Precision Immuno-Oncology in NSCLC through Gender Equity Lenses

Simple Summary Precision immuno-oncology, the development of personalized treatments using the unique nature of an individual's DNA, immune cells, and their tumor's molecular profile, offers great promise. However, it has been well documented that biological sex considerably influences innate and adaptive immune responses, thereby conferring differences in the efficacy of lung cancer therapy between men and women. Despite this, women remain underrepresented in oncology clinical trials; this exclusion has resulted in our harboring of a limited understanding of the impact of immunotherapy on females and their survivorship, in addition to imprecise clinical recommendations. This review provides an overview of the sex-specific differences in immunity and immunotherapy efficacy, discusses contributing factors for the lack of women in clinical trials, and suggests future directions for precision oncology research, to ultimately aid in the development of treatment guidelines and recommendations that wholly consider the unique impact of immunotherapy on females and the intersectionality among them.Abstract Precision immuno-oncology involves the development of personalized cancer treatments that are influenced by the unique nature of an individual's DNA, immune cells, and their tumor's molecular characterization. Biological sex influences immunity; females typically mount stronger innate and adaptive immune responses than males. Though more research is warranted, we continue to observe an enhanced benefit for females with lung cancer when treated with combination chemoimmunotherapy in contrast to the preferred approach of utilizing immunotherapy alone in men. Despite the observed sex differences in response to treatments, women remain underrepresented in oncology clinical trials, largely as a result of gender-biased misconceptions. Such exclusion has resulted in the development of less efficacious treatment guidelines and clinical recommendations and has created a knowledge gap in regard to immunotherapy-related survivorship issues such as fertility. To develop a more precise approach to care and overcome the exclusion of women from clinical trials, flexible trial schedules, multilingual communication strategies, financial, and transportation assistance for participants should be adopted. The impact of intersectionality and other determinants of health that affect the diagnosis, treatment, and outcomes in women must also be considered in order to develop a comprehensive understanding of the unique impact of immunotherapy in all women with lung cancer.