CLL Support Association
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Should men and women be treated differently?

Should men and women be treated differently?

In CLL muated/unmutated is beginning to matter in treatment choice.. but what about the other large component ...sex??

Surely in the fledgling era of personalised medicine this should be looked at?

A recent study look at this in DLBCL, think Richter's, and the use of rituxan a component in RCHOP, indicates that a higher dose in men was of great benefit...

As the study states

We conclude that the higher rituximab dose for elderly male patients abrogated the adverse prognosis of male sex without increasing toxicity. In the era of personalized medicine, sex-specific pharmacokinetics and toxicities should be investigated for all drugs where these parameters impact on outcome.

Abstract

onlinelibrary.wiley.com/doi...

Food for thought... is there a similar poorer male prognosis in CLL?

~chris

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Slightly off topic. It is the intention of the NHS in England in 2019 to ask all medics to ask patients their gender to go on their medical records. This will include gay, transsexual etc etc. It will be compulsory for a medic to ask. Why? Who knows?

Is treatment dose based on height and weight/ BMI? Have any trials treated the different sexes with different doses?

There is supposed to be a higher percentage of males with CLL so this could affect results and resultant outcomes.

If treatment is based on male dosage are females being overdosed?

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Perhaps you have never had chemo immunotherapy, which is dosed by BSA(md/m2) There are two formulas...

BSA Dubois[m2] = 0.007184 * Height[cm]0.725 * Weight[kg]0.425

BSA Mosteller[m2] = sqr(Height[cm] * Weight[kg] / 3600)

Flat dosing in some drugs like Imbruvica (ibrutinib) is currently being looked at in regards to BSA based dosing.

cancercareontario.ca/file/4...

~chris

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Most chemo doses are based on your size - square metre of surface area, and capped at 2 sq metres.

Perhaps more men than women are in excess of 2 sq m in size and therefore consequently not getting full dose chemo?

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Interesting! I've seen somewhere that doses of general medicines are - or were - measured by how much an average male needed, rather than how much a female required. I don't know if this is still in force.

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