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. 2023 Jul;149(7):3847-3858.
doi: 10.1007/s00432-022-04309-2. Epub 2022 Aug 23.

The role of immune checkpoint inhibitors in clinical practice: an analysis of the treatment patterns, survival and toxicity rates by sex

Murielle N Wahli  1 , Stefanie Hayoz  2 , Dennis Hoch  1 , Christoph O Ryser  1 , Michèle Hoffmann  1 , Amina Scherz  1 , Birgit Schwacha-Eipper  3   4 , Simon Häfliger  1 , Julian Wampfler  1 , Martin D Berger  1 , Urban Novak  1 , Berna C Özdemir  5
Affiliations

The role of immune checkpoint inhibitors in clinical practice: an analysis of the treatment patterns, survival and toxicity rates by sex

Murielle N Wahli et al. J Cancer Res Clin Oncol. 2023 Jul.

Abstract

Purpose: Our aim is to describe the role of immune checkpoint inhibitors (ICI) in clinical practice by providing the patient and tumor characteristics as well as survival and toxicity rates by sex.

Methods: We used electronic health records to identify patients treated at the Cancer Center of the University Hospital Bern, Switzerland between January 1, 2017 and June 16, 2021.

Results: We identified 5109 patients, 689 of whom (13.5%) received at least one dose of ICI. The fraction of patients who were prescribed ICI increased from 8.6% in 2017 to 22.9% in 2021. ICI represented 13.2% of the anticancer treatments in 2017 and increased to 28.2% in 2021. The majority of patients were male (68.7%), who were older than the female patients (median age 67 vs. 61 years). Over time, adjuvant and first line treatments increased for both sexes. Lung cancer and melanoma were the most common cancer types in males and females. The incidence of irAEs was higher among females (38.4% vs. 28.1%) and lead more often to treatment discontination in females than in males (21.1% vs. 16.8%). Independent of sex, the occurrence of irAEs was associated with greater median overall survival (OS, not reached vs. 1.1 years). Female patients had a longer median OS than males (1.9 vs. 1.5 years).

Conclusions: ICI play an increasingly important role in oncology. irAEs are more frequent in female patients and are associated with a longer OS. More research is needed to understand the association between patient sex and toxicity and survival.

Keywords: Age; Clinical practice; Gender; Immune checkpoint inhibitors; Real-world; Role; Sex.

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Conflict of interest statement

BCÖ declared receiving institutional honoraria for lectures and advisory boards from BMS, MSD, Merck, Ipsen, Roche, Pfizer, Novartis. SHäfliger declared receiving honoraria for advisory boards from Bayer AstraZeneca Lilly Novartis Roche Takeda; and travel fee from Amgen. All the other authors declared to have no conflict of interest in relation to this article.

Figures

Fig. 1
Fig. 1
A Distribution of the tumor types over the years for female and male patients. B Distribution of the treatment settings over the years for female and male patients. C Reason for treatment discontinuation for female and male patients
Fig. 2
Fig. 2
Type of all grade toxicity during or after treatment with ICI for women and men. More than one toxicity type per patient is depicted
Fig. 3
Fig. 3
OS depicted for A presence of brain metastases at diagnosis, B median age, and C sex of the patients, and D any grade irAEs
See this image and copyright information in PMC

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