Women are more likely to survive cancer than men, but are at greater risk of serious side effects from treatment, according to a landmark international study from the University of Adelaide.
Published in Journal of the National Cancer Institute (JNCI) The study, conducted in collaboration with international collaborators, identified consistent differences between male and female cancer patients in both survival and treatment toxicity.
Female patients had a 21% lower risk of death than male patients, but a 12% higher risk of severe toxicity.
These gender-based differences were largely consistent across 12 types of advanced solid tumors and treatments including chemotherapy, targeted therapy, and immunotherapy, suggesting that these differences derive from underlying biological mechanisms and not just drug-specific effects.
Importantly, rather than focusing on how specific cancer treatments affect men and women differently (the traditional approach), this study focused on whether sex itself predicts survival and toxicity, regardless of treatment type.
Lead author Dr. Natanshu Modi said this study provides some of the clearest evidence to date that biological sex is an important predictor of cancer treatment outcome.
Gender is a fundamental biological factor that influences immune function, drug metabolism, body composition, and tumor biology.
However, despite long-standing recommendations by regulatory and funding bodies to report outcomes by gender, gender remains an afterthought in many trials, rarely factored into baseline risk or used in individualized treatment decisions.
Our study addresses this question by examining whether sex itself predicts survival and toxicity across different cancers and treatments.
The results were clear: women had a 21% lower risk of death than men, but also a 12% higher risk of serious side effects.
Females showed a survival advantage, but at the cost of increased severe toxicity. ”
Dr. Natanshu Modi, first author
The study analyzed data from more than 20,000 cancer patients across 39 clinical trials supporting U.S. Food and Drug Administration approval from 2011 to 2021, targeting 12 types of advanced solid tumors, including lung cancer, colorectal cancer, melanoma, and breast cancer.
The findings have important implications for how medicines are evaluated and prescribed, and reinforce the need to regularly report and act on sex-specific evidence in clinical research.
Researchers are now calling for recognition of biological sex as a core prognostic factor in oncology, both in clinical trials and routine cancer treatment.
“This is about improving outcomes for all cancer patients,” Dr. Modi said.
“If women are living longer but are experiencing more severe side effects, we need to acknowledge and address that. At the same time, we need to better understand why male patients appear to have lower survival rates.”
The researchers say further research is needed to understand the biological mechanisms driving these differences, including drug exposure, immune regulation, hormonal influences, and body composition.
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Reference magazines:
Chhetri, R. others. (2026). Gender-based prognosis in industry-sponsored advanced solid tumor trials: A meta-analysis of individual participant data on survival and adverse events. JNCI: Journal of the National Cancer Institute. DOI: 10.1093/jnci/djag046. https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djag046/8487769
