JAMA Oncology最新文献

{"title":"Lenvatinib Plus Ifosfamide and Etoposide in Children and Young Adults With Relapsed Osteosarcoma: A Phase 2 Randomized Clinical Trial.","authors":"Nathalie Gaspar,Giun-Yi Hung,Sandra J Strauss,Quentin Campbell-Hewson,Filemon S Dela Cruz,Julia L Glade Bender,Kyung-Nam Koh,Sarah B Whittle,Godfrey Chi-Fung Chan,Nicolas U Gerber,Sauli Palmu,Daniel A Morgenstern,Alessandra Longhi,Fredrik Baecklund,Jun Ah Lee,Franco Locatelli,Catalina Márquez Vega,Katherine A Janeway,Geoffrey McCowage,Martin G McCabe,Behzad Bidadi,Jie Huang,Jodi McKenzie,Chinyere E Okpara,Francisco Bautista,","doi":"10.1001/jamaoncol.2024.4381","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4381","url":null,"abstract":"ImportanceThe combination of ifosfamide and etoposide (IE) is commonly used to treat relapsed or refractory osteosarcoma; however, second-line treatment recommendations vary across guidelines.ObjectiveTo evaluate whether the addition of lenvatinib to IE (LEN-IE) improves outcomes in children and young adults with relapsed or refractory osteosarcoma.Design, Setting, and ParticipantsThe OLIE phase II, open-label, randomized clinical trial was conducted globally across Europe, Asia and the Pacific, and North America. From March 22, 2020, through November 11, 2021, the trial enrolled patients aged 2 to 25 years with high-grade osteosarcoma, measurable or evaluable disease per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST 1.1), and 1 to 2 prior lines of systemic treatment. The data analyses were performed between March 22, 2020 (first patient in) and June 22, 2022 (data cutoff for the primary analysis), and September 29, 2023 (end of study final database lock).InterventionsThe OLIE trial assessed the efficacy and safety of lenvatinib (14 mg/m2 taken orally once daily) combined with up to 5 cycles of ifosfamide (3000 mg/m2 intravenously) and etoposide (100 mg/m2 intravenously) on days 1 to 3 of each cycle vs IE alone at the same doses. Patients randomized to IE could cross over to receive lenvatinib upon disease progression by independent imaging review.Main Outcomes and MeasuresThe primary end point was progression-free survival (PFS) per RECIST 1.1 by independent imaging review. The Kaplan-Meier method was used to estimate the PFS distribution, with a prespecified 1-sided significance threshold of .025 by stratified log-rank test. Secondary end points included PFS rate at 4 months and overall survival. Adverse events were summarized using descriptive statistics.ResultsA total of 81 patients were enrolled (median [IQR] age, 15.0 [12.0-18.0] years; 46 males [56.8%]), with 40 in the LEN-IE arm and 41 in the IE arm. Median PFS was 6.5 months (95% CI, 5.7-8.2 months) for the LEN-IE arm and 5.5 months (95% CI, 2.9-6.5 months) for the IE arm (hazard ratio [HR], 0.54; 95% CI, 0.27-1.08; 1-sided P = .04). The rate of PFS at 4 months was 76.3% (95% CI, 59.3%-86.9%) in the LEN-IE arm and 66.0% (95% CI, 47.7%-79.2%) in the IE arm. Median overall survival was 11.9 months (95% CI, 10.1 months to not estimable) with LEN-IE and 17.4 months (95% CI, 14.2 months to not estimable) with IE (HR, 1.28; 95% CI, 0.60-2.70; 1-sided nominal P = .75). Grade 3 or higher treatment-related adverse events occurred in 35 of 39 patients (89.7%) in the LEN-IE arm and 31 of 39 patients (79.5%) in the IE arm.Conclusions and RelevanceAlthough LEN-IE did not meet prespecified statistical significance for improved PFS vs IE, this study demonstrates the importance of international collaboration and randomized clinical trials in patients with relapsed or refractory osteosarcoma and may inform future trial design.Trial RegistrationClinicalTrials.gov Identifier: NCT0415418","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"11 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142448029","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":"Endometrial Cancer Classification and Management in the Molecular Subtyping Era","authors":"Anjelica Hodgson, Kathy Han","doi":"10.1001/jamaoncol.2024.4376","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4376","url":null,"abstract":"A 65-year-old woman presented with a 6-month history of postmenopausal vaginal bleeding, and endometrial biopsy showed grade 2 endometrioid adenocarcinoma. What would you do next?","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"27 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405151","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":"Differences in Sentinel Node Biopsy and Targeted Axillary Dissection Following Neoadjuvant Chemotherapy-Reply.","authors":"Giacomo Montagna,Monica Morrow,Walter P Weber","doi":"10.1001/jamaoncol.2024.4572","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4572","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"19 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436028","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":"Differences in Sentinel Node Biopsy and Targeted Axillary Dissection Following Neoadjuvant Chemotherapy.","authors":"Mangesh A Thorat","doi":"10.1001/jamaoncol.2024.4569","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4569","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"55 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436023","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":"Natural Language Processing–Assessed Unmet Medical and Social Needs in Cancer Crowdfunding Stories","authors":"Zhiyuan Zheng, Shaojun Yu, Farhad Islami, Matthew P. Banegas, Jingxuan Zhao, Jing Zhang, Fumiko Chino, K. Robin Yabroff","doi":"10.1001/jamaoncol.2024.4412","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4412","url":null,"abstract":"This cross-sectional study uses a large natural language processing model to examine unmet medical and social needs based on cancer-related fundraising stories in the US.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"228 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405150","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":"Ninth Version of the AJCC and UICC Nasopharyngeal Cancer TNM Staging Classification","authors":"Jian-Ji Pan, Hai-Qiang Mai, Wai Tong Ng, Chao-Su Hu, Jin-Gao Li, Xiao-Zhong Chen, James C. H. Chow, Edwin Wong, Victor Lee, Ling-Yu Ma, Qiao-Juan Guo, Qin Liu, Li-Zhi Liu, Ting-Ting Xu, Xiao-Chang Gong, Meng-Yun Qiang, Kwok-Hung Au, Tsz-Chim Liu, Chi Leung Chiang, You-Ping Xiao, Shao-Jun Lin, Yun-Bin Chen, Shan-Shan Guo, Charlene H. L. Wong, Lin-Quan Tang, Zhi-Yuan Xu, Yi-Zhen Jia, Wen-Sa Peng, Li-Ping Hu, Tian-Zhu Lu, Feng Jiang, Cai-Neng Cao, Wei Xu, Jun Ma, Pierre Blanchard, Michelle Williams, Christine M. Glastonbury, Ann D. King, Snehal G. Patel, Raja R. Seethala, A. Dimitrios Colevas, Dai-Ming Fan, Melvin L. K. Chua, Shao Hui Huang, Brian O’Sullivan, William Lydiatt, Anne W. M. Lee","doi":"10.1001/jamaoncol.2024.4354","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4354","url":null,"abstract":"ImportanceAccurate staging is a fundamental step in treating patients with nasopharyngeal carcinoma (NPC) worldwide; this is crucial not only for prognostication, but also for guiding treatment decisions. The American Joint Committee on Cancer (AJCC)/Union for International Cancer Control (UICC) tumor-node-metastasis (TNM) system is the global language for clinicians, researchers, and cancer registries. Continual improvement that aligns with contemporary pattern of care is essential.ObjectiveTo improve the prognostic accuracy and clinical applicability of the eighth edition (TNM-8) for NPC.Design, Setting, and ParticipantsThis multicenter study analyzed patients with NPC with detailed tumor features during January 2014 and December 2015 and was reviewed by experienced radiologists. The data analysis was completed in December 2023. The findings were further confirmed with internal and external validation. Statistical analyses and clinical considerations were reviewed by the AJCC/UICC multidisciplinary head and neck panels and attained consensus. The recommendations were evaluated by the AJCC Evidence-Based Medicine Committee before final endorsement as the ninth version (TNM-9).Main Outcomes and MeasuresThe primary end point was overall survival. Adjusted hazard ratios of different subgroups were then assessed for confirmation of optimal stage grouping.ResultsOf the 4914 patients analyzed, 1264 (25.7%) were female and 3650 (74.3%) were male; the median (SD) age was 48.1 (12.0) years. Advanced radiological extranodal extension (with involvement of adjacent muscles, skin, and/or neurovascular bundles) was identified as an independent adverse factor for all end points: this was added as a criterion for N3. Patients with nonmetastatic disease were regrouped into stages I to III instead of TNM-8 stages I to IVA. Significant hazard discrimination was achieved by grouping T1-2N0-1 as stage I, T3/N2 as stage II, and T4/N3 as stage III. Although the T1-2N0-1 subgroups had comparable 5-year overall survival, subdivisions into IA (T1-T2N0) and IB (T1-T2N1) were recommended due to the distinction in adjusted hazard ratios following adjustment for chemotherapy use. Metastatic disease was exclusively classified as stage IV, and prognostication was further refined by subdivision into IVA (M1a, ≤3 lesions) and IVB (M1b, >3 lesions). TNM-9 demonstrated superiority compared with TNM-8 in major statistical aspects.Conclusion and RelevanceThe results of this diagnostic study suggest that the ninth version of TNM staging for NPC, based on robust analyses and a comprehensive review by the AJCC/UICC staging committees, provides an improved staging system for global application and a framework for future incorporation of nonanatomical factors. This will be launched for global application in January 2025.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"64 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405206","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":"Staging and Prognosis of Nasopharyngeal Cancer: The Time for Change Is Now.","authors":"Sweet Ping Ng,Darrion Mitchell","doi":"10.1001/jamaoncol.2024.4201","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4201","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"460 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142436024","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":"Implementing Resource-Stratified Guidelines in LMICs—More Issues Than Solutions","authors":"Shweta Baral","doi":"10.1001/jamaoncol.2024.4351","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4351","url":null,"abstract":"This Viewpoint discusses the importance of formulating more stable local treatment guidelines because international guidelines and even resource-stratified guidelines may not be as applicable in low- to middle-income countries.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"100 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142405105","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":"Error in Abstract and Methods.","authors":"","doi":"10.1001/jamaoncol.2022.0062","DOIUrl":"10.1001/jamaoncol.2022.0062","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":" ","pages":"1443"},"PeriodicalIF":22.5,"publicationDate":"2024-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8874905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39949639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oral Microbiome and Subsequent Risk of Head and Neck Squamous Cell Cancer.","authors":"Soyoung Kwak,Chan Wang,Mykhaylo Usyk,Feng Wu,Neal D Freedman,Wen-Yi Huang,Marjorie L McCullough,Caroline Y Um,Martha J Shrubsole,Qiuyin Cai,Huilin Li,Jiyoung Ahn,Richard B Hayes","doi":"10.1001/jamaoncol.2024.4006","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.4006","url":null,"abstract":"ImportanceThe oral microbiota may be involved in development of head and neck squamous cell cancer (HNSCC), yet current evidence is largely limited to bacterial 16S amplicon sequencing or small retrospective case-control studies.ObjectiveTo test whether oral bacterial and fungal microbiomes are associated with subsequent risk of HNSCC development.Design, Setting, and ParticipantsProspective nested case-control study among participants providing oral samples in 3 epidemiological cohorts, the American Cancer Society Cancer Prevention Study II Nutrition Cohort, the Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial, and the Southern Community Cohort Study. Two hundred thirty-six patients who prospectively developed HNSCC were identified during a mean (SD) of 5.1 (3.6) years of follow-up. Control participants who remained HNSCC free were selected by 2:1 frequency matching on cohort, age, sex, race and ethnicity, and time since oral sample collection. Data analysis was conducted in 2023.ExposuresCharacterization of the oral bacterial microbiome using whole-genome shotgun sequencing and the oral fungal microbiome using internal transcribed spacer sequencing. Association of bacterial and fungal taxa with HNSCC was assessed by analysis of compositions of microbiomes with bias correction. Association with red and orange oral pathogen complexes was tested by logistic regression. A microbial risk score for HNSCC risk was calculated from risk-associated microbiota.Main Outcomes and MeasuresThe primary outcome was HNSCC incidence.ResultsThe study included 236 HNSCC case participants with a mean (SD) age of 60.9 (9.5) years and 24.6% women during a mean of 5.1 (3.6) years of follow-up, and 485 matched control participants. Overall microbiome diversity at baseline was not related to subsequent HNSCC risk; however 13 oral bacterial species were found to be differentially associated with development of HNSCC. The species included the newly identified Prevotella salivae, Streptococcus sanguinis, and Leptotrichia species, as well as several species belonging to beta and gamma Proteobacteria. The red/orange periodontal pathogen complex was moderately associated with HNSCC risk (odds ratio, 1.06 per 1 SD; 95% CI, 1.00-1.12). A 1-SD increase in microbial risk score (created based on 22 bacteria) was associated with a 50% increase in HNSCC risk (multivariate odds ratio, 1.50; 95% CI, 1.21-1.85). No fungal taxa associated with HNSCC risk were identified.Conclusions and RelevanceThis case-control study yielded compelling evidence that oral bacteria are a risk factor for HNSCC development. The identified bacteria and bacterial complexes hold promise, along with other risk factors, to identify high-risk individuals for personalized prevention of HNSCC.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"217 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142325298","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}