastric (OG) cancer, finding significant differences in a number of important side-effects experienced by male and female patients.

The trials selected for this pooled analysis were all evaluating first line chemotherapy regimens for patients with advanced OG cancer. The four trials included were large international trials conducted in the UK and Australasia with comparable patient populations and treatments. In total, 1654 patients were included: 80 percent were male and 20 percent were female. A greater proportion of gastric as opposed to junctional or oesophageal cancers were seen in female patients.

Based on the toxicities captured commonly in all four trials, the analysis showed no significant difference between the overall rates of toxicity experienced by men and women. Although women were found to have experienced significantly higher rates of nausea and vomiting, with 89.3 percent of women versus 78.3 percent of men experiencing this common toxicity.

Women were also more prone to diarrhoea (53.8 percent of females compared to 46.9 percent of males), mouth ulceration (49.5 percent versus 40.7 percent) and hair loss (81.4 percent versus 74.3 percent) at all grades of severity. However more male patients suffered from peripheral neuropathy (49.3 percent ) – damage to peripheral nerves resulting in loss of sensation – compared to 42.6 percent of females.

In terms of treatment efficacy, no significant difference was seen in survival between male and female patients. The overall response rate – namely the number of patients achieving a reduction in tumour size on chemotherapy – was higher in males to an extent that approached but did not reach statistical significance.

Study author Dr. Michael Davidson, Royal Marsden Hospital NHS Foundation Trust, London, said, “Going forward, we might consider stratifying patients according to their gender in clinical trials, so as to evaluate the efficacy and tolerance of treatments in each sex from the beginning of drug development.”

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