Female patients more likely to survive but experience worse side effects from cancer treatment

Author: Ingrid Torjesen

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Female patients are more likely to survive longer than male patients, but experience more nausea, vomiting and diarrhoea during chemotherapy, an analysis of over 3000 patients with cancer of the oesophagus and stomach suggests.

Oncologists from The Royal Marsden NHS Foundation Trust who led the research, in collaboration with the UK Medical Research Council Clinical Trials Unit at University College London, say their findings, which will be presented in a poster session at this weekend's American Society of Clinical Oncology Annual Meeting in Chicago, could potentially help to tailor the management of patients and also highlight those more at risk from specific side effects.

They analysed data taken from four previously published large randomised trials conducted primarily in the UK. Patients in the trials had been allocated to receive chemotherapy before undergoing surgery to remove the tumours.

In the analysis of 3265 patients - 2668 male patients and 597 female - researchers found female patients were significantly more likely to experience nausea (10% versus 5%), vomiting (10% versus 4%) and diarrhoea (9% versus 4%). Female patients were also significantly more likely to live longer than males following treatment for their cancer, with researchers finding an average of five months additional survival for women.

The researchers also looked to see whether there were any differences dependent on age. They found that whilst older patients (70 years or more) experienced significantly more neutropenia - low white blood cells - whilst receiving chemotherapy, there were otherwise no significant differences in cancer-related survival when compared with the younger patients (aged below 70).

Senior author Professor David Cunningham, consultant medical oncologist at The Royal Marsden NHS Foundation Trust, said: "This is a significant finding based on a large scale data set, and furthers our understanding about two types of cancer that affect almost 16,000 people each year in the UK alone."

"The complexity of cancer is a constant challenge to developing effective treatments, with hundreds of different types affecting patients in different ways. At The Royal Marsden we are focused on developing smarter, kinder and more personalised treatments."

Dr Avani Athauda, clinical research fellow at The Royal Marsden NHS Foundation Trust, said: "We tend to use a standard treatment approach for managing oesophageal and stomach cancers. What this research suggests is that there are significant differences between male and female patients not only in how they react to chemotherapy but also how long they survive following treatment for their cancer. For female patients, it may be worthwhile providing additional awareness and counselling for gastrointestinal side effects when prescribing chemotherapy.

"We already know that there are vast differences in the biology of these cancers between individual patients and we plan to further investigate at a genetic level why there might be such differences in how patients benefit from chemotherapy with varying survival. This may help to explain the differences we have observed between male and female patients undergoing the same treatments."

Researchers are following on from this study by looking at tumour samples from patients enrolled into the trials to identify, at a molecular level, markers that may help to predict which patients do well and which don't.


*Impact of age and sex on chemotherapy (CTx) efficacy, toxicity and survival in early oesophagogastric (OG) cancer: A pooled analysis of 3265 patients from four large randomised trials (OE02, OE05, MAGIC & ST03), will be presented by Dr Avani Athauda on Monday 3rd June 2019 at the American Society of Clinical Oncology (ASCO) Annual Meeting in Chicago

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