Sex-Based Approaches to Oncology in the Era of Precision Oncology: Upcoming ESMO Workshop

Sex-based approaches to studying and treating disease have remained largely unexplored in medical oncology, despite the field’s growing interest in precision medicine and accumulating evidence that sex is a major factor in disease risk and response to treatment. At an upcoming European Society for Medical Oncology (ESMO) workshop to be held in Lausanne, Switzerland, later this year, a multidisciplinary faculty of experts will discuss the concepts and methods of medicine and sex and their implications for clinical practice and research in oncology.

According to Anna Dorothea Wagner, MD, of Lausanne University Hospital, who initiated the workshop and co-authored a recent paper on the subject in the Journal of Clinical Oncology, “The need for further research to understand [the] impacts [of sex] in oncology is significant.” This meeting format—which will bring together pharmacologists, statisticians, basic scientists, and medical oncologists from different specialties—will be the first organized discussion of medicine and sex in the oncology community.

“With efforts to include sex aspects in biomedical research abounding in other areas, like cardiovascular medicine, it was high time for us in the oncology field to take notice. Now, ESMO is providing the ideal setting to do just that,” said Dr. Wagner. In five consecutive sessions, participants will take stock of existing evidence and produce perspectives for the future of this possibly important aspect of cancer treatment and care.  

The JCO paper had already pointed to various areas in which differences based on sex have been known to exist for many years, but are still poorly understood. These will be picked up at the workshop, where several discussions will focus on the differences in body composition, hormones, genetic makeup, and metabolism. For example, women experience higher toxicity with certain types of drugs, which is likely a result of their metabolizing these differently from men, due to factors that could range from higher body fat levels to differences in the activity of drug-metabolizing enzymes.

“Toxicity is a problem in itself, not least because it can cause…patients to discontinue treatment,” Dr. Wagner explained. In the case of chemotherapy, however, where chemotherapy-related toxicity is usually correlated with response, lower rates of toxicity observed in men could therefore be interpreted as a sign of relative underdosing, which may help to explain their poorer prognosis in several cancer types. “This surely deserves further investigation, as sex-specific treatment strategies might be able to improve outcomes, in particular with regard to doses and types of drugs,” said Dr. Wagner.

The known differences in immune responses between men and women are another question that will be addressed in more detail during the workshop.

When it comes to drug development, recent efforts to bring more women into traditionally male-dominated phase I and phase II trials have been only moderately successful, with enrollment of female patients remaining at a low 37%. Additionally, almost two-thirds of clinical trials still do not report any results by sex.

While sex differences in efficacy are reported more often, sex differences related to toxicity are only rarely analyzed and systematically reported. “At the ESMO Workshop in November, we will dedicate an entire session to the methodological aspects of integrating [sex] medicine into cancer clinical research. That is one step from which we all might benefit—men and women alike,” Dr. Wagner concluded.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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