Gender differences may influence outcomes with vincristine, doxorubicin, and cyclophosphamide (VAC) in the treatment of patients with standard-risk Ewing sarcoma, a recent study published online ahead of print in the European Journal of Cancer has shown.
A previous study called Euro-EWING99-R1 compared the safety and efficacy of VAC with vincristine, doxorubicin, and ifosfamide (VAI) for standard-risk Ewing sarcoma and found that VAC may be able to replace VAI; however, outcomes differed between genders.
Therefore, researchers sought to conduct an exploratory analysis to evaluate the impact of gender on treatment efficacy and toxicity.
Results showed that event-free survival was not significantly different between the 509 men and 347 women (P=0.33), but VAC was associated with a shorter event-free survival than VAI in males (HR = 1.37; 95% CI: 0.98, 1.90). On the other hand, VAC was associated with a better event-free survival compared with VAI in women (HR = 0.81; 95% CI: 0.53, 1.24).
In regard to safety, researchers found that severe toxicity was more common in women than men. Moreover, 12% of women patients and 4% of men patients switched from VAI to VAC, mostly due to renal toxicity, while only 0.6% and 0.8% of women and men patients, respectively, switched from VAC to VAI.
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The study also demonstrated that women were more likely than men to require a >20% cumulative dose reduction of cyclophosphamide or ifosfamide (P=0.005).
The findings suggest that further studies are warranted to explore the role of gender on VAC/VAI treatment outcomes in patients with Ewing sarcoma.
- van den Berg H, Paulussen M, Le Teuff G, et al. Impact of gender on efficacy and acute toxicity of alkylating agent -based chemotherapy in Ewing sarcoma: secondary analysis of the Euro-Ewing99-R1 trial. E J Cancer. 2015. [epub ahead of print]. doi: 10.1016/j.ejca.2015.06.123.