Surgery, chemotherapy and radiotherapy and now immunotherapy: The last frontier in the fight against cancer does not seek to destroy cancerous cells but rather to awaken the immune system so that it targets only the cells that are ill and eliminate them without resorting to drugs. If this were always possible, cancer could become a chronic disease, with which people could live for several years. However, the response to this new therapy seems to be better in male subjects. We talk about this topic with Professor Alberto Mantovani, Scientific Director of Humanitas and Professor at Humanitas University.
The gender involved in the success of the immune response
According to recent publications in “The Lancet Oncology”, the survival of male patients treated with immunotherapy is twice that of female patients. The group of researchers of the European Institute of Oncology have referred to about twenty publications that had considered more than eleven thousand patients with a tumor in an advanced stage: melanoma, renal cancer, lung cancer, tumors of the head and neck and urothelial neoplasms. At the end of treatment with immune checkpoint inhibitor drugs (ipilimumab, tremelimumab, nivolumab or pembrolizumab), results showed that the gain in terms of prolonging the survival of men receiving immunotherapy is almost twice that of women.
The immune response, in short, seems to be implied by the gender to which the patient belongs. On average, women have a stronger response than men to many pathogens, which is why they generally contract fewer infections and are less severe and more responsive to vaccinations. On the other hand, only 8% of patients with autoimmune diseases are women. It therefore appears that differences in the immune system between women and men play a decisive role in the course of chronic inflammatory diseases and their response to medication.
The authors of the study also added that these differences would be linked at the cellular level to complex interactions between genes, hormones, environment and the composition of the microbiome, the set of genomes of bacterial species that inhabit the intestine.
Prospects for the future
The result reported by Lancet Oncology requires confirmation and above all an understanding of the immunological mechanisms underlying them, in order to develop effective immunotherapy approaches in both sexes. On the other hand, gender differences should be studied more deeply, in order to better understand the mechanisms underlying male-female differences to ensure that innovative treatments are optimized for all, women and men. The results obtained underline the need for gender-specific analyses, in order to avoid extending results obtained mainly in male patients to women, an error that could lead to lower quality of care and, potentially, damage.