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Table of Contents
Year : 2021  |  Volume : 4  |  Issue : 3  |  Page : 595-596

Authors' reply to Sansar et al. and Kumar

1 Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre, Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh, India
2 Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, India

Date of Submission16-Aug-2021
Date of Acceptance29-Aug-2021
Date of Web Publication08-Oct-2021

Correspondence Address:
Akhil Kapoor
Department of Medical Oncology, Mahamana Pandit Madan Mohan Malviya Cancer Centre, Homi Bhabha Cancer Hospital, Tata Memorial Centre, Varanasi, Uttar Pradesh
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_195_21

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How to cite this article:
Kapoor A, Noronha V, Prabhash K. Authors' reply to Sansar et al. and Kumar. Cancer Res Stat Treat 2021;4:595-6

How to cite this URL:
Kapoor A, Noronha V, Prabhash K. Authors' reply to Sansar et al. and Kumar. Cancer Res Stat Treat [serial online] 2021 [cited 2021 Dec 9];4:595-6. Available from: https://www.crstonline.com/text.asp?2021/4/3/595/327784

We thank Sansar and Kumar et al. for reading our article and the accompanying editorial with interest and providing valuable comments.[1],[2],[3],[4] We completely agree with the comment that women were underrepresented in the study as they comprised only 23% of the study population. However, our study represents the real-world data, with a similar percentage of female patients (29%) reported even in the study from France.[5] Since our study included patients who were treated with immunotherapy until 2018, there were no patients who received the combination of chemotherapy plus immunotherapy as this was not approved at that time. In addition, our study included patients who received immunotherapy in the second-line setting or beyond, consistent with the approvals at the time of treatment of the study patients.

The comment by Sansar and Sambasivaiah that pneumonitis was more commonly seen in male patients compared to female patients and that smoking could be a confounding factor for the same is intriguing.[3] However, in a case–control study by Cui et al., the risk factors for pneumonitis in patients treated with immunotherapy included prior thoracic radiotherapy, prior lung disease, and combination therapy identified by multiple logistic regression analysis.[6] Smoking was not found to be a risk factor in this study. In another study by Voong et al., former/current smokers were found to have a significantly higher incidence of pneumonitis than non-smokers.[7] An interesting finding in this regard is that the incidence of any-grade pneumonitis was found to be significantly higher in patients receiving programmed death (PD)-1 inhibitors than in those receiving PD-L1 inhibitors.[8] It is hypothesized that this could stem from the fact that anti-PD-1 drugs can influence both the PD-L1 and PD-L2 pathways, while anti-PD-L1 drugs can only impact the PD-L1 pathway.[8]

Finally, we agree with both Sansar and Kumar et al. that the hunt for the perfect biomarker for response to immunotherapy is still ongoing.[3],[4] It may be possible that there will never be a single biomarker, which will do the job;[9] instead, a “cancer immunogram,” comprising multiple clinical, pathologic, and biomarker-based analysis, may guide the clinicians in selecting the patients for immunotherapy.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Kapoor A, Noronha V, Patil VM, Joshi A, Menon N, Mahajan A, et al. Impact of sex of the patient on efficacy and safety of cancer immunotherapy: A retrospective audit. Cancer Res Stat Treat 2021;4:238-43.  Back to cited text no. 1
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Khaddar S, Mishra BK. Biomarkers for response to immune checkpoint inhibitors: Where do we stand? Cancer Res Stat Treat 2021;4:363-4.  Back to cited text no. 2
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Sansar B, Sambasivaiah K. Evolving immunotherapy approaches and their efficacy based on sex of the patient: A reflection. Cancer Res Stat Treat 2021;4:593-4.  Back to cited text no. 3
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Kumar S. A perfect biomarker for immune checkpoint inhibition-An elusive goal? Cancer Res Stat Treat 2021;4:594-5.  Back to cited text no. 4
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Giaj Levra M, Cotté FE, Corre R, Calvet C, Gaudin AF, Penrod JR, et al. Immunotherapy rechallenge after nivolumab treatment in advanced non-small cell lung cancer in the real-world setting: A national data base analysis. Lung Cancer 2020;140:99-106.  Back to cited text no. 5
Cui P, Liu Z, Wang G, Ma J, Qian Y, Zhang F, et al. Risk factors for pneumonitis in patients treated with anti-programmed death-1 therapy: A case-control study. Cancer Med 2018;7:4115-20.  Back to cited text no. 6
Voong KR, Hazell S, Hu C, Hayman J, Hales R, Marrone K, et al. MA 09.08 Receipt of chest radiation and immune-related pneumonitis in patients with NSCLC treated with anti-PD-1/PD-L1. J Thorac Oncol 2017;12:S1837.  Back to cited text no. 7
Khunger M, Rakshit S, Pasupuleti V, Hernandez AV, Mazzone P, Stevenson J, et al. Incidence of pneumonitis with use of programmed death 1 and programmed death-ligand 1 inhibitors in non-small cell lung cancer: A systematic review and meta-analysis of trials. Chest 2017;152:271-81.  Back to cited text no. 8
Rangarajan B, Abhinav RK. Beyond the tumor and tumor milieu-Factors affecting responses to immunotherapy. Cancer Res Stat Treat 2019;2:224-5.  Back to cited text no. 9
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