{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T06:52:39Z","timestamp":1781765559832,"version":"3.54.5"},"reference-count":33,"publisher":"BMJ","license":[{"start":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T00:00:00Z","timestamp":1776384000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["875171"],"award-info":[{"award-number":["875171"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Mexico\u2019s National Council of Science and Technology","award":["1074186"],"award-info":[{"award-number":["1074186"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Thorax"],"accepted":{"date-parts":[[2026,3,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sex-based differences in immune response are well established, but whether men and women derive comparable benefit from immune checkpoint inhibitors (ICIs) in advanced non-small cell lung cancer (NSCLC) remains uncertain. This systematic review and meta-analysis aimed to investigate sex-related differences in effectiveness of ICI for the treatment of advanced NSCLC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted to compare overall survival (OS) and progression-free survival (PFS) between men and women treated with ICIs versus chemotherapy for stage III\u2013IV NSCLC. Eligible studies compared programmed cell death protein 1\/programmed cell death ligand 1 (PD-L1) inhibitors with chemotherapy and reported sex-specific OS and\/or PFS outcomes. HRs were pooled using random-effects models, and secondary analyses incorporated updated follow-up data where available.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>55 RCTs comprising 28\u2009550 adults (71.6% men; 28.4% women) were included. ICIs significantly improved OS in both men (HR=0.75, 95%\u2009CI 0.72 to 0.78)\u2009and women (HR=0.81, 95%\u2009CI 0.76 to 0.86; p=0.17 for difference). However, PFS benefits favoured men (HR=0.62, 95%\u2009CI 0.59 to 0.65) compared with women (HR=0.76, 95%\u2009CI 0.70 to 0.81; p=0.005). In analyses using the most recent follow-up data, women showed lower ICI effectiveness for both OS (p=0.043) and PFS (p=0.003).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ICIs confer similar OS benefits in men and women with advanced NSCLC, but women show shorter PFS, particularly in PD-L1-positive and monotherapy settings. Further research should clarify the biological and clinical factors underlying these differences and ensure balanced representation and equitable evaluation in future trials.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>PROSPERO registration number<\/jats:title>\n                    <jats:p>CRD42024451670.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/thorax-2025-223372","type":"journal-article","created":{"date-parts":[[2026,4,17]],"date-time":"2026-04-17T17:20:37Z","timestamp":1776446437000},"page":"thorax-2025-223372","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Sex-based differences in effectiveness of immune checkpoint inhibitors in the treatment of advanced non-small-cell lung cancer: systematic review and meta-analysis"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1518-7405","authenticated-orcid":false,"given":"Erick","family":"Suazo-Zepeda","sequence":"first","affiliation":[{"name":"Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Grietje G","family":"Talen","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sjoukje","family":"van der Werf","sequence":"additional","affiliation":[{"name":"Medical Library, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"},{"name":"Medical Library, University of Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0665-2160","authenticated-orcid":false,"given":"Jeroen T J N","family":"Hiltermann","sequence":"additional","affiliation":[{"name":"Pulmonary Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willemijn","family":"Maas","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3104-4471","authenticated-orcid":false,"given":"Geertruida H","family":"De Bock","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5712-4085","authenticated-orcid":false,"given":"Marjolein A","family":"Heuvelmans","sequence":"additional","affiliation":[{"name":"Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands"},{"name":"Institute for Diagnostic Accuracy, Groningen, The Netherlands"},{"name":"Department of Respiratory Medicine, Amsterdam University Medical Center, Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,4,17]]},"reference":[{"key":"2026041710201918000_thorax-2025-223372v1.1","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1038\/nature25183","article-title":"The biology and management of non-small cell lung cancer","volume":"553","author":"Herbst","year":"2018","journal-title":"Nature New Biol"},{"key":"2026041710201918000_thorax-2025-223372v1.2","doi-asserted-by":"publisher","DOI":"10.3322\/CAAC.21834"},{"key":"2026041710201918000_thorax-2025-223372v1.3","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-023-33011-7"},{"key":"2026041710201918000_thorax-2025-223372v1.4","unstructured":"Jemal A , Torre L , Soerjomataram I . 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