JAMA Oncology最新文献

{"title":"Five Years After Pathologic Complete Response Without Surgery.","authors":"Zemin Tian,Yinde Huang,Yuan Qiu","doi":"10.1001/jamaoncol.2025.2123","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2123","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"32 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Defining Lifetime Risk Thresholds for Breast Cancer Surgical Prevention.","authors":"Xia Wei,Lea Mansour,Samuel Oxley,Caitlin T Fierheller,Ashwin Kalra,Jacqueline Sia,Subhasheenee Ganesan,Michail Sideris,Li Sun,Adam Brentnall,Stephen Duffy,D Gareth Evans,Li Yang,Rosa Legood,Ranjit Manchanda","doi":"10.1001/jamaoncol.2025.2203","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2203","url":null,"abstract":"ImportanceExpanding access to genetic testing and availability of validated breast cancer (BC) risk prediction models are increasingly identifying women at elevated BC risk who do not carry high-penetrance BRCA1/BRCA2/PALB2 pathogenic variants. The precise BC risk threshold for offering risk-reducing mastectomy (RRM) for BC prevention is unknown.ObjectiveTo define the lifetime BC risk thresholds for RRM to be cost-effective compared with nonsurgical alternatives for BC prevention.Design, Setting, and ParticipantsThis economic evaluation used a decision-analytic Markov model to compare the cost-effectiveness of RRM with BC screening and medical prevention in a simulated cohort. Extensive sensitivity analyses were performed. The study setting was from a UK payer perspective over a lifetime horizon until age 80 years. The simulated cohort included women aged 30 to 60 years at varying lifetime BC risks from 17% to 50%. The study was conducted between September 2022 and September 2024.ExposuresUndergoing RRM or receiving risk-stratified BC screening with medical prevention (tamoxifen or anastrozole).Main Outcomes and MeasuresThe incremental cost-effectiveness ratio was calculated as incremental cost per quality-adjusted life-year (QALY) gained and compared with the UK willingness-to-pay (WTP) threshold of £20 000 (US $27 037) to £30 000 (US $40 555) per QALY. BC cases prevented were estimated at the population level.ResultsIn the simulated cohort of 100 000 thirty-year-old women in the UK, undergoing RRM became cost-effective at a 34% lifetime BC risk using the £30 000 (US $40 555) per QALY WTP threshold. This increased to a 42% lifetime BC risk using the £20 000 (US $27 037) per QALY WTP threshold. The identified lifetime BC risk thresholds for RRM to be cost-effective among women aged 35, 40, 45, 50, 55, and 60 years were 31%, 29%, 29%, 32%, 36%, and 42%, respectively, using the £30 000 (US $40 555) per QALY WTP threshold. Overall, undergoing RRM was deemed cost-effective for women aged 30 to 55 years with a lifetime BC risk of at least 35%, with more than 50% of simulations being cost-effective in probabilistic sensitivity analysis. Offering RRM for women with a lifetime BC risk of 35% or higher could potentially prevent approximately 6538 (95% CI, 4454-7041), or approximately 11% (95% CI, 8%-12%), of the 58 756 BC cases occurring annually in women in the UK. In the probabilistic sensitivity analysis, 20.71% to 59.96%, 44.04% to 81.29%, and 97.26% to 99.35% of simulations were cost-effective for women with 35%, 40%, and 50% lifetime BC-risk undergoing RRM at age 30 under the £20 000 to £30 000 per QALY WTP threshold, respectively.Conclusions and RelevanceIn this economic evaluation, undergoing RRM appears cost-effective for women aged 30 to 55 years with a lifetime BC risk of 35% or higher. These results could have significant clinical implications to expand access to RRM beyond BRCA1/BRCA2/PALB2 pathogenic variant carriers. Future studies evaluati","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"143 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Five Years After Pathologic Complete Response Without Surgery-Reply.","authors":"Henry M Kuerer","doi":"10.1001/jamaoncol.2025.2126","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2126","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"14 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sequential vs Induction Plus Concurrent Chemoradiotherapy in Nasopharyngeal Carcinoma: A Randomized Clinical Trial.","authors":"Fen Xue,Dan Ou,Congying Xie,Shaojun Lin,Jingao Li,Xiaozhong Chen,Fuzheng Zhang,Hongmei Ying,Xueguan Lu,Chunying Shen,Tingting Xu,Xiaomin Ou,Weiwei Li,Xin Zhou,Chengrun Du,Changming Zhou,Chaosu Hu,Xiayun He","doi":"10.1001/jamaoncol.2025.2191","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2191","url":null,"abstract":"ImportanceInduction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) has been a standard treatment for locoregionally advanced nasopharyngeal carcinoma (LA-NPC) but with high acute toxic effects in CCRT phase. Whether CCRT can be safely replaced by radiation therapy with adjuvant chemotherapy (AC) is unknown.ObjectiveTo assess if sequential chemoradiotherapy (SCRT; IC, followed by radiotherapy alone, followed by AC) is noninferior to IC plus CCRT for LA-NPC in terms of efficacy, with less acute toxic effects.Design, Setting, and ParticipantsThis multicenter, open-label, phase 3 noninferiority randomized clinical trial was conducted from January 2018 to September 2021 in 6 centers in China. Patients aged 18 to 65 years with newly diagnosed stage III/IVA NPC were enrolled. The data cutoff date was June 30, 2024.InterventionsPatients were randomly assigned 1:1 to receive 2 cycles of IC with a gemcitabine and cisplatin (GP) regimen (gemcitabine, 1000 mg/m2, on days 1 and 8 plus cisplatin, 25 mg/m2, on days 1, 2, and 3, repeated every 3 weeks) plus radiotherapy alone, followed by 2 cycles of AC with a GP regimen (SCRT group) or 2 cycles IC (GP regimen) followed by radiotherapy concurrent with weekly cisplatin, 30 mg/m2 (IC plus CCRT group).Main Outcomes and MeasuresThe primary end points were 3-year failure-free survival (FFS) with a noninferiority margin of 10% (hazard ratio [HR] less than 1.6) and the incidence of grade 3 or higher acute mucositis during radiotherapy. The secondary end points included overall survival, locoregional FFS, distant FFS, response rate, and toxic effects.ResultsOf 420 enrolled patients, 107 (25.5%) were women, and the median (IQR) age was 48 (41-54) years. A total of 210 patients were randomized to the SCRT group and 210 to the IC plus CCRT group. The median (IQR) follow-up time was 50 (40-61) months. In the intention-to-treat population, 3-year FFS was 83.7% (95% CI, 78.6-88.8) vs 79.5% (95% CI, 74.0-85.0) in the SCRT group vs the IC plus CCRT group, respectively (HR, 0.77; 95% CI, 0.50-1.19; P = .24), with the upper bound of the 95% CI less than 1.6. Identical outcomes were reported in the per-protocol population. Compared with the IC plus CCRT group, the SCRT group had significantly lower incidences of grade 3 or higher acute nonhematological toxic effects (acute mucositis, 61 [29.0%] vs 88 [41.9%], respectively; P < .001; nausea, 20 [9.5%] vs 38[18.1%], respectively; P = .01; vomiting, 8 [3.8%] vs 20 [9.5%], respectively; P = .02). No differences were observed in late toxic effects.Conclusions and RelevanceResults from this noninferiority randomized clinical trial suggest that SCRT is noninferior to IC plus CCRT in terms of 3-year FFS in LA-NPC, with less severe acute nonhematological toxic effects.Trial RegistrationClinicalTrials.gov Identifier: NCT03366415.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"12 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Redefining Systemic Therapy Timing in Nasopharyngeal Cancer-Before, During, or After Radiation.","authors":"Alisa Rybkin,Aarti Bhatia,Henry S Park","doi":"10.1001/jamaoncol.2025.2171","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2171","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"17 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144693270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Vaccine Booster Uptake and Effectiveness Among US Adults With Cancer.","authors":"Jacek Skarbinski,Eric P Elkin,Yonah C Ziemba,Elham Kazemian,Brigid M Wilson,Hinnah Siddiqui,Cheryl B Schleicher,Crystal A Hsiao,Joshua R Nugent,Karen L Reckamp,Akil Merchant,James M Crawford,David A Zidar,Lawrence H Kushi,Jane C Figueiredo","doi":"10.1001/jamaoncol.2025.2020","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2020","url":null,"abstract":"ImportancePersons with cancer are at increased risk of severe COVID-19 infection, but the additional benefit of COVID-19 boosters is unclear.ObjectiveTo assess COVID-19 vaccine effectiveness (VE) and number needed to vaccinate (NNV) among persons with cancer of an additional dose of the monovalent COVID-19 vaccine.Design, Setting, and ParticipantsRetrospective cohort study conducted in 4 health care systems in the US among persons with cancer receiving chemotherapy or immunotherapy. Statistical analysis was conducted between March 2023 and August 2024.ExposuresReceipt of an additional dose of the monovalent COVID-19 vaccine before January 1, 2022, with follow-up until August 31, 2022, and the bivalent COVID-19 vaccine from September 1, 2022, to August 31, 2023.Main Outcomes and MeasuresCOVID-19 hospitalization, diagnosed COVID-19, and COVID-19-related intensive care unit (ICU) admission.ResultsAmong 72 831 persons with cancer (17 922 female individuals [24.6%]), 69% received a monovalent booster by January 1, 2022. During 34 006 person-years of follow-up, the COVID-19 hospitalization rate was 30.5 per 1000 person-years among patients who received a monovalent booster vs 41.9 per 1000 person-years among patients who received the primary series alone, with an adjusted VE of 29.2% (95% CI, 19.9%-37.3%) and NNV to prevent 1 COVID-19 hospitalization of 166 (95% CI, 130-244). There was also significant VE to prevent diagnosed COVID-19 (8.5% [95% CI, 3.7%-13.0%]) and COVID-19-related ICU admission (35.6% [95% CI, 20.0%-48.3%]). Among 88 417 persons with cancer (24 589 female individuals [27.8%]) with 81 027 person-years of follow-up during the bivalent period, patients who received this booster (38%) had a COVID-19 hospitalization rate of 13.4 per 1000 person-years vs 21.7 per 1000 person-years among persons who did not receive a bivalent vaccine, with an adjusted VE of 29.9% (95% CI, 19.4%-39.1%) and NNV to prevent 1 COVID-19 hospitalization of 451 (95% CI, 345-697); the adjusted VE was 30.1% (95% CI, 7.7%-47.0%) to prevent COVID-19-related ICU admission.Conclusions and RelevanceIn this retrospective cohort study, COVID-19 booster vaccinations were associated with significant protection against severe COVID-19, with a favorable NNV among persons with cancer. However, uptake of COVID-19 vaccine boosters was low, and interventions are therefore justified to increase COVID-19 uptake in this high-risk population.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"24 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645809","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for COVID-19-Related Hospitalization and Death in Patients With Cancer: The National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS).","authors":"Brian I Rini,Ana F Best,Mel D Bowman,Grace E Mishkin,Andrea M Denicoff,Larry V Rubinstein,Lyndsay Harris,Ann M Geiger,Nicholas M Mark,Steven A Pergam,Jeremy L Warner,Alok A Khorana,Sacha Gnjatic,Tina W F Yen,Darla K Liles,Christine M Bestvina,Neil J Shah,Jacqueline T Norrell,Dawn L Hershman,Jennifer L Holter-Chakrabarty,Andrew S Poklepovic,Stephen J Chanock,Hari Sankaran,Larissa A Korde","doi":"10.1001/jamaoncol.2025.2010","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2010","url":null,"abstract":"ImportanceRetrospective case series have identified having cancer and receiving treatment for cancer as risk factors for inferior COVID-19 outcomes.ObjectiveTo determine risk factors for hospitalization and death in patients with cancer with COVID-19 infection.Design, Setting, and ParticipantsThe National Cancer Institute COVID-19 in Cancer Patients Study (NCCAPS) is a prospective longitudinal natural history cohort study examining the impact of COVID-19 on patients with cancer. Adults were eligible within 14 days of an initial positive SARS-CoV-2 test result if they were receiving active treatment for cancer or had prior stem cell/bone marrow transplant or CAR T-cell treatment. The statistical analysis took place between September 2024 and April 2025.Main Outcomes and MeasuresThe primary objective of the study was to determine patient factors, therapy types, and cancer types associated with COVID-19 severity, defined as hospitalization for or death from COVID-19 within 30 and 90 days after the first positive SARS-CoV-2 test result. Multivariable regressions were performed for COVID-19-specific hospitalization and mortality (proportional hazard and cause-specific hazard models).ResultsOf 1572 eligible adult patients (median [range] age, 60 [18-93] years; 840 female [53.4%]), 1066 (67.8%) had a solid tumor, with 683 (64.0%) having metastatic disease; breast (252 [23.6%]) and lung cancer (148 [13.9%]) were most common. At enrollment, 1013 patients (64.4%) were unvaccinated for SARS-CoV-2. COVID-19-related mortality at 90 days was 3.0% and did not increase at subsequent time points. The cumulative incidence of COVID-19-specific death in the first 90 days was highest in patients with lymphoma, intermediate in patients with acute leukemia and lung cancer, and lowest in patients with other solid tumors and other hematologic cancers. In multivariable analysis, receipt of chemotherapy (hazard ratio [HR], 1.97; 95% CI, 1.52-2.54) and baseline history of stroke, atrial fibrillation, or pulmonary embolism (HR, 1.78; 95% CI, 1.33-2.38) were associated with a higher risk of hospitalization. Vaccination prior to SARS-CoV-2 infection was associated with a lower risk of hospitalization (HR, 0.52; 95% CI, 0.38-0.70). Over 2 years of follow-up, there were 1739 cancer treatment disruptions, of which 881 (50.7%) were attributed to COVID-19, with most disruptions occurring within the first 30 days.Conclusions and RelevanceThe results of this prospective cohort study showed that COVID-19 had a significant impact on patients with cancer, including hospitalization, treatment disruptions, and death.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"6 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Proper Definition of Postprostatectomy Prostate-Specific Antigen Persistence.","authors":"Brian R Lane,Kevin B Ginsburg,Tudor Borza","doi":"10.1001/jamaoncol.2025.2117","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.2117","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"24 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Considerations for Using Clinical Practice Data to Study COVID-19 Vaccines in Patients With Cancer.","authors":"Larry Han","doi":"10.1001/jamaoncol.2025.1937","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.1937","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"109 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Pandemic and Posttreatment Breast Cancer Surveillance and Outcomes.","authors":"Erin E Hahn,Sarah Eng,Aiyu Chen,Eric C Haupt,Shannon Goodall,Corrine E Munoz-Plaza,Huong Q Nguyen,Michael K Gould,Patricia A Ganz,Ernest Shen","doi":"10.1001/jamaoncol.2025.1991","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.1991","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"52 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}