Sex differences in oncology: from molecular mechanisms to personalized therapy

Epidemiological studies demonstrate the existence of sex differences in cancer incidence and mortality. A substantial body of evidence indicates sex-related differences in responses to anticancer chemotherapy: women experience higher treatment-­related toxicity than men, while at the same time exhibiting better survival, i. e., greater therapeutic efficacy. However, sex differences in oncology remain an underappreciated factor related to tumor biology, treatment efficacy, and patient survival. Purpose of the study . This review aims to systematically consolidate current evidence on the influence of sex on malignant tumor biology, therapeutic efficacy, and toxicity, and to support the integration of sex as a fundamental variable in oncological research and clinical practice to advance personalized treatment approaches. Materials and methods . A systematic literature search was conducted in the PubMed, Web of Science, Scopus, and eLibrary.ru databases for publications from 2010 to 2025. Studies were selected based on scientific relevance, topical relevance, and compliance with contemporary standards of evidence-­based medicine. Results . The analysis identified numerous studies demonstrating significant sex-based differences in cancer epidemiology, the efficacy of anticancer therapy, and the impact of comorbid conditions. The synthesized evidence indicates that sex differences play a fundamental biological role across all aspects of oncology, from molecular mechanisms of carcinogenesis to clinical outcomes. However, despite the accumulated evidence, sex as a biological variable remains insufficiently considered in routine clinical practice. Conclusion . Consideration of sexual characteristics in oncology would optimize treatment regimens, improve survival rates, reduce therapy side effects, and enhance prognostic models. This would ensure personalized therapy that considers the biological characteristics of men and women.