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      Sex Differences and Adverse Effects between Chemotherapy and Immunotherapy for Non-Small Cell Lung Cancer

      research-article
      1 , 2 , 3 , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 1 , 4 , 4 , 4 , 4 , 4 , 4 , 4 , 2 , 5 , 4 , 6 , 7 , 8 , 9 , 10 , 10 , 11 , 4 ,
      Journal of Cancer
      Ivyspring International Publisher
      Lung cancer, chemotherapy, immunotherapy, adverse effects

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          Abstract

          Introduction: Lung cancer remains the leading cause of cancer mortality in men and women and around the world. Approximately 90% of cases of lung cancer are caused by smoking and the use of tobacco products. However, other factors such as asbestos, air pollution and chronic infections can contribute to pulmonary carcinogenesis. Lung cancer is divided into two broad histological categories, which develop and spread different small cell lung carcinomas and non-small cell lung carcinomas. The treatment options for lung cancer include surgery, radiotherapy, chemotherapy and targeted treatments. Tumor induced immune suppression is vital for malignant progression. Immunotherapies act by strengthening the patient's innate tendency for an immune response and give positive promise to patients with non-small cell lung cancer and small cell lung cancer. Immune checkpoint inhibitors are a new approach to cancer therapies. Just as immune therapies include a new approach to cancer biology, the toxicities associated with these factors have created new challenges in clinical practice.

          Materials & Methods: Patients (218) aged 40-80 years were treated with either chemotherapy or immunotherapy. Their response to treatment and any subsequent adverse drug reactions were studied.

          Results: 69% of patients were treated with chemotherapy and 31% were treated with immunotherapy. The type of treatment had a statistically significant effect on the undesirable effects of the treatment.

          Conclusions: The type of treatment was statistically significant in responding to the treatment and treatment side effects but not in the rate of death.

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          Most cited references21

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          Cancer immunotherapy efficacy and patients' sex: a systematic review and meta-analysis

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            PD-L1 expression in advanced NSCLC: Insights into risk stratification and treatment selection from a systematic literature review.

            Tumors can evade immune detection by exploiting inhibitory immune checkpoints such as the programmed cell death-1 (PD-1)/programmed cell death ligand-1 (PD-L1) pathway. Antibodies that block this pathway offer a promising new approach to treatment in advanced/metastatic non-small cell lung cancer (NSCLC). A systematic review of the literature was conducted to assess the association of PD-L1 with important patient and disease characteristics, the prognostic significance of PD-L1 expressing NSCLC tumors, and the value of PD-L1 as a predictive biomarker of response to anti-PD-1/PD-L1 treatments in advanced/metastatic NSCLC. A total of 35 eligible studies were selected for analysis. Methods used to determine PD-L1 in NSCLC tissue varied considerably; with different PD-L1 antibodies, antibody detection methods, and staining cut-offs. Immunohistochemistry was the most frequent type of PD-L1 assay. Overall, study evidence did not support an association between PD-L1 expression and gender, age, smoking history, tumor histology (adenocarcinoma vs. squamous cell carcinoma), performance status, pathologic tumor grade or EGFR/KRAS/ALK mutational status. In several studies, high PD-L1 expression was associated with shorter survival compared with low expression. Most evidence indicated that patients with high vs. low PD-L1 expression were more likely to experience treatment benefit with anti-PD-1/PD-L1 agents (nivolumab, pembrolizumab, durvalumab, atezolizumab, and avelumab) in advanced NSCLC. Variability in the methods used to determine PD-L1 expression in NSCLC tissue suggests a need for standardized use of well-validated PD-L1 diagnostic assays. Although considerable research links PD-L1 expression in tumors to shorter survival in advanced/metastatic NSCLC, its use as a prognostic factor requires more study. As studies of anti-PD-1/PD-L1 agents continue, PD-L1 is likely to play an important role as a predictive biomarker for selecting patients deriving most benefit from anti-PD-1/PD-L1 monotherapy and directing patients with lower levels of tumor PD-L1 expression (with a high unmet medical need), to alternative treatments, such as combination immunotherapies.
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              Health-related quality-of-life results for pembrolizumab versus chemotherapy in advanced, PD-L1-positive NSCLC (KEYNOTE-024): a multicentre, international, randomised, open-label phase 3 trial.

              In the phase 3 KEYNOTE-024 trial, treatment with pembrolizumab conferred longer progression-free survival than did platinum-based therapy in patients with treatment-naive, advanced non-small-cell lung cancer (NSCLC) with a programmed cell death-ligand 1 (PD-L1) tumour proportion score of 50% or greater (PD-L1-positive). Here we report the prespecified exploratory endpoint of pembrolizumab versus chemotherapy on patient-reported outcomes (PROs).
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                Author and article information

                Journal
                J Cancer
                J Cancer
                jca
                Journal of Cancer
                Ivyspring International Publisher (Sydney )
                1837-9664
                2020
                5 March 2020
                : 11
                : 11
                : 3407-3415
                Affiliations
                [1 ]Pulmonary Department, “Theageneio” Cancer Hospital, Thessaloniki, Greece.
                [2 ]Department of Pharmacology & Clinical Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
                [3 ]Pulmonary Department, G. “Papanikolaou” General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
                [4 ]3rd Department of Surgery, “AHEPA” University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece.
                [5 ]General Surgery Clinic 1, University of Medicine and Pharmacy of Craiova, Craiova County Emergency Hospital, Craiova, Romania.
                [6 ]Thoracic Surgery Department, “Interbalkan” European Medical Center, Thessaloniki, Greece.
                [7 ]Pulmonary Department (NHS), G.H. “G. Papanikolaou” Thessaloniki, Thessaloniki, Greece.
                [8 ]Urology Department (NHS), General Hospital of Giannitsa, Giannitsa, Greece.
                [9 ]Oncology Department, “Interbalkan” European Medical Center, Thessaloniki, Greece.
                [10 ]Institute for Pulmonary Diseases of Vojvodina, Faculty of Medicine, University of Novi Sad, Serbia.
                [11 ]Department of Pulmonology, I.M. Sechenov First Moscow State Medical University, Moscow, Russian Federation.
                Author notes
                ✉ Corresponding author: Paul Zarogoulidis, M.D, Ph.D, 3rd Department of Surgery, AHEPA University Hospital, Aristotle University of Thessaloniki, Medical School, Thessaloniki, Greece; Mobile: 00306977271974. E-mail: pzarog@ 123456hotmail.com .

                Competing Interests: The authors have declared that no competing interest exists.

                Article
                jcav11p3407
                10.7150/jca.40196
                7097940
                32231747
                5c89a884-ae65-484b-af01-d1b8c7485dfe
                © The author(s)

                This is an open access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/). See http://ivyspring.com/terms for full terms and conditions.

                History
                : 11 September 2019
                : 20 January 2020
                Categories
                Research Paper

                Oncology & Radiotherapy
                lung cancer,chemotherapy,immunotherapy,adverse effects
                Oncology & Radiotherapy
                lung cancer, chemotherapy, immunotherapy, adverse effects

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