We read with interest the systematic review and meta-analysis by Fabio Conforti and colleagues.
The authors reviewed 20 randomised controlled trials of immune checkpoint inhibitors (ipilimumab, tremelimumab, nivolumab, or pembrolizumab) including more than 11 000 patients, finding a relative reduction in the risk of death resulting from immunotherapy compared with standard therapies, which was significantly higher in male than in female patients. The pooled overall survival hazard ratio (HR) was 0·72 (95% CI 0·65–0·79) for men versus 0·86 (0·79–0·93) for women, with a significant difference in treatment efficacy identified between the two sexes (p=0·0019). The studied population included patients with advanced or metastatic cancers; 3632 (32%) of 11 351 patients had melanoma and 3482 (31%) had non-small-cell lung cancer. Although this meta-analysis was well conducted and attempted to identify predictive markers of response to immune checkpoint inhibitors, in our opinion, a strong bias was ignored in the interpretation of the results
fuente: the lancet oncology
