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Brain cancer differs markedly between men and women

February 1, 2019

The malignant brain cancer glioblastoma behaves distinctly differently in men and women, according to new research. The newly discovered insights may elevate sex as an important factor in how patients are treated.

Scientists have long understood that men are more likely to get cancer than women  and are more likely to die of it. Glioblastoma, diagnosed twice as often in men, claims the lives of half its patients within 14 months of diagnosis.

Researchers are Washington University School of Medicine in St. Louis say they have discovered distinct molecular signatures of glioblastoma in men and women that help explain disparities in patients’ response to treatment and survival.

“The research suggests that tailoring treatments to men and women with glioblastoma based on the molecular subtypes of their tumors may improve survival for all patients,” the school said in a news release.

Imaging, genetics illuminate glioblastoma sex differences

Standard glioblastoma treatment is surgery followed by chemotherapy and radiation, yet most tumors recur within six months. Studying adults with glioblastoma, the researchers found that standard treatment is more effective in women than men.

To arrive at their findings, researchers looked at:

Tumor velocity, or the rate at which tumors grow, based on a review of MRI scans. “While initial tumor growth velocities were similar between females and males, only the females showed a steady and significant decline in tumor growth after treatment with temozolomide, the most common chemotherapy drug used to treat glioblastoma,” the school said.

Genetics. Consulting The Cancer Genome Atlas (TCGA), researchers classified tumors into 10 subtypes – five each for males and females – distinguished by gene activity and survival.

Survival factors. “We identified genetic pathways that correlated with the longest survival, and they were very different in males compared with females,” Joshua B. Rubin, MD, PhD, a Washington University professor of pediatrics and of neuroscience and the study’s co-senior author, saidin the news release. “For example, in males survival was all about regulating cell division, which suggests that drugs that block cell-cycle progression may be more effective in men. For females, survival was all about regulating invasiveness, which suggests that drugs targeting integrin signaling may be more effective in women.” Researchers also performed in vitro drug screens using glioblastoma cell lines.

Rubin discounted sex hormones as an explanation for the differences.

As he told NBC News, “The work that we have been doing would suggest that molecular mechanisms are just fundamentally different in males and females….Personalized cancer treatment approaches have to take into account whether a patient is male versus female, in the same way personalized medicine has to take into account the age of a patient.”

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