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Research Reveals Immunotherapy More Effective in Men

Couple receiving test results

For mesothelioma patients, immunotherapy is mostly available through clinical trials at this time.

Immunotherapy is a relatively new way to treat cancer, and doctors still are learning who will respond best to these novel therapies.

Newly released medical research has found men seem to respond better to immunotherapy than women.

But this doesn’t mean immunotherapy is off the table for women with mesothelioma.

You should learn all you can about how immunotherapy works, why it may or may not be right for you and how you can best prepare yourself if you decide an immunotherapy clinical trial is right for you.

Thorough Review of Immunotherapy Research

In June 2018, Lancet Oncology published a systematic review and meta-analysis of high-quality immunotherapy clinical trials.

A systematic review answers a defined research question by carefully considering the highest quality evidence about the question of interest.

In the Lancet Oncology report, the question of interest was, “Is there a difference in how well men and women with cancer respond to a type of immunotherapy known as immune checkpoint inhibitors?”

A meta-analysis uses statistical methods to combine the data from the studies included in the review. By combining the studies together, researchers end up with a larger pool of people to analyze.

Having a larger study sample improves a researcher’s ability to uncover differences between the groups. In the Lancet Oncology paper, the groups being compared were men and women receiving immunotherapy.

How Men and Women Respond to Immunotherapy

The study authors wanted to understand if there is a difference in efficacy of immune checkpoint inhibitors between men and women, in terms of overall survival in male and female participants.

The systematic review included 20 high-quality randomized, controlled trials of four immune checkpoint inhibitors:

  • Yervoy (ipilimumab)

  • Tremelimumab

  • Opdivo (nivolumab)

  • Keytruda (pembrolizumab)

The 20 studies included 11,351 people with metastatic cancer. Sixty-seven percent of study participants were men and 33 percent were women.

Sixty-three percent of the people in the studies had melanoma or non-small cell lung cancer. The remaining participants had renal cell carcinoma, urothelial cancer or head and neck cancer.

Men receiving checkpoint inhibitors had 28 percent reduced risk of dying during the study period compared with men who did not receive these drugs.

Women receiving checkpoint inhibitors had 14 percent reduced risk of dying during the study period compared with women who did not receive these drugs.

This difference represents a significantly better response rate to immune checkpoint inhibitors among men compared with women.

Study authors concluded all patients benefitted from receiving immune checkpoint inhibitors, but women received less benefit than men.

Should Women Be Considered for Immunotherapy?

According to a commentary by Dr. Omar Abdel-Rahman, which accompanied the study publication, “Female patients who are otherwise indicated for treatment with any immune checkpoint inhibitor should not be denied treatment solely on the basis of these findings.”

Even if women with advanced cancer did not seem to benefit from immune checkpoint inhibitors as much as men, they still fared better than women in control groups not receiving these drugs.

How to Make the Most of Immunotherapy

CancerCare recently hosted two one-hour education workshops featuring panels of immunotherapy experts. Part I of the teleconference presented an overview of immunotherapy.

Part II focused exclusively on immunotherapy side effects.

The experts shared information on differences between chemotherapy and immunotherapy side effects and how these side effects are addressed to ensure patient well-being and safer use of the newer medications.

Harness Your Microbiome

Also consider the role of your microbiome in how your immune system functions.

The microbiome refers to the trillions of bacteria, viruses, fungi and other microbes that inhabit the human body. These microbes play an important role in normal, human immune function.

Experts now know a healthier microbiome — particularly in the gut — means better immune function.

Certain diet and lifestyle choices support a more diverse microbiome. A richer gut microbiome, in turn, seems to support the body’s healthy response to immunotherapy.

The following steps support a varied and healthy microbiome:

  • Eat microbiome-friendly foods such as vegetables, fruit, nuts, seeds, beans, peas and whole grains.

  • Eat fermented foods such as yogurt, kefir and sauerkraut.

  • Get enough sleep. Most experts recommend between seven and nine hours of sleep per night and keeping consistent sleeping and waking hours.

  • Move your body every day. Avoid sitting for hours and enjoy daily physical activity such as walking.

  • Maintain a healthy body weight.

For healthier gut bacteria, experts also advise avoiding artificial sweeteners and taking antibiotics only when needed. They recommend eating more high-fiber foods such as oatmeal, apples, bananas, broccoli, lentils and other edible plants.

These nutrition tips may not be appropriate for some mesothelioma cancer patients during treatment.

Talk to your doctor or dietitian if you are losing weight without trying or have questions about your diet before, during or after mesothelioma treatment.


Suzanne Dixon is a registered dietitian, epidemiologist and experienced medical writer. She has volunteered with the National Cancer Policy Forum, Oncology Nutrition Dietetic Practice Group, American Institute for Cancer Research, American Society for Clinical Oncology, The National Academies of Sciences, Engineering, and Medicine. The New York Times and Time Magazine also have reviewed her cancer patient resources. Read More

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