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Poster Discussion session -Gastrointestinal, non-colorectal

5236 - Influence of sex on chemotherapy efficacy and toxicity in oesophagogastric (OG) cancer: a pooled analysis of 4 randomised trials


19 Oct 2018


Poster Discussion session -Gastrointestinal, non-colorectal


Management of Systemic Therapy Toxicities;  Cytotoxic Therapy;  Supportive Care and Symptom Management

Tumour Site

Oesophageal Cancer;  Gastric Cancer


Michael Davidson


M. Davidson1, A.D. Wagner2, K. Kouvelakis3, N. Starling1, I. Chau1, D. Watkins1, S. Rao1, C. Peckitt3, D. Cunningham1

Author affiliations

  • 1 Gastrointestinal Department, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB
  • 2 Medical Oncology, Centre Hospitalier Universitaire Vaudois - CHUV, 1011 - Lausanne/CH
  • 3 R&d, Royal Marsden Hospital NHS Foundation Trust, SW3 6JJ - London/GB


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Abstract 5236


Sex is a contributing factor to inter-patient variability of chemo metabolism and dose-response, potentially influencing both efficacy and toxicity. Use of a triplet chemo regimen comprising an anthracycline, platinum and fluoropyrimidine remains a standard option in first line treatment of advanced OG cancer. Comparative data on the effect of sex on chemo-related toxicity in this tumour type are lacking.


Data for pts randomised to ECF, ECX, EOF or EOX chemo within 4 UK-NCRI multicentre RCTs of first line treatment in advanced OG cancer were pooled. Demographic and outcome data, and prevalence of all grade and grade ≥3 toxicity were compared between males and females. Adverse events and response rates were compared by Chi-squared test; survival outcomes by log-rank test.


1654 pts were included; 1328 males (80.3%) and 326 females (19.7%). Age and PS were equally distributed; gastric tumours were more prevalent in females (57.4 vs 34.1%). For toxicities captured commonly across all 4 trials there was no significant difference in all grade or grade ≥3 toxicity between females and males (67.2 vs 62.8%; p=0.19). Females experienced significantly higher rates of nausea and vomiting, both all grade (89.3 vs 78.3%; p<0.001) and grade ≥3 (16.7 vs 9.5%; p<0.001); all grade diarrhoea (53.8 vs 46.9%; p=0.027); all grade stomatitis (49.5 vs 40.7%; p=0.004) and all grade alopecia (81.4 vs 74.3%; p=0.009). There was a trend towards increased rates of grade ≥3 neutropaenia and febrile neutropaenia (45.1 vs 40.4% and 11.8 vs 7.7% respectively), although significance was not reached. Males experienced significantly more all grade peripheral neuropathy (49.3 vs 42.6%; p=0.03). There was no difference in PFS or OS by sex; ORR was higher in males (46.6 vs 40.4%), which approached significance (p=0.051).


This represents the largest pooled analysis of sex effect on outcome and toxicity in advanced OG cancer pts treated with equivalent first line chemo. Females demonstrated significantly higher rates of a number of toxicities, primarily GI in nature, and a trend towards increased rates of neutropaenia. Such results suggest that further research on the impact of sex on the efficacy and toxicity of chemo is necessary.

Clinical trial identification

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