JAMA Oncology Current Issue

Error in Figure Axis Label

Tue, 01 Nov 2022 00:00:00 GMT

In the Original Investigation titled “Association of High Tumor Mutation Burden in Non–Small Cell Lung Cancers With Increased Immune Infiltration and Improved Clinical Outcomes of PD-L1 Blockade Across PD-L1 Expression Levels,” the y-axis label in Figure 1C was incorrect. It should have read “Overall survival, %.” The article has been corrected online.

JAMA Oncology

Tue, 01 Nov 2022 00:00:00 GMT

JAMA肿瘤学致力于出版influential original research, opinions, and reviews that advance the science of oncology and improve the clinical care of patients with cancer.

Incidence of Cutaneous Adverse Events With PI3K Inhibitors as Adjuvant Therapy in Patients With Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This systematic review with meta-analysis examines the incidence of phosphoinositide 3-kinase inhibitor–associated cutaneous adverse events in patients with cancer.

Surrogacy of Pathologic Complete Response in Trials of Neoadjuvant Therapy for Early Breast Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This systematic review analyzes available evidence that supports pathologic complete response as a surrogate end point for disease-free and overall survival in neoadjuvant trials for patients with early-stage breast cancer.

Defining a Therapeutic Ratio for Stereotactic Ablative Radiation Therapy in Oligometastatic Disease

Tue, 01 Nov 2022 00:00:00 GMT

For more than a century, radiation therapy has played a key role in palliating symptomatic, incurable cancers to alleviate localized symptoms for patients with metastatic cancer. In the past 2 decades since the potential existence of an oligometastatic state was described, there has been increased enthusiasm for treating metastatic cancer. As a result, technical advances in radiation delivery and research have sought to define a role for radiation beyond symptom relief.

Cancer and COVID-19 Complicated Deaths in the US, March to December 2020

Tue, 01 Nov 2022 00:00:00 GMT

这个横断面研究使用2020年死亡率data in the US to analyze deaths caused by cancer and COVID-19 in terms of demographic characteristics, cancer site, and place of death.

Quantifying Abemaciclib Benefit in Breast Cancer

Tue, 01 Nov 2022 00:00:00 GMT

To the Editor Martin et al conducted an important clinical study to assess the efficacy of abemaciclib plus endocrine therapy (A+ET) vs endocrine therapy alone (ET). Invasive disease-free survival (IDFS) was the primary end point. They concluded that A+ET demonstrated an improvement of a 39% relative risk reduction based on a hazard ratio (HR) of 0.61 (95% CI, 0.46-0.81; P < .001). The authors then used a difference of 6.6% in 2-year IDFS rates to enhance the clinical utility interpretation for A+ET. There are several issues with this analysis. The hazard, which can be much larger than 1, is not a probability measure like risk. The above interpretation of HR is incorrect. Also, the clinical utility of an HR alone without a reference hazard value from the control is difficult to assess. Moreover, in Figure 1A, the Kaplan-Meier curves for the 2 treatment groups are tangled together for the first 9 months. The proportional hazards assumption is invalid, and the observed HR cannot meaningfully quantify the treatment effect. The 2-year IDFS rate is a local summary of the survival curve, which does not use the event occurrence information before or after 2 years. Furthermore, the authors did not conduct a formal comparison analysis between the 2 treatment groups for the 2-year IDFS. The median IDFS, which usually is used to support the clinical interpretation of the HR, is not observable for the present study. It seems that the only convincing evidence for the benefit of A+ET is from the P value for the IDFS HR, which is not a clinically meaningful quantifier for the treatment effect (see formal statement by the American Statistical Association).

Quantifying Abemaciclib Benefit in Breast Cancer—Reply

Tue, 01 Nov 2022 00:00:00 GMT

In Reply We thank Drs Sun and Wei for their comments in response to our analysis of the monarchE randomized clinical trial assessing the efficacy of abemaciclib plus endocrine therapy (ET) compared with ET alone in patients receiving neoadjuvant chemotherapy. The authors acknowledge that the different metrics used in conveying clinical trial outcomes have their own values and limitations. Hazard ratio (HR), together with the P value from log-rank tests, is the standardized way of assessing treatment effect for time-to-event end points in the clinical trial setting. This is commonly accepted by regulatory agencies and medical communities around the world in interpreting treatment effect size in cancer trials, which drove the statistical design for key efficacy end points in the monarchE study.

Treatment With Stereotactic Ablative Radiotherapy for Up to 5 Oligometastases in Patients With Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This nonrandomized clinical trial examines toxic effects of treatment with stereotactic ablative radiotherapy in a large cohort from a Canadian population-based, provincial cancer program.

Adoption and Comparative Effectiveness of Extended-Interval Pembrolizumab

Tue, 01 Nov 2022 00:00:00 GMT

This retrospective cohort study examines adoption and real-world effectiveness of extended-interval pembrolizumab among a cohort of more than 800 US veterans being treated with single-agent pembrolizumab.

Subacute Abdominal Pain in a Patient With Chronic Liver Disease and Hepatocellular Carcinoma

Tue, 01 Nov 2022 00:00:00 GMT

A 66-year-old woman with chronic hepatitis B infection and hepatocellular carcinoma presented with moderate radiating epigastric pain with nausea, anorexia, and water brash without emesis. What is your diagnosis?

Keeping the Heartbeat Off-Target in Cancer Therapy

Tue, 01 Nov 2022 00:00:00 GMT

The field of cardio-oncology and the management of cardiac conditions in patients receiving chemotherapy, radiation therapy, and immunotherapy have grown in importance as more treatment options become available, survival from cancer improves, and the general population ages. Most research in this area to date has been focused on the effects of cancer therapy on the working myocardium, leading to changes in ejection fraction, and on the cell layers comprising the coronary arteries, with resultant premature ischemic heart disease. In contrast, in this issue of JAMA Oncology, 2 cohort studies focus on quantifying the association of cancer therapies with elements of the cardiac conduction system and with the electrocardiographic manifestation of myocardial repolarization, each critical for the maintenance of normal cardiac rhythm. Kim et al investigated the outcomes of mediastinal radiation therapy for small cell lung cancer (SCLC) and non–small cell lung cancer (NSCLC) by estimating radiation doses to the sinoatrial node (SAN) and neighboring substructures and report the association with new-onset atrial fibrillation (AF) and mortality in both populations. In the article by Richardson and colleagues, the clinical consequences of the formulae used to correct the QT interval for heart rate, a key determinant of ventricular proarrhythmia, were evaluated in a large cohort of patients receiving chemotherapy.

Inhibition of Omicron BA.1 and BA.4 Variants After Fourth Vaccination or Tixagevimab and Cilgavimab Administration

Tue, 01 Nov 2022 00:00:00 GMT

This cohort study assesses the capacity of passive immunization and tixagevimab and cilgavimab to inhibit interaction between receptor-binding domains and angiotensin-converting enzyme 2 in patients with hemato-oncologic diseases.

Etirinotecan Pegol Treatment for Patients With Metastatic Breast Cancer and Brain Metastases

Tue, 01 Nov 2022 00:00:00 GMT

To the Editor We read with interest the article by Tripathy et al reporting the results of the ATTAIN randomized clinical trial, which found no statistically significant difference in survival outcomes between treatment with etirinotecan pegol (EP) and chemotherapy of physician’s choice (CPC) in patients with breast cancer with brain metastases. Although this study is impressive, we have a few concerns and suggestions for this study.

Etirinotecan Pegol Treatment for Patients With Metastatic Breast Cancer and Brain Metastases—Reply

Tue, 01 Nov 2022 00:00:00 GMT

回复的评论中发送的Drs Bin Zhang and Shuixing Zhang regarding the ATTAIN randomized clinical trial, we would first like to address the fact that the size, number, and location of brain metastases were not compared between groups, but relevant prognostic factors that are contained in the validated and refined Graded Prognostic Assessment score were not different between treatment groups nor were other factors shown in Table 1. The objective response rates were low, as might be expected with treated brain metastases, but the more relevant end point of overall survival was assessed in this population based on the poorer prognosis and the observed benefit seen in the earlier BEACON trial. The same point holds for the number of patients not evaluable for response, higher than might be expected in a non–central nervous system (CNS) metastasis cohort, with a majority of nonevaluable cases owing to some patients not having postbaseline evaluations that were commonly due to deteriorating clinical status. This illustrates the challenges of studies for this population (perhaps in contrast to ERBB2-positive disease, where outcomes are better) and also highlights the importance of overall survival along with quality of life being the most relevant outcomes. We would additionally like to point out that while P values were provided for secondary end points such as progression-free survival, these were not adjusted for multiple end point comparisons, and hence not considered significantly different between treatment groups. Progression-free survival for non-CNS and CNS metastasis was only 0.2 months longer in the etirinotecan pegol (EP) arm (2.1 vs 1.9) even though the 95% CI of the hazard rate (0.62) did not overlap unity (0.40-0.96). Our study allowed 7 drugs to be used in the comparator (physicians’ choice) arm, as a pragmatic and accepted design, and while it would be of interest to compare EP with each drug individually, this would not be feasible in this population and may not reflect real-world practice. Finally, we agree with Drs Zhang and Zhang that the benefit of EP in other tumor types or scenarios cannot be excluded. Trends in improved outcome not meeting predefined threshold were reported in the initial BEACON trial for advanced breast cancer, where notable improvements were seen in patients with liver and brain metastases, motivating the ATTAIN trial. Similarly, activity has been seen in refractory ovarian and other cancers. Innovations in preclinical models are clearly needed to improve the success of drugs entering early-phase trials, and clinical trial methodologic advancements, such as a synthetic control arm, may also aid in compensating for rapid changes in standards of care.

Differences in Cancer Phenotypes Among Frequent CHEK2 Variants and Implications for Clinical Care

Tue, 01 Nov 2022 00:00:00 GMT

This retrospective cohort study examines the association of different CHEK2 pathogenic variants with different cancer phenotypes.

Association of QTc Formula With the Management of Patients With Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This cohort study describes the association of variation in QTc formula selection with adverse event grading and chemotherapy delivery in patients with cancer.

Association of Sinoatrial Node Radiation Dose With Atrial Fibrillation and Mortality in Patients With Lung Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This cohort study describes the incidence of atrial fibrillation in patients with lung cancer and assesses predictive cardiac dosimetric parameters.

The Unwritten Code

Tue, 01 Nov 2022 00:00:00 GMT

You won’t find them listed in the ICD-10. Not after congestive heart failure, end-stage renal disease or diabetes. But perhaps they should be. The true, twisted roots beneath sugars higher than your weekly salary. The ballooned, weeping legs that leave you crying out in the middle of the night. The mass left to spread its tendrils in your lung, because you yourself Have been left with Reasons to distrust.

Pushing the Envelope for Active Surveillance

Tue, 01 Nov 2022 00:00:00 GMT

甲状腺癌是最常见的癌症之一ng adults and the seventh most common among women. Papillary thyroid cancer (PTC), a category of differentiated thyroid cancer, accounts for up to 90% of thyroid cancer. Diagnosis of thyroid cancer has steadily increased over time, partly because of overdiagnosis of subcentimeter microcarcinomas. The 2015 American Thyroid Association guidelines recommended active surveillance as an alternative for very low-risk tumors based on early evidence from observational and cohort studies in Japan and Korea that demonstrated low rates of disease progression. Despite these recommendations, the US has been slow to adopt active surveillance.

Expanded Parameters in Active Surveillance for Low-risk Papillary Thyroid Carcinoma

Tue, 01 Nov 2022 00:00:00 GMT

This prospective clinical trial examines if expanded size/growth parameters for patients with low-risk thyroid cancer are viable.

Laparoscopic vs Open Surgery for Low Rectal Cancer (LASRE)

Tue, 01 Nov 2022 00:00:00 GMT

This randomized clinical trial compares the short-term efficacy of laparoscopic surgery vs open surgery for treatment of low rectal cancer.

Agents for Metastatic or Advanced Breast Cancer Without ERBB2 Amplification (HER2-Low)

Tue, 01 Nov 2022 00:00:00 GMT

This review of current literature evaluates whether ERBB2 (formerly HER2) offers a potential therapeutic target in patients with ERBB2-low breast cancer.

Misinterpretation of Surgeons' Statements on Cancer Removal—The Adverse Effects of “We Got It All”

Tue, 01 Nov 2022 00:00:00 GMT

This Viewpoint describes the miscommunication and potential adverse effects of the phrase “we got it all” after cancer surgery and advises using with caution.

Opioid Prescriptions and Potential Misuse Among Childhood Cancer Survivors After 2016 Guideline

Tue, 01 Nov 2022 00:00:00 GMT

This cohort study examines changes in opioid prescriptions and potential misuse and substance use disorders among childhood cancer survivors and peers without cancer following the 2016 Centers for Disease Control and Prevention guideline release.

Evolution of Early-Phase Anticancer Drug Investigations in China

Tue, 01 Nov 2022 00:00:00 GMT

This study examines phase 1 anticancer drug clinical trials performed in China from 2017 to 2021.

Constitutional BRCA1 Methylation and Risk of Incident Triple-Negative Breast Cancer and High-grade Serous Ovarian Cancer

Tue, 01 Nov 2022 00:00:00 GMT

这个病例对照研究探讨了潜在的屁股ociation between white blood cell BRCA1 promoter methylation and subsequent risk of incident triple-negative breast cancer and high-grade serous ovarian cancer.

High-Quality Shared Decision-making for Lung Cancer Screening

Tue, 01 Nov 2022 00:00:00 GMT

This Viewpoint discusses the role of the International Patient Decision Aid Standards Collaboration in emphasizing the importance of shared decision-making facilitated by trained individuals and the use of decision aids that meet minimal quality standards when counseling patients for lung cancer screening.

Pretreatment and Posttreatment Evolution of NfL Levels in ICANS

Tue, 01 Nov 2022 00:00:00 GMT

This cross-sectional study quantifies serial neurofilament light chain levels in patients undergoing cellular therapy.

Incidence Trends of Primary Cutaneous T-Cell Lymphoma in the US From 2000 to 2018

Tue, 01 Nov 2022 00:00:00 GMT

Using SEER database data, this cohort study analyzed cutaneous T-cell lymphoma incidence by tumor subtype, sex, age, race and ethnicity, socioeconomic status, and geography.

Hereditary Cancer Syndromes—A Broader Clinical Spectrum Than Previously Understood?

Tue, 01 Nov 2022 00:00:00 GMT

To the Editor We read with great interest the study by Zeng et al published recently in JAMA Oncology evaluating the association of pathogenic variants in hereditary cancer genes with multiple diseases. This phenome-wide association study used data from 3 large cohorts with a total sample size of 214 020, validated 38 known gene-cancer associations, and identified 19 new gene-phenotype associations, 6 of which were associated with malignant tumors. This study demonstrates the power of combining electronic health records with genomic data to quickly identify novel gene-phenotype associations with far-reaching effects. We are particularly intrigued by the associations between hereditary cancer genes and nonneoplastic diseases reported here.

Hereditary Cancer Syndromes—A Broader Clinical Spectrum Than Previously Understood?—Reply

Tue, 01 Nov 2022 00:00:00 GMT

In Reply We appreciate the thoughtful comments from Drs Narayanan and Najjar, who questioned whether the associations with noncancer diagnoses were the result of increased surveillance after a genetic diagnosis. We have reviewed our data from the electronic health records linked to the Hereditary Cancer Registry (HCR). As expected, many of the carriers in our studies were under intensive surveillance once they had genetic diagnoses. However, for the BRCA1/2 association with ovarian cysts, 50% of the ovarian cysts were diagnosed at least 1 year before their pathogenic or likely pathogenic genetic test report. The most common reasons for imaging were pelvic pain and/or menorrhagia and thus was due to diagnostic imaging rather than high-risk surveillance. These data supported the possibility of a higher risk of ovarian cysts among these carriers even before surveillance.

Five-Year Outcomes of FOLFIRINOX vs Gemcitabine as Adjuvant Therapy for Pancreatic Cancer

Tue, 01 Nov 2022 00:00:00 GMT

This randomized clinical trial examines 5-year outcomes and prognostic factors for overall survival for treatment with modified FOLFIRINOX for patients with pancreatic ductal adenocarcinoma.

Early Death After Chemotherapy as a Quality Indicator

Tue, 01 Nov 2022 00:00:00 GMT

This Viewpoint examines chemotherapy at the end of life as a quality metric.

The Body’s Scorecard

Tue, 01 Nov 2022 00:00:00 GMT

In this essay, the author describes how trauma has led not only to physical ailments, including cancer, but also greater appreciation of her body and life.