4.6 Review

New Implications of Patients' Sex in Today's Lung Cancer Management

Journal

CANCERS
Volume 14, Issue 14, Pages -

Publisher

MDPI
DOI: 10.3390/cancers14143399

Keywords

sex; gender; lung cancer; epidemiology; screening; immunotherapy

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This paper highlights the importance of considering sex as a significant factor in modern thoracic oncology practice. It discusses the differences between males and females in lung cancer demographics, immune system responses, presence of oncogenic drivers, and response to targeted therapies. The paper also emphasizes the need for targeted smoking cessation campaigns for women and the importance of including women in lung cancer screening trials.
Simple Summary We aim to raise awareness that sex is an important factor to take into account in modern-day thoracic oncology practice. Summarized, women should be specifically targeted in smoking cessation campaigns and sex-specific barriers should be addressed. Women present more often with adenocarcinoma histology and EGFR/ALK alterations, as lung cancer in never-smokers is more common in women compared to men. Lung cancer in female patients may show a poorer response to immune checkpoint inhibition; therefore, the addition of chemotherapy should be considered. On the other hand, women experience more benefits from targeted therapy against EGFR. In general, prognosis for women is better compared to that in men. Lung cancer screening trials report that women derive more benefit from screening, although they have not been designed for women. Future trial designs should take this into account and encourage participation of women. This paper describes where and how sex matters in today's management of lung cancer. We consecutively describe the differences between males and females in lung cancer demographics; sex-based differences in the immune system (including the poorer outcomes in women who are treated with immunotherapy but no chemotherapy); the presence of oncogenic drivers and the response to targeted therapies according to sex; the greater benefit women derive from lung cancer screening and why they get screened less; and finally, the barriers to smoking cessation that women experience. We conclude that sex is an important but often overlooked factor in modern-day thoracic oncology practice.

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