Women are more likely to survive cancer than men but face a higher risk of serious and adverse side effects from treatment, according to a landmark international study from Adelaide University.
Published in the Journal of the National Cancer Institute (JNCI) and conducted in partnership with a international collaborators, the research identified consistent differences between male and female cancer patients in both survival and treatment toxicity.
Female patients had a 21% lower risk of death compared with male patients, yet a 12% higher risk of severe toxicities.
These sex-based differences were largely consistent across 12 advanced solid tumour types as well as treatment modalities including chemotherapy, targeted therapies and immunotherapy, suggesting they stem from underlying biological mechanisms, not just drug-specific effects.
Importantly, rather than focusing on how specific cancer treatments affect men and women differently – the traditional approach – the study looked at whether sex itself predicts survival and toxicity, regardless of treatment type.
Lead author Dr Natansh Modi said the study provides some of the clearest evidence yet that biological sex is a key predictor of outcomes in cancer care.
“Sex is a fundamental biological factor that influences immune function, drug metabolism, body composition and tumour biology,” Dr Modi said.
“Yet despite longstanding recommendations from regulatory and funding bodies to report outcomes by sex, it is still treated as an afterthought in many trials and is rarely factored into baseline risk or used to personalise treatment decisions.
“Our study addresses this by looking at whether sex itself predicts survival and toxicity across a wide range of cancers and therapies.
“The results were clear: women had a 21% lower risk of death compared to men, but they also faced a 12% higher risk of severe side effects.
“Women demonstrated a survival advantage, but at the cost of increased severe toxicity.”
The study analysed data from more than 20,000 cancer patients across 39 clinical trials supporting US FDA approvals between 2011 and 2021, and spanned 12 advanced solid tumour types, including lung, colorectal, melanoma, and breast cancers.
The findings have important implications for how drugs are evaluated and prescribed, strengthening the case for routinely reporting and acting on sex-specific evidence in clinical research.
Researchers are now calling for biological sex to be recognised as a core prognostic factor in oncology, both in clinical trials and everyday cancer care.
“This is about improving outcomes for every cancer patient,” Dr Modi said.
“If women are living longer but experiencing more severe side effects, we need to acknowledge that and respond to it. At the same time, we need to better understand why male patients appear to have poorer survival.”
The team says 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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Media contacts:
Dr Natansh Modi, School of Pharmacy and Biomedical Sciences, Adelaide University. E: natansh.modi@adelaide.edu.au
Annabel Mansfield, Senior Media Adviser Adelaide University. T : +61 479 182 489 E : Annabel.Mansfield@adelaide.edu.au
JNCI Journal of the National Cancer Institute
Meta-analysis
Not applicable
Sex-based prognosis in industry-sponsored advanced solid tumour trials: an individual participant data meta-analysis of survival and adverse events
16-Feb-2026
Ashley M. Hopkins is a recipient of investigator-initiated funding for research outside the scope of the current study from Boehringer Ingelheim. Andrew Rowland and Michael J. Sorich are recipients of investigator-initiated funding for research outside the scope of the current study from AstraZeneca, Boehringer Ingelheim, Pfizer, and Takeda. Andrew Rowland is a recipient of speaker fees from Boehringer Ingelheim and Genentech outside the scope of the current study. Nicole M. Kuderer reports receiving consulting fees from AstraZeneca, Janssen, Pfizer Inc., Bristol Myers Squibb, BeyondSpring Inc., G1 Therapeutics, Inc., Sandoz, Seagen Inc., and Fresenius Kabi outside the submitted work. Gary H. Lyman reported receiving consulting fees from AstraZeneca, Sandoz, G1 Therapeutics, Inc., BeyondSpring Inc., and Fresenius Kabi outside the submitted work. Sandra M. Swain reports a grant to the institution and paid non-promotional speaking, consulting, and in-kind manuscript writing monies from Genentech–Roche. Swain also reports grants to the institution from Kailos Genetics and consulting fees paid from Sanofi, AstraZeneca, Daiichi Sankyo, Merck, Molecular Templates, Chugai, Tersera, and Napo Pharmaceuticals. SM. Swain reports a board of director position for Seagen with stock (discontinued 12.23) and Immunome with stock options. Sandra M. Swain reports support for attending meetings and travel from Sanofi, Daiichi Sankyo, and Downloaded from https://academic.oup.com/jnci/advance-article/doi/10.1093/jnci/djag046/8487769 by guest on 15 March 2026Roche/Genentech. The author team has no other support, financial relationship, or other relationship activities that could appear to have influenced the submitted work.