Inclusion and Reporting of Transgender and Nonbinary Persons in Clinical Trials and Tumor Registries—The Time Is Now

Cortina, Chandler S.

doi:10.1001/jamaoncol.2022.1638

Cited by 15 publications

(17 citation statements)

References 8 publications

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“…In addition, the gay, bisexual, lesbian, transgender, and intersex populations also need more attention from future trials 94,95 . As the transgender population increases, 96 the implications that gender‐affirming hormone therapy and social determinants of health may have on immunotherapy effectiveness should be better evaluated 94–97 . Moreover, since sexual chromosomes can have several roles in immune response and regulation, 93 intersex patients should also receive more attention based on their chromosome status.…”

Section: Discussionmentioning

confidence: 99%

“… 94 , 95 As the transgender population increases, 96 the implications that gender‐affirming hormone therapy and social determinants of health may have on immunotherapy effectiveness should be better evaluated. 94 , 95 , 96 , 97 Moreover, since sexual chromosomes can have several roles in immune response and regulation, 93 intersex patients should also receive more attention based on their chromosome status. Consequently, upcoming studies and clinical trials should consider addressing these questions in their designs to guarantee a better‐personalized approach for the future.…”

Section: Discussionmentioning

confidence: 99%

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Effectiveness of immunological agents in non‐small cell lung cancer

et al. 2022

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Background and aim: Non-small cell lung cancer (NSCLC) continues to claim millions of lives worldwide. Although its poor prognosis is largely attributed to the lack of adequate and precise detection technologies, cancer cells' suppression of the immune system adds on to the difficulty of identifying abnormal NSCLC tumors in their early stages. Therefore, cancer immunotherapy, which activates the immune system and helps it fight tumors, has recently become the most sought-after technique, especially in the advanced stages of NSCLC, where surgery or chemotherapy may or may not bring about the desired survival benefits in patients.Methods: This review focuses on the various immunotherapeutic interventions and their efficacy in advanced NSCLC clinical trials. Monoclonal antibodies like anti-PD-1/PD-L1 agents and anti-CTLA-4 antibodies, cancer vaccines, oncolytic viruses and adoptive T cell therapy have been discussed in brief. Furthermore, the effects of gender, age, and race on the efficacy of immune checkpoint inhibitors and suggest plausible future approaches in the realm of immuno-oncology.Results: Immunotherapy is used alone or in combination either with other immunological agents or with chemotherapy. However, the efficacy of these strategies depends extensively on various demographic variables, as some patients respond perfectly well to immunotherapy, while others do not benefit at all or experience disease progression. By targeting a "hallmark" of cancer (immune evasion), immunotherapy has transformed NSCLC management, though several barriers prevent its complete effectiveness.Conclusions: All these immunological strategies should be interpreted in the current setting of synergistic treatment, in which these agents can be combined with chemotherapy, radiotherapy, and, or surgery following patient and tumor characteristics to proportionate the best-individualized treatment and achieve superior results. To better pursue this goal, further investigations on cost-effectiveness and sex-gender, race, and age differences in immunotherapy are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Effectiveness of immunological agents in non‐small cell lung cancer

et al. 2022

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“…Because transgender individuals experience incongruence between the sex assigned to them at birth and their sex identity, they are excluded from conventional clinical studies (or standard screening) that require persons to identify within the typical sex dichotomy criteria (male or female) (Cortina, 2022). There are no studies that have evaluated routine screening mammography for transgender women (MtF) upon treatment with hormonal therapy; however, recent cohort studies have reported multiple cases of BC in these populations.…”

Section: Introductionmentioning

confidence: 99%

Risk and incidence of breast cancer in transgender individuals: a systematic review and meta-analysis

Corso

Gandini

D’Ecclesiis

et al. 2023

European Journal of Cancer Prevention

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Background and aimsThe risk of developing breast cancer in transgender individuals [male-to-female (MtF) or female-to-male (FtM)] is still inadequately quantified. We aimed to evaluate the impact of breast cancer in this population. MethodsWe conducted a systematic literature search and review using the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines through the PUBMED and SCOPUS databases. We identified six cohort studies (for both populations) plus 35 case reports. Incidence and breast cancer risk quantification were the main outcomes considered. ResultsFtM individuals had a higher risk of developing breast cancer in comparison to cisgender men [standardized incidence ratio (SIR) = 63.4; 95% confidence interval (CI), 32.2-124.9] but a lower risk than cisgender women (SIR = 0.42; 95% CI, 0.07-2.41). Similarly, MtF individuals were at higher risk of developing breast cancer in comparison to cisgender men (SIR = 22.5; 95% CI, 5.54-91.8) and at lower risk than cisgender women (SIR = 0.30; 95% CI, 0.22-0.42). ConclusionIn this systematic study and metaanalysis, we identified that FtM and MtF individuals are at substantially higher risk of developing breast cancer in comparison to cisgender men, though at lower risk than cisgender women. These individuals, in the absence of defined guidelines for breast cancer prevention, should periodically undergo breast or chest examinations.

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“…Examples of gender-affirming operations for transmasculine persons include chest masculinization surgery, colloquially called top surgery, in which the majority of breast tissue is removed, and bottom surgery, which includes metoidioplasty, phalloplasty, and scrotoplasty and may also include hysterectomy with or without bilateral-salpingo oophorectomy . While gender-affirming therapies are used to treat gender incongruence and/or gender dysphoria and are associated with improved mental health outcomes and overall well-being for transgender and nonbinary individuals, the potential long-term effects that these therapies may have on overall health, particularly gender-affirming hormone therapy and the risk of hormonally sensitive malignant tumors, is not currently well understood …”

mentioning

confidence: 99%

“…Although it will take time and continued research to elucidate the potential long-term effects of gender-affirming therapies, surgeons who perform gender-affirming operations can currently minimize the risk of future cancer development by considering germline genetic testing prior to gender-affirming surgeries for individuals who may harbor a germline genetic sequence variant or are at increased cancer risk based on family history alone. Pathogenic germline variants known to cause hereditary breast and ovarian cancer syndromes, most notably the BRCA1 and BRCA2 sequence variants, can significantly influence the type of gender-affirming operations that transgender and nonbinary persons may choose to undergo.…”

mentioning

confidence: 99%