Sex Differences and Adverse Effects between Chemotherapy and Immunotherapy for Non-Small Cell Lung Cancer

Our plain-English summary of Sex Differences and Adverse Effects between Chemotherapy and Immunotherapy for Non-Small Cell Lung Cancer, by T. Tsiouda, C. Sardeli, K. Porpodis, et al (Journal of Cancer, 2020).

The study

• Authors: T. Tsiouda, C. Sardeli, K. Porpodis, M. Pilikidou, G. Apostolidis, K. Kyrka, A. Miziou, K. Kyrka, Z. Tsingerlioti, S. Papadopoulou, A. Heva, C. Koulouris, D. Giannakidis, K. Boniou, I. Kesisoglou, A. Vagionas, C. Kosmidis, C. Sevva, G. Papazisis, A.M. Goganau, K. Sapalidis, K. Tsakiridis, S. Tryfon, M. Platanas, S. Baka, B. Zaric, B. Perin, S. Petanidis, P. Zarogoulidis
• Journal: Journal of Cancer
• Published: 2020;11(11):3407-3415
• Cited by: 17 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Lung cancer remains the leading cause of cancer mortality in men and women and around the world. Approximately 90% of cases of lung cancer are caused by smoking and the use of tobacco products. However, other factors such as asbestos, air pollution and chronic infections can contribute to pulmonary carcinogenesis. Lung cancer is divided into two broad histological categories, which develop and spread different small cell lung carcinomas and non-small cell lung carcinomas. The treatment options for lung cancer include surgery, radiotherapy, chemotherapy and targeted treatments. Tumor induced immune suppression is vital for malignant progression. Immunotherapies act by strengthening the patient's innate tendency for an immune response and give positive promise to patients with non-small cell lung cancer and small cell lung cancer. Immune checkpoint inhibitors are a new approach to cancer therapies. Just as immune therapies include a new approach to cancer biology, the toxicities associated with these factors have created new challenges in clinical practice. Materials & Methods: Patients (218) aged 40-80 years were treated with either chemotherapy or immunotherapy. Their response to treatment and any subsequent adverse drug reactions were studied. Results: 69% of patients were treated with chemotherapy and 31% were treated with immunotherapy. The type of treatment had a statistically significant effect on the undesirable effects of the treatment. Conclusions: The type of treatment was statistically significant in responding to the treatment and treatment side effects but not in the rate of death.

© The author(s).

In plain English

This study at the Theageneio Cancer Hospital, Thessaloniki, Greece, examined 218 patients with newly diagnosed squamous cell non-small cell lung cancer. Patients with tumor PD-L1 expression of 50% or less received carboplatin and nab-paclitaxel chemotherapy (151); those with 50% or more received pembrolizumab immunotherapy (67). Among 149 chemotherapy and 66 immunotherapy patients with response data, response differed significantly: complete response in 4.7% versus 21.2%, worsening disease in 40.9% versus 22.7%. Deaths did not differ significantly (20.5% versus 14.9%). In a selected subset of frequent side effects (106 chemotherapy, 41 immunotherapy patients), lower-limb neuropathy was recorded in 24 of 106 versus 1 of 41, and hypothyroidism in 1 of 106 versus 13 of 41. In a similar subset of 78 men and 68 women, side-effect patterns differed significantly by sex; gastrointestinal disorders, for example, occurred in 11 women and no men. Sex did not significantly affect response or deaths. The authors concluded that treatment type was statistically significant for response and side effects but not for death rate. The article contains several inconsistent numbers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Observational study of patient medical data from one hospital, comparing first-line chemotherapy with immunotherapy. The authors do not name the design or say whether the data were collected retrospectively.
• Who was studied: 218 patients with newly diagnosed squamous cell non-small cell lung cancer whose PD-L1 expression was available, at the Theageneio Cancer Hospital in Thessaloniki, Greece. The death table shows 119 men and 98 women. Study dates are not given.
• Exposure: Cancer treatment, not asbestos.
• Patients with PD-L1 expression of 50% or less received carboplatin and nab-paclitaxel chemotherapy (151 patients).
• Patients with 50% or more received pembrolizumab immunotherapy (67 patients).
• Main results:
  • Response differed significantly between the treatment groups (chi-square 22.01, df 3, p = 0.0005).
• Chemotherapy patients with response data (149): complete response 4.7%, partial response 32.9%, stable disease 21.5%, progressive disease 40.9%.
• Immunotherapy patients with response data (66): complete response 21.2%, partial response 45.5%, stable disease 10.6%, progressive disease 22.7%.
  • Deaths did not differ significantly by treatment type (p = 0.33). In the chemotherapy group, 31 of 151 patients (20.5%) died; in the immunotherapy group, 10 of 67 patients (14.9%) died.
  • This result comes from a selected, recoded subset of the most frequent side effects (106 chemotherapy and 41 immunotherapy patients).
• Lower-limb neuropathy: 24 of 106 chemotherapy patients (22.6%) and 1 of 41 immunotherapy patients (2.4%).
• Pancytopenia with infections: 20 of 106 chemotherapy patients (18.9%) and 1 of 41 immunotherapy patients (2.4%).
  • In the same side-effect subset (106 chemotherapy, 41 immunotherapy patients):
• Hypothyroidism: 1 chemotherapy patient (0.9%) and 13 immunotherapy patients (31.7%).
• Hyperthyroidism: 0 chemotherapy patients and 9 immunotherapy patients (22%).
• Pneumonitis: 0 chemotherapy patients and 5 immunotherapy patients (12.2%).
  The difference in side-effect pattern between the treatments was statistically significant (chi-square 90, df 12, p = 0.0005).
  • In a selected sample of 146 patients (78 men, 68 women), sex significantly differentiated the most frequent side effects (chi-square 30.38, df 12, p = 0.002). For example:
• Gastrointestinal disorders: 0 of 78 men and 11 of 68 women (16.2%).
• Newly appearing type II diabetes: 8 of 78 men (10.3%) and 2 of 68 women (2.9%).
  • Sex did not significantly affect treatment response (p = 0.22). Sex also did not significantly affect deaths (p = 0.12): 18 of 119 men (15.1%) and 23 of 98 women (23.5%) died.
• The authors' conclusion: The authors concluded that treatment type was statistically significant for treatment response and complications but not for death rate. They also concluded that sex had a statistically significant effect on treatment complications but not on response or deaths.

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Immunotherapy, Non-Small Cell Lung Cancer, Lung Cancer, Carcinogenesis, Carcinoma, Small Cell Lung Cancer, checkpoint inhibitors.

Related studies

• Role of Immunotherapy in Small Cell Lung Cancer, Thymic Epithelial Tumors, and Mesothelioma — C.L. Hann, A. Scherpereel, et al. (2019)
• Adjuvant dendritic cell based immunotherapy (DCBI) after cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for peritoneal mesothelioma, a phase II single centre open-label clinical trial: rationale and design of the MESOPEC trial — N.L. de Boer, J.P. van Kooten, et al. (2019)
• Simple nutritional intervention in patients with advanced cancers of the gastrointestinal tract, non-small cell lung cancers or mesothelioma and weight loss receiving chemotherapy: a randomised controlled trial — C. Baldwin, A. Spiro, et al. (2011)
• Activity of chemotherapy and immunotherapy on malignant mesothelioma: a systematic review of the literature with meta-analysis — T. Berghmans, M. Paesmans, et al. (2002)
• Combination raltitrexed (Tomudex(R))-oxaliplatin: a step forward in the struggle against mesothelioma? The Institut Gustave Roussy experience with chemotherapy and chemo-immunotherapy in mesothelioma — K. Fizazi, R. Caliandro, et al. (2000)
• Systemic approach to malignant pleural mesothelioma: what news of chemotherapy, targeted agents and immunotherapy? — D. Signorelli, M. Macerelli, et al. (2016)

Browse return to medical research.