TY  -  JOUR
AU  -  Rossi, Francesca
AU  -  Parisi, Alessandro
AU  -  Bianchi, Alessia
AU  -  Boni, Elena
AU  -  Pompilii, Paolo
AU  -  Prendi, Enio
AU  -  Tarantino, Valentina
AU  -  Giampieri, Riccardo
AU  -  Berardi, Rossana
T1  -  Gender oncology: differences in epidemiology, clinical outcome and toxicity in the two sexes. A narrative review
PY  -  2023
Y1  -  2023-09-01
DO  -  10.1723/4155.41522
JO  -  Journal of Sex- and Gender-Specific Medicine
JA  -  J Sex Gender Specif Med
VL  -  9
IS  -  3
SP  -  130
EP  -  142
PB  -  Il Pensiero Scientifico Editore
SN  -  2974-8623
Y2  -  2026/04/15
UR  -  http://dx.doi.org/10.1723/4155.41522
N2  -  Summary. Background. For a long time, there has been an androcentric view of medicine and the interest in women’s health has been relegated to specific aspects concerning reproduction. Over the last twenty years traditional medicine has undergone a significant evolution owing to an innovative approach aimed at investigating how gender and all the factors that define it (biological, environmental, cultural, and socioeconomic) affect the physiology, pathophysiology and clinical features of diseases. An increasing amount of epidemiological, clinical, and experimental data suggests the presence of gender differences in the pathogenesis, clinical manifestations, and in the response and adverse events associated with treatments of diseases common to men and women. In the field of oncology, a growing body of scientific evidence shows differences in the occurrence of diseases, as well as in the response and adverse events associated with therapies, in the two sexes.Materials and methods. To investigate gender differences in oncology regarding epidemiological data we queried the AIRTUM and GLOBOCAN databases. Furthermore, we conducted a bibliography search of scientific papers from 02.01.23 to 14.01.23 by querying Pubmed/MEDLINE to explore gender differences regarding treatments, especially in outcomes and toxicities related to therapies. The search strategy involved the use of several queries (keywords/MESH terms). The database was searched by looking for papers published from 01.01.2012 to 31.12.2022. For each query an evidence report of the selected studies is shown. A total of 42 studies were selected.Results. Analysing the incidence and mortality of cancer in association with sex, the types of cancer that can affect both sexes frequently affect men more, with very few exceptions, and deaths are also higher among men. The data shows a global reality that does not take into account differences between countries and, even relating to our country, the trend remains unchanged. Women experience a lower survival benefit than men when treated with immunotherapy as monotherapy and a greater survival benefit when treated with the combination of immunotherapy and chemotherapy. The heterogeneity of response to treatments has led to speculation about differences in the molecular mechanisms that drive the anti-tumour immune response in the two sexes. It has long been known and proven that the immune systems of men and women are different due to different hormonal structures and different genetic heritages. More drug related toxicities are detected in women than men, especially in immunotherapy and 5-FU treatment. Differences in toxicity can also be explained in a number of ways, the main one of these being concerned with differences in drug pharmacokinetics and pharmacodynamics.Conclusions. Personalised medicine that considers biological differences between patients, and which also takes into consideration cultural and social factors, should be one of the objectives for the future of medical care. Despite the rising interest in this area of oncology, there are still insufficient prospective studies. Knowing the importance of variables including race, histologic type, and tumour stage among others in making clear the effect of gender on cancer epidemiology and outcome and toxicity related to therapies could be a necessity, boosting the proportion of female patients recruited into trials. Additionally, studies might be designed with separate enrolment for men and women with suitable sample sizes planned for each. In this context the importance of gender pharmacology and the problem of the underrepresentation of women in clinical trials concerning medicinal products should not be overlooked.
ER  -