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  • Lead-Time Bias in the Analyses of Overall Mortality of Breast Cancer in Men vs Women—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-23
    Fei Wang; Xiao-Ou Shu

    In Reply von Euler-Chelpin expressed a concern regarding lead-time bias in our recently published study1 comparing mortality after breast cancer diagnosis between men and women, owing to a high breast cancer screening rate in women. We agree that the lack of breast cancer screening in men could be one reason why men had higher mortality than women. This speculation is supported by our observation that men were more likely to have later-stage breast cancer compared with their female counterparts.2 The lead-time bias, if existent, would be more likely to present in patients diagnosed with earlier stages of breast cancer.3 However, in our study,1 the mortality disparity between male and female patients with breast cancer existed across all cancer stages. In fact, the mortality difference between men and women with stage I breast cancer was slightly smaller than the difference between men and women with stage II and III cancers. These results suggest that lead-time bias is not the sole explanation for the disparity that we observed between men and women.

    更新日期:2020-01-23
  • Lead-Time Bias in the Analyses of Overall Mortality of Breast Cancer in Men vs Women
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-23
    My von Euler-Chelpin

    To the Editor Wang et al1 recently published a cohort study evaluating the association of clinical characteristics and treatment patterns with the survival difference between male and female patients with breast cancer. The authors presented both mortality analyses and survival analyses. Overall survival was the primary outcome and was defined as months from cancer diagnosis to death of any cause. The difference in survival between men and women was reported for 3-year, 5-year, and overall survival and stratified by disease stage.

    更新日期:2020-01-23
  • The Future of Cancer Care in the United States—Overcoming Workforce Capacity Limitations
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-23
    Lawrence N. Shulman; Lisa Kennedy Sheldon; Edward J. Benz

    The growth in the number of patients with cancer and cancer survivors in the United States is greatly outpacing the number of clinicians available to care for them. Although age-adjusted cancer incidences and mortality rates are decreasing in the United States, population growth and aging have contributed to a substantial increase in patients requiring cancer care and survivorship care. According to the American Association for Cancer Research, approximately 1.76 million people were expected to receive a cancer diagnosis in the United States in 2019, and the number is estimated to increase to 2.3 million by 2035.1 The number of cancer survivors in the United States was estimated to be 15.5 million in 2016 and is predicted to be 20.3 million by 2026.2 However, the number of oncology clinicians is increasing at a much slower rate, and the first generation of oncologists and oncology nurses trained in the 1970s is beginning to retire.3 In some geographic areas, this disparity is exacerbated by the known maldistribution of oncologists, with greater shortages observed in rural areas.4

    更新日期:2020-01-23
  • Objective Response Rate Among Patients With Locally Advanced or Metastatic Sarcoma Treated With Talimogene Laherparepvec in Combination With Pembrolizumab: A Phase 2 Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-23
    Ciara M. Kelly; Cristina R. Antonescu; Timothy Bowler; Rodrigo Munhoz; Ping Chi; Mark A. Dickson; Mrinal M. Gounder; Mary Louise Keohan; Sujana Movva; Reena Dholakia; Hamza Ahmad; Matthew Biniakewitz; Mercedes Condy; Haley Phelan; Margaret Callahan; Phillip Wong; Sam Singer; Charlotte Ariyan; Edmund K. Bartlett; Aimee Crago; Sam Yoon; Sinchun Hwang; Joseph P. Erinjeri; Li-Xuan Qin; William D. Tap; Sandra P. D’Angelo
    更新日期:2020-01-23
  • Cost-effectiveness of Tisagenlecleucel vs Standard Care in High-risk Relapsed Pediatric Acute Lymphoblastic Leukemia in Canada
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-23
    Jill Furzer; Sumit Gupta; Paul C. Nathan; Tal Schechter; Jason D. Pole; Joerg Krueger; Petros Pechlivanoglou
    更新日期:2020-01-23
  • Association of Early Palliative Care With Survival in Patients With Advanced Lung Cancer—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Donald R. Sullivan; Christopher G. Slatore

    In Reply We thank Skelin and colleagues for their comments regarding our study1 evaluating the association of early palliative care with survival among patients with advanced lung cancer. Performance status is an important parameter in cancer treatment decision-making, and the Eastern Cooperative Oncology Group scale is one set of criteria used to encourage standardized reporting of treatment toxic effects and response, especially in the conduct of randomized clinical trials. Unfortunately, interrater reliability is inconsistent,2 inherent clinician bias may contribute to inconsistencies,3 and missing values are common in administrative data. Instead, we included the Charlson Comorbidity Index score, which measures comorbidities, and the Functional Comorbidity Index score, which measures physical function to predict survival in modeling, as surrogates of performance status because both are well validated in administrative data. Ultimately, treatment decision-making in oncology is complex, multifactorial, and influenced by clinician-related and patient-related factors; therefore, no single measure of patient suitability for treatment is likely to be sufficient.

    更新日期:2020-01-17
  • Association of Early Palliative Care With Survival in Patients With Advanced Lung Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Marko Skelin; Eugen Javor; Marko Lucijanic

    To the Editor We have read with great interest the retrospective population-based cohort study by Sullivan et al.1 They found an association of early palliative care (received 0 to 30 days after cancer diagnosis) with decreased survival (adjusted hazard ratio, 2.13; 95% CI, 1.97-2.30) in patients with advanced lung cancer. The authors used the propensity score method for reduction of selection bias among groups. The propensity score included factors such as the Charlson Comorbidity Index score and the Functional Comorbidity Index score. However, these parameters do not represent the true performance status of patients. Performance status is one of the major factors in cancer treatment decision-making and is assessed using the Eastern Cooperative Oncology Group scale2 or the Karnofsky scale.3 In addition, performance status is also associated with specialists’ decisions to deliver palliative care. Therefore, patients with greater functional impairment are more likely to receive palliative care sooner.

    更新日期:2020-01-17
  • Optimizing Targeted Therapy for Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Karen R. Rabin

    In 1996, Druker and colleagues1 published the initial report on the inhibitory effects of a compound later named imatinib, a BCR-ABL inhibitor that reduced proliferation of BCR-ABL–positive chronic myeloid leukemia (CML) cells in vitro. The concluding paragraph of their report captures the compelling promise of targeted anticancer therapy: “This compound serves as an example of a drug that was rationally designed to inhibit the function of a specific protein when the protein’s function was known to be involved in the pathogenesis of a specific disease state. It is hoped that by directing therapy toward the underlying disease mechanism, this will result in more effective and less toxic therapies.”1(p565)

    更新日期:2020-01-17
  • Can Cannabis Cure Cancer?
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Donald I. Abrams; Manuel Guzmán

    Not long ago, discussion was focused on whether cannabis caused cancer. A thorough review by the US National Academies of Sciences, Engineering, and Medicine found moderate evidence of no statistical association between cannabis use and the development of lung and head and neck cancers.1 Limited evidence of a statistical association was found between cannabis use and the development of nonseminomatous testicular carcinomas without good support for a causative effect. Throughout the past few years, the pendulum has swung to the point where many patients with cancer diagnoses are convinced, mainly by internet testimonials, that cannabis, particularly highly concentrated oils or tinctures of Δ9-tetrahydrocannabinol (THC) and/or cannabidiol (CBD), may actually cure their cancers. What is the basis of this belief?

    更新日期:2020-01-17
  • A Diffuse Medullary Hypercaptation With No Bone Lesion
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Alexia Christin; Laurence de Leval; Michel Obeid
    更新日期:2020-01-17
  • Analysis of Price Transparency via National Cancer Institute–Designated Cancer Centers’ Chargemasters for Prostate Cancer Radiation Therapy
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Ankit Agarwal; Anupriya Dayal; Sheetal M. Kircher; Ronald C. Chen; Trevor J. Royce
    更新日期:2020-01-17
  • Effect of Dasatinib vs Imatinib in the Treatment of Pediatric Philadelphia Chromosome–Positive Acute Lymphoblastic Leukemia: A Randomized Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-16
    Shuhong Shen; Xiaojuan Chen; Jiaoyang Cai; Jie Yu; Ju Gao; Shaoyan Hu; Xiaowen Zhai; Changda Liang; Xiuli Ju; Hua Jiang; Runming Jin; Xuedong Wu; Ningling Wang; Xin Tian; Kaili Pan; Hui Jiang; Lirong Sun; Yongjun Fang; Chi-kong Li; Qun Hu; Minghua Yang; Yiping Zhu; Hui Zhang; Chunfu Li; Deqing Pei; Sima Jeha; Jun J Yang; Cheng Cheng; Jingyan Tang; Xiaofan Zhu; Ching-Hon Pui
    更新日期:2020-01-17
  • Errors in Figure 3
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-09

    In the Original Investigation titled, “Long-term Effects of Repeat Hepatectomy vs Percutaneous Radiofrequency Ablation Among Patients with Recurrent Hepatocellular Carcinoma: A Randomized Clinical Trial,” which published online November 27, 2019,1 there were errors in Figure 3. The 2 scales at the bottom should have been labeled “ln HR (95% CI)” This article was corrected online.

    更新日期:2020-01-09
  • First Rites—A Spiritual History Case Study
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-09
    Alex Herbert Lion

    My patient was playing high school tennis when she noticed a painful bump on her right hand. She had heard about some players getting bone spurs, but the bump became bigger and more painful over the next few weeks. Soon it was marching band season, and she had trouble playing her trumpet. Her parents brought her to a pediatrician, who noted her symptoms of back pain, trouble breathing, and the hand mass. A chest radiographic image was taken, and she was found to have pleural effusions, fluid accumulating between the lungs and a saran wrap–like covering for the lungs (the pleura). A chest computed tomography scan was done, and the pediatrician then sent the patient to my pediatric oncology clinic.

    更新日期:2020-01-09
  • Progressive Dyspnea in a Woman With Genital Skin Lesions
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-09
    Hiroyuki Teruya; Mitsuru Mukaigawara; Kazuhito Hirata
    更新日期:2020-01-09
  • Association of Insurance Status and Racial Disparities With the Detection of Early-Stage Breast Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-09
    Naomi Y. Ko; Susan Hong; Robert A. Winn; Gregory S. Calip
    更新日期:2020-01-09
  • Association Between 21-Gene Assay Recurrence Score and Locoregional Recurrence Rates in Patients With Node-Positive Breast Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-09
    Wendy A. Woodward; William E. Barlow; Reshma Jagsi; Thomas A. Buchholz; Steven Shak; Frederick Baehner; Timothy J. Whelan; Nancy E. Davidson; James N. Ingle; Tari A. King; Peter M. Ravdin; C. Kent Osborne; Debasish Tripathy; Robert B. Livingston; Julie R. Gralow; Gabriel N. Hortobagyi; Daniel F. Hayes; Kathy S. Albain
    更新日期:2020-01-09
  • Highlights
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01

    In this open-label, single-arm phase 2 trial, Edeline and colleagues evaluated concomitant first-line chemotherapy with cisplatin and gemcitabine with selective internal radiotherapy for treatment of unresectable intrahepatic cholangiocarcinoma (ICC). A total of 41 patients were enrolled. The combination chemotherapy and radiotherapy had antitumor activity in unresectable ICC, and a significant proportion of patients were downstaged to surgical intervention. Scott and Shroff provide an Editorial. Editorial In this single-arm phase 2 clinical trial by Cercek and colleagues, 38 patients with unresectable intrahepatic cholangiocarcinoma (ICC) were treated with hepatic arterial infusion of floxuridine in combination with systemic gemcitabine and oxaliplatin. Hepatic arterial infusion plus systemic chemotherapy appears to be highly active and tolerable in patients with unresectable ICC. Scott and Shroff provide an Editorial.

    更新日期:2020-01-09
  • JAMA Oncology
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01

    JAMA Oncology is committed to publishing influential original research, opinions, and reviews that advance the science of oncology and improve the clinical care of patients with cancer. Mission Statement: JAMA Oncology is the definitive journal for scientists, clinicians, and trainees in the field of oncology worldwide. Our original, innovative, and timely scientific and educational content provides a deeper understanding of cancer pathogenesis and recent treatment advances for our readers. JAMA Oncology aims to effectively convey the findings of important clinical research, major scientific breakthroughs, actionable discoveries, and state-of-the-art treatment pathways to the oncology community. Our goal is that successful communication of new knowledge will ultimately translate to clinical benefit for people living with and surviving cancer. Mary L. (Nora) Disis, MD, Seattle, Washington

    更新日期:2020-01-09
  • Error in Figure
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01

    In the Viewpoint titled “Neuroendocrine Tumors—Less Well Known, Often Misunderstood, and Rapidly Growing in Incidence,”1 published online November 7, 2019, there was an error in the x-axis in the Figure. The label should read, “Reported Cases (×100 000).” This article was corrected online.

    更新日期:2020-01-09
  • Errors in Results
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01

    In the Brief Report titled “Assessment of Molecular Relapse Detection in Early-Stage Breast Cancer,”1 published online August 1, 2019, and in print on October 10, 2019, there were a data errors in the Results section. Validated personalized digital polymerase chain reaction assays were developed for 150 mutations (90.9%), not 91.5%. Of the 29 patients who relapsed, 23 (79.3%), not 88.4%, relapsed with prior circulating tumor DNA detection, whereas 6 (20.7%), not 21.6%, relapsed without circulating tumor DNA detection before or at the time of relapse. This article has been corrected online.

    更新日期:2020-01-09
  • Error in Author’s Name
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01

    In the Original Investigation titled “Risk-Adapted Starting Age of Screening for Relatives of Patients With Breast Cancer,”1 published online November 14, 2019, a correction was made to correct author Xing Xu’s name in the byline and author affiliations; Ms Xu’s first name and surname had been transposed. This article was corrected online.

    更新日期:2020-01-09
  • Going Beyond Results of the PEMBRO-RT Trial—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Willemijn S. M. E. Theelen; Paul Baas

    In Reply We would like to thank Zhang and Han and Yang and colleagues for their appreciation of our work in the PEMBRO-RT trial.1 Both letters address the need for additional research on different radiotherapy modalities in combination with immunotherapy. We agree that our phase 2 study leaves many questions unanswered about the possibilities of this treatment combination. However, in 2019, use of pembrolizumab with or without the addition of chemotherapy became the standard of care in the first-line treatment of advanced non–small cell lung cancer, as pointed out by Yang and colleagues. Our pembrolizumab monotherapy setting enabled us to generate hypotheses without a possible interference of chemotherapy effects, especially in the subgroups with lower PD-L1 expression. Indeed, these hypotheses will need to be tested and translated to the new treatment landscape.

    更新日期:2020-01-09
  • Going Beyond Results of the PEMBRO-RT Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Bo Zhang; Baohui Han

    To the Editor We read with great interest the work by Theelen et al,1 which reported that treatment with pembrolizumab combined with radiotherapy had a manageable safety profile and synergistic effect. We think that the work provides powerful clinical data to this field. Although the authors suggested that radiotherapy prior to treatment with pembrolizumab was well tolerated and conferred notably improved outcomes, we would like to raise 3 points for discussion.

    更新日期:2020-01-09
  • Going Beyond Results of the PEMBRO-RT Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Xu Yang; Yu Men; Zhouguang Hui

    To the Editor The recently published Original Investigation by Theelen and colleagues regarding the PEMBRO-RT trial1 has brought promising and encouraging results for the efficacy and safety of stereotactic body radiotherapy (SBRT) followed by treatment with pembrolizumab compared with treatment with pembrolizumab alone in patients with advanced non–small cell lung cancer (NSCLC) that progressed after at least 1 regimen of chemotherapy, though the primary end point was not reached. However, in addition to the perspectives and limitations mentioned by the authors, several other issues deserve attention.

    更新日期:2020-01-09
  • Additional Factors in the Association of Gender and Parenthood With Conference Attendance—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Miriam A. Knoll; Reshma Jagsi

    In Reply We appreciate the comments of Wu and colleagues, who shared insights from their own lived experiences to enhance the understanding of the phenomena we investigated in our survey study.1 The findings of that study showed that both male and female oncologists highly valued attending conferences.1 We identified childcare as an important barrier to meeting attendance.

    更新日期:2020-01-09
  • Additional Factors in the Association of Gender and Parenthood With Conference Attendance
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Yi-Ying Wu; Ren-Hua Ye; Tzu-Chuan Huang

    To the Editor Knoll et al1 explored the associations of gender and parenthood with conference attendance among early-career oncologists and found that female oncologists attend fewer conferences because of childcare responsibilities, namely, having children who required adult supervision. Career satisfaction was also notably lower in women compared with men.1 In addition to childcare responsibilities, other factors may be associated with this disparity. First, there is a growing trend for increasing the number of female physicians; however, women are underrepresented in leadership roles.2

    更新日期:2020-01-09
  • Association of Anesthesia Care and Cognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Kevin R. Krull; Ching-Hon Pui

    In Reply It is well recognized that long-term survivors of childhood acute lymphoblastic leukemia treated without cranial irradiation are still at increased risk for neurocognitive impairment and neuroimaging abnormalities. These outcomes have previously been associated with treatment with intrathecal chemotherapy and high-dose intravenous methotrexate.1,2 However, these treatments alone could not explain all the variance in neurocognitive outcomes, and other risk factors, such as genetic predispositions, infections, and stroke, have been identified.3 It is important to identify these multiple risk factors to develop interventions for each to improve outcomes. In our recently published study,4 we identified exposure to general anesthesia (ie, propofol, fluranes, cumulative duration of anesthesia) as another risk factor associated with neurocognitive impairment in long-term survivors of childhood acute lymphoblastic leukemia. This article has drawn much attention, including the 2 letters by Colquhoun and Mathis and Ishida and Kuratani.

    更新日期:2020-01-09
  • Association of Anesthesia Care and Cognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Douglas A. Colquhoun; Michael R. Mathis

    To the Editor We read with interest the work of Banerjee et al1 that described the long-term neurocognitive outcomes of childhood acute lymphoblastic leukemia. The adult sequelae of pediatric major illness are of substantial interest as short-term therapeutic outcomes continue to improve and the number of adult survivors of major illness increases. As observational researchers in anesthesiology, after reading the article we were left with 3 questions.

    更新日期:2020-01-09
  • Association of Anesthesia Care and Cognitive Outcomes in Survivors of Childhood Acute Lymphoblastic Leukemia
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Sachi Ishida; Norifumi Kuratani

    To the Editor We read with much interest the Original Investigation by Banerjee et al.1 The authors found that accumulated anesthesia exposures may be associated with poor neurocognitive outcomes in long-term survivors of childhood acute lymphoblastic leukemia (ALL). The authors suggested that anesthesia exposures should be limited in pediatric patients with chronic health conditions who undergo multiple medical procedures. Given that millions of children worldwide receive anesthesia and sedation for various purposes, the study results and implications may raise important public health concerns. We wish to highlight some important limitations in the methods used to estimate associations between anesthesia exposures and neurocognitive outcomes.

    更新日期:2020-01-09
  • Defining Equity in Eligibility for Cancer Screening—Reply
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Melinda C. Aldrich; William J. Blot; Jeffrey D. Blume

    In Reply We thank Robbins and Johansson for their comments on our proposed changes to the lung cancer screening guidelines for African American individuals.1 The question of equity in lung cancer screening is an important one; access, effectiveness, harms, and benefits need to be carefully considered and ultimately balanced as best possible. Robbins and Johansson are concerned that African American individuals with a 20- to 29-pack-year history of smoking do not have sufficient risk to make screening a net benefit. However, the risk of lung cancer among African American individuals who smoke lower amounts of cigarettes is known to equal or exceed risks among white individuals smoking higher amounts.2,3 This pattern is observed in the Southern Community Cohort Study, in which the absolute risk of lung cancer among African American individuals with a 20- to 29-pack-year history of smoking was equal to (for current smokers) or exceeded (for former smokers) the risk of lung cancer among white individuals with a 30- to 39-pack-year history of smoking (W.J.B., unpublished data, August 2019).

    更新日期:2020-01-09
  • Defining Equity in Eligibility for Cancer Screening
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Hilary A. Robbins; Mattias Johansson

    To the Editor Aldrich et al1 reported that according to the current US lung cancer screening criteria set forth by the US Preventive Services Task Force, a lower proportion of current and former smokers who will be diagnosed with lung cancer may be classified as eligible for screening among African American individuals (32%) than white individuals (56%). This report is important in highlighting the issue of equity in how cancer screening is offered across racial and ethnic groups, and also prompts the question of how to define equity in the specific context of screening eligibility.

    更新日期:2020-01-09
  • A Resident’s Courage
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Shan Ali

    更新日期:2020-01-09
  • A Daily Struggle to Improve Kaplan-Meier Curves—Doctors on the Swing
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Marco Badinella Martini

    I have always been attracted to graphics because they are intuitive and allow us to understand any concept in a more direct way compared with other types of explanations. During my university studies, I was particularly fascinated by Kaplan-Meier survival curves: the survival rate displayed on the ordinate axis, the time displayed on the abscissa axis, and the characteristic lines lying in the middle with their stepped appearance that seemed to bend downward too laconically and inevitably. Nowadays in my everyday practice, I often find myself drawing this type of curve when I try to explain to patients the need for a specific treatment, especially when I see them disoriented and confused. Drawing on paper to explain what I am talking about is a good way to demonstrate a practical point to those patients sitting in front of me.

    更新日期:2020-01-09
  • Additional Lumpectomy and Irradiation for In-Breast Recurrence of Cancer—When Less Is More
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Kiri Cook; Maggie DiNome

    Despite modern surgical and irradiation techniques, approximately 1 in 10 women treated with lumpectomy and irradiation will experience recurrence of breast cancer in the ipsilateral breast (in-breast recurrence). Historically, this event has been managed definitively with mastectomy. However, many local recurrences are small and detected early, and even after a recurrence, long-term survival is achievable.1 Thus, there has been an interest in examining the feasibility of subsequent breast-conserving therapy. Rates of second recurrence after lumpectomy alone for first recurrence are unacceptably high,2,3 similar to those after lumpectomy alone for primary breast cancer. Fears of unacceptable toxic effects have prevented most investigators from pursuing lumpectomy with reirradiation of the whole breast; however, a number of groups reported their experience with a second lumpectomy with partial breast reirradiation (PBrI). Most studies used brachytherapy, and the largest study was the multi-institutional observational Groupe Européen de Curiethérapie and the European Society for Radiotherapy and Oncology (GEC-ESTRO) study.4 In this series, a 5-year second in-breast recurrence rate of 5.2% was reported, with a 5-year distant metastasis rate of 9.6% and overall survival of 88.7%. Regarding the cosmetic outcome, 48% of patients rated their cosmesis as excellent, with the remaining 52% rating it as fair or poor. Although these results are promising and comparable to clinical outcomes after mastectomy for in-breast recurrence, this study included a heterogeneous and incompletely defined patient population (eg, margin status was not reported). Thus, prospective data to better inform outcomes and patient selection are sorely needed.

    更新日期:2020-01-09
  • Tumor Origins Through Genomic Profiles
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Edison T. Liu; Susan M. Mockus

    One way to look at genome panels in cancer is as a collection of hundreds of individual genetic diagnostic tests, such as, EGFR mutation, EML4-ALK translocation, that can each be used to extract useful clinical information to guide therapy. However, the behavior of the collection of mutations can also act as a clinical parameter of value. For example, the tumor mutational burden (TMB), which scores the total mutational load within a tumor, is used to measure the proclivity of a tumor to respond to immuno-oncologic agents.1 In this issue of JAMA Oncology, Penson et al2 from Memorial Sloan Kettering Cancer Center advanced this concept further in describing an approach that uses artificial intelligence to assess higher meaning of the mutational profile from a 468-gene cancer panel, the Memorial Sloan Kettering–Integrated Mutation Profiling of Actionable Cancer Targets (MSK-IMPACT). From a training cohort of tumors from 7791 patients with a variety of cancers, they used single-nucleotide variations, indels, copy number changes, and structural rearrangements to build classifiers that could distinguish the tissue of origin of each tumor. They then validated the classifier in an independent test cohort of 11 644 patient tumors. Their results showed an accuracy of between 73.8% and 74.1% in predicting the correct tissue of origin with greater successes in some tumor types than others. The best predictor was for uveal melanomas, gliomas, and colorectal cancers, whereas, the poorest was for esophagogastric, ovarian, and head and neck cancer, cancers with greatest genomic mutational heterogeneity. A unique aspect of their predictor is that a probability score was assigned to each result that allowed the clinician to have an estimate of the certainty of the tissue assignment. Thus, even in those problematic tumors, misdiagnosis could be avoided by censoring the ambiguous cases.

    更新日期:2020-01-09
  • Toward Risk-Stratified Breast Cancer Screening: Considerations for Changes in Screening Guidelines
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Gretchen L. Gierach; Parichoy Pal Choudhury; Montserrat García-Closas

    Populationwide breast cancer screening programs have been established in many countries to reduce breast cancer mortality through early detection and treatment. These programs offer routine mammographic screening to women at average risk starting at age 40 to 50 years with frequency of 1 to 3 years and enhanced screening starting at earlier ages to women at elevated risk owing to family history or genetic susceptibility from high-penetrance genetic mutations (eg, in BRCA1/2 or TP53).1 Screening guidelines recommend different approaches to identify women at elevated risk, including the use of risk prediction models with pedigree-level family history information and genetic testing.

    更新日期:2020-01-09
  • Moving the Needle Forward With Locoregional Treatment in Unresectable Cholangiocarcinoma—The Jury Is Still Out
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Aaron J. Scott; Rachna T. Shroff

    Cholangiocarcinomas are epithelial cell tumors that originate within the biliary tree and comprise 3 subtypes: intrahepatic, perihilar, and distal.1 Intrahepatic cholangiocarcinoma (ICC) accounts for approximately 20% of all cholangiocarcinomas diagnosed in the United States.1,2 The incidence and mortality associated with ICC have been increasing over the past several decades related to an increase in known risk factors, such as nonalcoholic steatohepatitis, hepatitis C, and cirrhosis.3 Intrahepatic cholangiocarcinoma is an aggressive cancer often diagnosed in advanced stages owing to a lack of adequate early detection, its insidious clinical character, challenging anatomic access, and limitations of pathologic and cytologic diagnostic tools. Because of these factors, only approximately 35% of patients diagnosed with cholangiocarcinoma will have tumors amenable to curative intent resection at time of diagnosis.4 Prognosis is especially poor for the majority of patients diagnosed with unresectable biliary tract cancers, with median overall survival limited to less than 1 year.5 For most cases, surgical approaches are generally not indicated and recurrence rates remain high even in the minority of patients who respond to treatment and are able to undergo surgical resection. Approaches to improve survival outcomes for patients with unresectable ICC remain a grave unmet need.

    更新日期:2020-01-09
  • 更新日期:2020-01-09
  • Shots, Not Moonshots—The Importance of Broad Population Immunization to Patients Who Undergo Cancer Treatment
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Maresa C. Woodfield; Paul A. Carpenter; Steven A. Pergam

    In a seemingly prophetic announcement in January, the World Health Organization named vaccine hesitancy as a top-10 global threat to public health for 2019. Months later, measles outbreaks expanded substantially in New York and ignited in Washington State.1 By May, the number of measles cases in the United States had surpassed the annual totals for each of the previous 25 years. As of November 2019, the US Centers for Disease Control and Prevention have reported more than 1200 cases in 31 states, and these numbers continue to rise.2 The current outbreaks are occurring as more parents opt out of childhood immunization, decreasing vaccination rates and weakening the protective layer of population immunity that the United States has enjoyed for the past 2 decades. There are well-founded concerns that undervaccinated communities create growing pockets of vulnerability that threaten to make measles endemic again.

    更新日期:2020-01-09
  • Neuroendocrine Tumors—Less Well Known, Often Misunderstood, and Rapidly Growing in Incidence
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Aman Chauhan; Elise Kohn; Jaydira Del Rivero
    更新日期:2020-01-09
  • Population-Based Quality Indicators for End-of-Life Cancer Care: A Systematic Review
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Lesley Anne Henson; Polly Edmonds; Anna Johnston; Halle Elizabeth Johnson; Clarissa Ng Yin Ling; Alexandros Sklavounos; Clare Ellis-Smith; Wei Gao
    更新日期:2020-01-09
  • Eligibility and Radiologic Assessment for Adjuvant Clinical Trials in Kidney Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Sundeep Agrawal; Naomi B. Haas; Mohammadhadi Bagheri; Brian R. Lane; Jonathan Coleman; Hans Hammers; Gennady Bratslavsky; Cynthia Chauhan; Lauren Kim; Venkatesh P. Krishnasamy; Jamie Marko; Virginia Ellen Maher; Amna Ibrahim; Frank Cross; Ke Liu; Julia A. Beaver; Richard Pazdur; Gideon M. Blumenthal; Harpreet Singh; Elizabeth R. Plimack; Toni K. Choueiri; Robert Uzzo; Andrea B. Apolo
    更新日期:2020-01-09
  • Association of Rising Cost and Use of Oral Anticancer Drugs With Medicare Part D Spending From 2013 Through 2017
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Kira Seiger; Arash Mostaghimi; Ann W. Silk; Chrysalyne D. Schmults; Emily Stamell Ruiz
    更新日期:2020-01-09
  • Racial Disparities in Patient-Reported Measures of Physician Cultural Competency Among Cancer Survivors in the United States
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Santino S. Butler; Karen M. Winkfield; Chul Ahn; Zirui Song; Edward C. Dee; Brandon A. Mahal; Nina N. Sanford
    更新日期:2020-01-09
  • Efficacy and Safety of Trifluridine/Tipiracil Treatment in Patients With Metastatic Gastric Cancer Who Had Undergone Gastrectomy: Subgroup Analyses of a Randomized Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    David H. Ilson; Josep Tabernero; Aliaksandr Prokharau; Hendrik-Tobias Arkenau; Michele Ghidini; Kazumasa Fujitani; Eric Van Cutsem; Peter Thuss-Patience; Giordano D. Beretta; Wasat Mansoor; Edvard Zhavrid; Maria Alsina; Ben George; Daniel Catenacci; Sandra McGuigan; Lukas Makris; Toshihiko Doi; Kohei Shitara
    更新日期:2020-01-09
  • Factors Associated With Successful Discontinuation of Immune Suppression After Allogeneic Hematopoietic Cell Transplantation
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Joseph Pidala; Michael Martens; Claudio Anasetti; Jeanette Carreras; Mary Horowitz; Stephanie J. Lee; Joseph Antin; Corey Cutler; Brent Logan
    更新日期:2020-01-09
  • Response Rate Following Albumin-Bound Paclitaxel Plus Gemcitabine Plus Cisplatin Treatment Among Patients With Advanced Pancreatic Cancer: A Phase 1b/2 Pilot Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Gayle S. Jameson; Erkut Borazanci; Hani M. Babiker; Elizabeth Poplin; Anna A. Niewiarowska; Michael S. Gordon; Michael T. Barrett; Adam Rosenthal; Amy Stoll-D’Astice; John Crowley; Lynn Shemanski; Ron L. Korn; Karen Ansaldo; Leticia Lebron; Ramesh K. Ramanathan; Daniel D. Von Hoff
    更新日期:2020-01-09
  • The Effect of Abemaciclib Plus Fulvestrant on Overall Survival in Hormone Receptor–Positive, ERBB2-Negative Breast Cancer That Progressed on Endocrine Therapy—MONARCH 2: A Randomized Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    George W. Sledge; Masakazu Toi; Patrick Neven; Joohyuk Sohn; Kenichi Inoue; Xavier Pivot; Olga Burdaeva; Meena Okera; Norikazu Masuda; Peter A. Kaufman; Han Koh; Eva-Maria Grischke; PierFranco Conte; Yi Lu; Susana Barriga; Karla Hurt; Martin Frenzel; Stephen Johnston; Antonio Llombart-Cussac
    更新日期:2020-01-09
  • Effect of Supplementation With Marine ω-3 Fatty Acid on Risk of Colorectal Adenomas and Serrated Polyps in the US General Population: A Prespecified Ancillary Study of a Randomized Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Mingyang Song; I-Min Lee; JoAnn E. Manson; Julie E. Buring; Rimma Dushkes; David Gordon; Joseph Walter; Kana Wu; Andrew T. Chan; Shuji Ogino; Charles S. Fuchs; Jeffrey A. Meyerhardt; Edward L. Giovannucci
    更新日期:2020-01-09
  • Safety, Tolerability, and Potential Clinical Activity of a Glucocorticoid-Induced TNF Receptor–Related Protein Agonist Alone or in Combination With Nivolumab for Patients With Advanced Solid Tumors: A Phase 1/2a Dose-Escalation and Cohort-Expansion Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Kimberley M. Heinhuis; Matteo Carlino; Markus Joerger; Massimo Di Nicola; Tarek Meniawy; Sylvie Rottey; Victor Moreno; Anas Gazzah; Jean-Pierre Delord; Luis Paz-Ares; Christian Britschgi; Russell J. Schilder; Kenneth O’Byrne; Giuseppe Curigliano; Emanuela Romano; Poliana Patah; Rui Wang; Yali Liu; Gaurav Bajaj; Lillian L. Siu
    更新日期:2020-01-09
  • Sequential Ipilimumab After Chemoradiotherapy in Curative-Intent Treatment of Patients With Node-Positive Cervical Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Jyoti S. Mayadev; Danielle Enserro; Yvonne G. Lin; Diane M. Da Silva; Heather A. Lankes; Carol Aghajanian; Sharad Ghamande; Kathleen N. Moore; Vanessa A. Kennedy; Paula M. Fracasso; Russell J. Schilder
    更新日期:2020-01-09
  • Development of Genome-Derived Tumor Type Prediction to Inform Clinical Cancer Care
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Alexander Penson; Niedzica Camacho; Youyun Zheng; Anna M. Varghese; Hikmat Al-Ahmadie; Pedram Razavi; Sarat Chandarlapaty; Christina E. Vallejo; Efsevia Vakiani; Teresa Gilewski; Jonathan E. Rosenberg; Maha Shady; Dana W. Y. Tsui; Dalicia N. Reales; Adam Abeshouse; Aijazuddin Syed; Ahmet Zehir; Nikolaus Schultz; Marc Ladanyi; David B. Solit; David S. Klimstra; David M. Hyman; Barry S. Taylor; Michael F. Berger
    更新日期:2020-01-09
  • Effectiveness of Breast-Conserving Surgery and 3-Dimensional Conformal Partial Breast Reirradiation for Recurrence of Breast Cancer in the Ipsilateral Breast: The NRG Oncology/RTOG 1014 Phase 2 Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Douglas W. Arthur; Kathryn A. Winter; Henry M. Kuerer; Bruce Haffty; Laurie Cuttino; Dorin A. Todor; Pramila Rani Anne; Penny Anderson; Wendy A. Woodward; Beryl McCormick; Sally Cheston; Walter M. Sahijdak; Daniel Canaday; Doris R. Brown; Adam Currey; Christine M. Fisher; Reshma Jagsi; Jennifer Moughan; Julia R. White
    更新日期:2020-01-09
  • Risk-Adapted Starting Age of Screening for Relatives of Patients With Breast Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Trasias Mukama; Elham Kharazmi; Xing Xu; Kristina Sundquist; Jan Sundquist; Hermann Brenner; Mahdi Fallah
    更新日期:2020-01-09
  • Assessment of Hepatic Arterial Infusion of Floxuridine in Combination With Systemic Gemcitabine and Oxaliplatin in Patients With Unresectable Intrahepatic Cholangiocarcinoma: A Phase 2 Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Andrea Cercek; Thomas Boerner; Benjamin R. Tan; Joanne F. Chou; Mithat Gönen; Taryn M. Boucher; Haley F. Hauser; Richard K. G. Do; Maeve A. Lowery; James J. Harding; Anna M. Varghese; Diane Reidy-Lagunes; Leonard Saltz; Nikolaus Schultz; T. Peter Kingham; Michael I. D’Angelica; Ronald P. DeMatteo; Jeffrey A. Drebin; Peter J. Allen; Vinod P. Balachandran; Kian-Huat Lim; Francisco Sanchez-Vega; Neeta Vachharajani; Maria B. Majella Doyle; Ryan C. Fields; William G. Hawkins; Steven M. Strasberg; William C. Chapman; Luis A. Diaz; Nancy E. Kemeny; William R. Jarnagin
    更新日期:2020-01-09
  • Radioembolization Plus Chemotherapy for First-line Treatment of Locally Advanced Intrahepatic Cholangiocarcinoma: A Phase 2 Clinical Trial
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-01
    Julien Edeline; Yann Touchefeu; Boris Guiu; Olivier Farge; David Tougeron; Isabelle Baumgaertner; Ahmet Ayav; Boris Campillo-Gimenez; Luc Beuzit; Marc Pracht; Astrid Lièvre; Samuel Le Sourd; Karim Boudjema; Yan Rolland; Eveline Boucher; Etienne Garin
    更新日期:2020-01-09
  • Minding the Gap for Survivors of Childhood Cancer
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-02
    Stephanie M. Smith; Michael P. Link; Karen E. Effinger

    Although more than 80% of children with cancer will survive 5 years after diagnosis, long-term survivors of childhood cancer have an elevated risk of morbidity and early mortality due to late effects of their prior cancer therapy.1 Knowledge of the link between therapeutic exposures and late effects has informed upfront childhood cancer treatment. Contemporary protocols use risk stratification to deintensify therapy for patients at low risk of treatment failure or recurrence, with the goal of limiting radiotherapy dose and fields and reducing cumulative anthracycline and alkylator chemotherapy exposures whenever possible to decrease late effects.

    更新日期:2020-01-02
  • How Is Money Changing Medicine?—Venture Capital Investment in Oncology
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-02
    Kevin B. Huang; Vinod E. Nambudiri

    Venture capital investment in new medical technologies has reached all-time highs, with more than $25 billion invested in biopharmaceutical, medical device, and diagnostics startups in 2018.1 However, what exact effect this has had on the clinical practice of oncology and on determining which therapies are available to patients is unclear. From 2010 to 2017, venture capital deal valuation in US biopharma companies increased by 139% to $10.5 billion and that of venture capital deals in US device companies increased by 61% to $5.0 billion.2 Given the role of venture capital in financing medical innovations, oncologists and policy makers should understand the basics of venture capital, including how venture capitalists decide on investments, the potential risk-benefit effect on patients, and the implications for how new therapeutics, diagnostics, and devices enter practice.

    更新日期:2020-01-02
  • Stereotactic Ablative Radiotherapy for the Management of Spinal Metastases: A Review
    JAMA Oncol. (IF 22.416) Pub Date : 2020-01-02
    Rachel M. Glicksman; Michael C. Tjong; Wellington F. P. Neves-Junior; Daniel E. Spratt; Kevin L. M. Chua; Alireza Mansouri; Melvin L. K. Chua; Alejandro Berlin; Jeff D. Winter; Max Dahele; Ben J. Slotman; Mark Bilsky; David B. Shultz; Marcos Maldaun; Nicholas Szerlip; Simon S. Lo; Yoshiya Yamada; Francisco Emilio Vera-Badillo; Gustavo N. Marta; Fabio Y. Moraes
    更新日期:2020-01-02
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