This randomized clinical trial examines whether adding chemotherapy with pemetrexed and carboplatin to gefitinib improves survival among patients with epidermal growth factor receptor (EGFR)–variant non–small cell lung cancer.
Pub Date : 2024-04-18DOI: 10.1001/jamaoncol.2024.0473
Laurent Phely, Luca Hensen, Christoph Faul, Christer Alexander Ruff, Dina Schneider, Wolfgang Andreas Bethge, Claudia Lengerke
This case series reports durable remissions in 2 patients with relapsed/refractory B-cell acute lymphoblastic leukemia treated with allogeneic bispecific CD19/CD22-targeting chimeric antigen receptor T cells.
本系列病例报告了两名接受异体双特异性 CD19/CD22 靶向嵌合抗原受体 T 细胞治疗的复发/难治性 B 细胞急性淋巴细胞白血病患者的持久缓解情况。
{"title":"Allogeneic CD19/CD22 CAR T-Cell Therapy for B-Cell Acute Lymphoblastic Leukemia","authors":"Laurent Phely, Luca Hensen, Christoph Faul, Christer Alexander Ruff, Dina Schneider, Wolfgang Andreas Bethge, Claudia Lengerke","doi":"10.1001/jamaoncol.2024.0473","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0473","url":null,"abstract":"This case series reports durable remissions in 2 patients with relapsed/refractory B-cell acute lymphoblastic leukemia treated with allogeneic bispecific CD19/CD22-targeting chimeric antigen receptor T cells.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"89 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620204","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}
Pub Date : 2024-04-18DOI: 10.1001/jamaoncol.2024.0662
Ryan Storgard, Kai Rejeski, Miguel-Angel Perales, Adam Goldman, Roni Shouval
This cohort study assesses the increase in second primary malignant neoplasms and T-cell malignant neoplasm cases associated with chimeric antigen receptor–T cells.
这项队列研究评估了与嵌合抗原受体-T 细胞相关的第二原发性恶性肿瘤和 T 细胞恶性肿瘤病例的增加情况。
{"title":"T-Cell Malignant Neoplasms After Chimeric Antigen Receptor T-Cell Therapy","authors":"Ryan Storgard, Kai Rejeski, Miguel-Angel Perales, Adam Goldman, Roni Shouval","doi":"10.1001/jamaoncol.2024.0662","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0662","url":null,"abstract":"This cohort study assesses the increase in second primary malignant neoplasms and T-cell malignant neoplasm cases associated with chimeric antigen receptor–T cells.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"30 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620352","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}
Pub Date : 2024-04-18DOI: 10.1001/jamaoncol.2024.0451
Alicia C. Smart, Michael J. Yunes, Karen M. Winkfield
This Viewpoint calls for health care systems, oncologists, and staff to prioritize and adopt policies that are inclusive and respectful of transgender patients with cancer.
本观点呼吁医疗保健系统、肿瘤学家和工作人员优先考虑并采取包容和尊重癌症变性患者的政策。
{"title":"Policy Priorities in Cancer Care for Transgender People","authors":"Alicia C. Smart, Michael J. Yunes, Karen M. Winkfield","doi":"10.1001/jamaoncol.2024.0451","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0451","url":null,"abstract":"This Viewpoint calls for health care systems, oncologists, and staff to prioritize and adopt policies that are inclusive and respectful of transgender patients with cancer.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"20 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620545","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}
Pub Date : 2024-04-18DOI: 10.1001/jamaoncol.2024.0470
Carter Baughman, Kathryn Norman, Kenneth Mukamal
ImportanceThe American Cancer Society’s (ACS’s) nutrition and physical activity guidelines are intended to reduce morbidity and mortality among cancer survivors, but to our knowledge, adherence to these guidelines has not been systematically quantified.ObjectiveTo evaluate adherence to and factors associated with adherence to lifestyle modification guidelines among cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from the Behavioral Risk Factor Surveillance System using survey administration years 2017 (surveys completed between January 2017 and March 2018), 2019 (surveys completed between January 2019 and December 2019), and 2021 (surveys completed between January 2021 and February 2022). The study included people who had completed cancer treatment at any point prior to the given survey administration year. Data were analyzed from September 19, 2022, to December 12, 2022.Main Outcomes and MeasuresThe primary outcome was adherence to current ACS guidelines for physical activity, body mass index, alcohol use, and fruit and vegetable intake. Factors associated with adherence rates to the guidelines, including age, sex, race and ethnicity, location, and educational level, were evaluated using linear regression. Complex survey weights were used.ResultsA total of 10 020 respondents (57% female; mean [SE] age, 64.2 [0.3] years) reported completion of cancer treatment, representing 2.7 million US individuals over 3 years. Of these respondents, 9121 completed questionnaires for all 4 metrics measured. A total of 72% (95% CI, 71%-74%) of cancer survivors met criteria for adequate physical activity, 68% (95% CI, 66%-69%) did not have obesity, 12% (95% CI, 11%-13%) ate adequate fruits and vegetables, and 50% (95% CI, 49%-52%) did not drink alcohol. In total, 4% (95% CI, 3%-4%) of cancer survivors adhered to all 4 guidelines, with the mean number of guidelines met being 2.0 (95% CI, 2.0-2.1). Factors associated with greater adherence included female sex, older age, Black race, higher educational level, and residence in Western US states.Conclusions and RelevanceIn this cross-sectional study, 4% of cancer survivors fully adhered to current ACS recommendations. Improved understanding of guideline adherence and its determinants may guide oncologists and general internists in providing recommendations for their patients who have completed cancer treatments.
{"title":"Adherence to American Cancer Society Nutrition and Physical Activity Guidelines Among Cancer Survivors","authors":"Carter Baughman, Kathryn Norman, Kenneth Mukamal","doi":"10.1001/jamaoncol.2024.0470","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0470","url":null,"abstract":"ImportanceThe American Cancer Society’s (ACS’s) nutrition and physical activity guidelines are intended to reduce morbidity and mortality among cancer survivors, but to our knowledge, adherence to these guidelines has not been systematically quantified.ObjectiveTo evaluate adherence to and factors associated with adherence to lifestyle modification guidelines among cancer survivors.Design, Setting, and ParticipantsThis cross-sectional study used data from the Behavioral Risk Factor Surveillance System using survey administration years 2017 (surveys completed between January 2017 and March 2018), 2019 (surveys completed between January 2019 and December 2019), and 2021 (surveys completed between January 2021 and February 2022). The study included people who had completed cancer treatment at any point prior to the given survey administration year. Data were analyzed from September 19, 2022, to December 12, 2022.Main Outcomes and MeasuresThe primary outcome was adherence to current ACS guidelines for physical activity, body mass index, alcohol use, and fruit and vegetable intake. Factors associated with adherence rates to the guidelines, including age, sex, race and ethnicity, location, and educational level, were evaluated using linear regression. Complex survey weights were used.ResultsA total of 10 020 respondents (57% female; mean [SE] age, 64.2 [0.3] years) reported completion of cancer treatment, representing 2.7 million US individuals over 3 years. Of these respondents, 9121 completed questionnaires for all 4 metrics measured. A total of 72% (95% CI, 71%-74%) of cancer survivors met criteria for adequate physical activity, 68% (95% CI, 66%-69%) did not have obesity, 12% (95% CI, 11%-13%) ate adequate fruits and vegetables, and 50% (95% CI, 49%-52%) did not drink alcohol. In total, 4% (95% CI, 3%-4%) of cancer survivors adhered to all 4 guidelines, with the mean number of guidelines met being 2.0 (95% CI, 2.0-2.1). Factors associated with greater adherence included female sex, older age, Black race, higher educational level, and residence in Western US states.Conclusions and RelevanceIn this cross-sectional study, 4% of cancer survivors fully adhered to current ACS recommendations. Improved understanding of guideline adherence and its determinants may guide oncologists and general internists in providing recommendations for their patients who have completed cancer treatments.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"100 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140620212","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}
Pub Date : 2024-04-11DOI: 10.1001/jamaoncol.2024.0280
Nicholas P. Verdini, Karolina L. Bryl, Raymond E. Baser, Kaitlyn Lapen, Jun J. Mao, Erin F. Gillespie
ImportanceClinical trials are critical for progress in oncology; however, only 5% of the adult cancer population participates. Harnessing data that are routinely collected (ie, electronic patient-reported outcomes [ePROs]) may serve as a method to promote trial enrollment.ObjectiveTo evaluate if an ePRO-prompted recruitment strategy is associated with increased clinical trial enrollment.Design, Setting, and ParticipantsA randomized substudy was conducted from September 2022 to March 2023 at a multisite tertiary cancer center as part of an ongoing clinical trial that was testing a symptom-intervention for cancer-related fatigue. Patients with breast cancer who were undergoing radiotherapy who completed at least 1 ePRO questionnaire during the study period were included. Physician-level cluster randomization assigned fatigue-eligible patients to either receive a portal message invitation to a symptom-intervention trial or standard of care (SOC; physician-based referral).ExposureePRO questionnaires distributed in routine practice were queried weekly and screened for moderate or greater fatigue, the principle inclusion criterion for the primary trial. To assess the association of the portal message source with response and enrollment, every other patient received a message from the primary radiation oncology team or the referral service.Main Outcomes and MeasuresClinical trial response/referral and enrollment.ResultsA total of 1041 patients completed ePRO questionnaires, of whom 394 (38%; 53 Asian [13.6%], 43 Black [11.0%], 29 Hispanic [7.4%], and 262 White individuals [66.5%]; median [IQR] age, 55 [47-65] years) endorsed moderate or greater fatigue while receiving treatment. A total of 210 patients (53.3%) were assigned to receive a portal message and 184 (46.7%) patients, SOC. In the portal message group, 73 patients (35%) responded and 41 (20%) enrolled compared with 1 patient (0.5%) referred and 0 enrolled in the SOC group (P < .001). The response rate to portal messages favored the referral service vs the primary radiation oncology service (44% vs 26%; P = .01), but there was no significant difference in enrollments.Conclusions and RelevanceThe study results suggest that use of routine care ePROs was associated with greater enrollment in a symptom-intervention trial compared with physician-based referral. Messaging directly from the referral service may support enrollment and help reduce oncology physician-level barriers to trial enrollment for studies testing symptom interventions.
{"title":"Patient-Reported Outcomes as a Recruitment Strategy for Clinical Trial Enrollment","authors":"Nicholas P. Verdini, Karolina L. Bryl, Raymond E. Baser, Kaitlyn Lapen, Jun J. Mao, Erin F. Gillespie","doi":"10.1001/jamaoncol.2024.0280","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0280","url":null,"abstract":"ImportanceClinical trials are critical for progress in oncology; however, only 5% of the adult cancer population participates. Harnessing data that are routinely collected (ie, electronic patient-reported outcomes [ePROs]) may serve as a method to promote trial enrollment.ObjectiveTo evaluate if an ePRO-prompted recruitment strategy is associated with increased clinical trial enrollment.Design, Setting, and ParticipantsA randomized substudy was conducted from September 2022 to March 2023 at a multisite tertiary cancer center as part of an ongoing clinical trial that was testing a symptom-intervention for cancer-related fatigue. Patients with breast cancer who were undergoing radiotherapy who completed at least 1 ePRO questionnaire during the study period were included. Physician-level cluster randomization assigned fatigue-eligible patients to either receive a portal message invitation to a symptom-intervention trial or standard of care (SOC; physician-based referral).ExposureePRO questionnaires distributed in routine practice were queried weekly and screened for moderate or greater fatigue, the principle inclusion criterion for the primary trial. To assess the association of the portal message source with response and enrollment, every other patient received a message from the primary radiation oncology team or the referral service.Main Outcomes and MeasuresClinical trial response/referral and enrollment.ResultsA total of 1041 patients completed ePRO questionnaires, of whom 394 (38%; 53 Asian [13.6%], 43 Black [11.0%], 29 Hispanic [7.4%], and 262 White individuals [66.5%]; median [IQR] age, 55 [47-65] years) endorsed moderate or greater fatigue while receiving treatment. A total of 210 patients (53.3%) were assigned to receive a portal message and 184 (46.7%) patients, SOC. In the portal message group, 73 patients (35%) responded and 41 (20%) enrolled compared with 1 patient (0.5%) referred and 0 enrolled in the SOC group (<jats:italic>P</jats:italic> &amp;lt; .001). The response rate to portal messages favored the referral service vs the primary radiation oncology service (44% vs 26%; <jats:italic>P</jats:italic> = .01), but there was no significant difference in enrollments.Conclusions and RelevanceThe study results suggest that use of routine care ePROs was associated with greater enrollment in a symptom-intervention trial compared with physician-based referral. Messaging directly from the referral service may support enrollment and help reduce oncology physician-level barriers to trial enrollment for studies testing symptom interventions.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"33 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547696","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}
Pub Date : 2024-04-11DOI: 10.1001/jamaoncol.2024.0286
Kristen D. Brantley, Shoshana M. Rosenberg, Laura C. Collins, Kathryn J. Ruddy, Rulla M. Tamimi, Lidia Schapira, Virginia F. Borges, Ellen Warner, Steven E. Come, Yue Zheng, Gregory J. Kirkner, Craig Snow, Eric P. Winer, Ann H. Partridge
ImportanceAmong women diagnosed with primary breast cancer (BC) at or younger than age 40 years, prior data suggest that their risk of a second primary BC (SPBC) is higher than that of women who are older when they develop a first primary BC.ObjectiveTo estimate cumulative incidence and characterize risk factors of SPBC among young patients with BC.Design, Setting, and ParticipantsParticipants were enrolled in the Young Women’s Breast Cancer Study, a prospective study of 1297 women aged 40 years or younger who were diagnosed with stage 0 to III BC from August 2006 to June 2015. Demographic, genetic testing, treatment, and outcome data were collected by patient surveys and medical record review. A time-to-event analysis was used to account for competing risks when determining cumulative incidence of SPBC, and Fine-Gray subdistribution hazard models were used to evaluate associations between clinical factors and SPBC risk. Data were analyzed from January to May 2023.Main Outcomes and MeasuresThe 5- and 10- year cumulative incidence of SPBC.ResultsIn all, 685 women with stage 0 to III BC (mean [SD] age at primary BC diagnosis, 36 [4] years) who underwent unilateral mastectomy or lumpectomy as the primary surgery for BC were included in the analysis. Over a median (IQR) follow-up of 10.0 (7.4-12.1) years, 17 patients (2.5%) developed an SPBC; 2 of these patients had cancer in the ipsilateral breast after lumpectomy. The median (IQR) time from primary BC diagnosis to SPBC was 4.2 (3.3-5.6) years. Among 577 women who underwent genetic testing, the 10-year risk of SPBC was 2.2% for women who did not carry a pathogenic variant (12 of 544) and 8.9% for carriers of a pathogenic variant (3 of 33). In multivariate analyses, the risk of SPBC was higher among PV carriers vs noncarriers (subdistribution hazard ratio [sHR], 5.27; 95% CI, 1.43-19.43) and women with primary in situ BC vs invasive BC (sHR, 5.61; 95% CI, 1.52-20.70).ConclusionsFindings of this cohort study suggest that young BC survivors without a germline pathogenic variant have a low risk of developing a SPBC in the first 10 years after diagnosis. Findings from germline genetic testing may inform treatment decision-making and follow-up care considerations in this population.
{"title":"Second Primary Breast Cancer in Young Breast Cancer Survivors","authors":"Kristen D. Brantley, Shoshana M. Rosenberg, Laura C. Collins, Kathryn J. Ruddy, Rulla M. Tamimi, Lidia Schapira, Virginia F. Borges, Ellen Warner, Steven E. Come, Yue Zheng, Gregory J. Kirkner, Craig Snow, Eric P. Winer, Ann H. Partridge","doi":"10.1001/jamaoncol.2024.0286","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0286","url":null,"abstract":"ImportanceAmong women diagnosed with primary breast cancer (BC) at or younger than age 40 years, prior data suggest that their risk of a second primary BC (SPBC) is higher than that of women who are older when they develop a first primary BC.ObjectiveTo estimate cumulative incidence and characterize risk factors of SPBC among young patients with BC.Design, Setting, and ParticipantsParticipants were enrolled in the Young Women’s Breast Cancer Study, a prospective study of 1297 women aged 40 years or younger who were diagnosed with stage 0 to III BC from August 2006 to June 2015. Demographic, genetic testing, treatment, and outcome data were collected by patient surveys and medical record review. A time-to-event analysis was used to account for competing risks when determining cumulative incidence of SPBC, and Fine-Gray subdistribution hazard models were used to evaluate associations between clinical factors and SPBC risk. Data were analyzed from January to May 2023.Main Outcomes and MeasuresThe 5- and 10- year cumulative incidence of SPBC.ResultsIn all, 685 women with stage 0 to III BC (mean [SD] age at primary BC diagnosis, 36 [4] years) who underwent unilateral mastectomy or lumpectomy as the primary surgery for BC were included in the analysis. Over a median (IQR) follow-up of 10.0 (7.4-12.1) years, 17 patients (2.5%) developed an SPBC; 2 of these patients had cancer in the ipsilateral breast after lumpectomy. The median (IQR) time from primary BC diagnosis to SPBC was 4.2 (3.3-5.6) years. Among 577 women who underwent genetic testing, the 10-year risk of SPBC was 2.2% for women who did not carry a pathogenic variant (12 of 544) and 8.9% for carriers of a pathogenic variant (3 of 33). In multivariate analyses, the risk of SPBC was higher among PV carriers vs noncarriers (subdistribution hazard ratio [sHR], 5.27; 95% CI, 1.43-19.43) and women with primary in situ BC vs invasive BC (sHR, 5.61; 95% CI, 1.52-20.70).ConclusionsFindings of this cohort study suggest that young BC survivors without a germline pathogenic variant have a low risk of developing a SPBC in the first 10 years after diagnosis. Findings from germline genetic testing may inform treatment decision-making and follow-up care considerations in this population.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"108 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547616","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}
Pub Date : 2024-04-11DOI: 10.1001/jamaoncol.2024.0294
George Rodrigues, Kristin A. Higgins, Andreas Rimner, Arya Amini, Joe Y. Chang, Stephen G. Chun, Jessica Donington, Martin J. Edelman, Matthew A. Gubens, Puneeth Iyengar, Benjamin Movsas, Matthew S. Ning, Henry S. Park, Andrea Wolf, Charles B. Simone
ImportanceThe treatment of locally advanced non–small cell lung cancer (LA-NSCLC) has been informed by more than 5 decades of clinical trials and other relevant literature. However, controversies remain regarding the application of various radiation and systemic therapies in commonly encountered clinical scenarios.ObjectiveTo develop case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable LA-NSCLC.Evidence ReviewThe American Radium Society (ARS) Appropriate Use Criteria (AUC) Thoracic Committee guideline is an evidence-based consensus document assessing various clinical scenarios associated with LA-NSCLC. A systematic review of the literature with evidence ratings was conducted to inform the appropriateness of treatment recommendations by the ARS AUC Thoracic Committee for the management of unresectable LA-NSCLC.FindingsTreatment appropriateness of a variety of LA-NSCLC scenarios was assessed by a consensus-based modified Delphi approach using a range of 3 points to 9 points to denote consensus agreement. Committee recommendations were vetted by the ARS AUC Executive Committee and a 2-week public comment period before official approval and adoption. Standard of care management of good prognosis LA-NSCLC consists of combined concurrent radical (60-70 Gy) platinum-based chemoradiation followed by consolidation durvalumab immunotherapy (for patients without progression). Planning and delivery of locally advanced lung cancer radiotherapy usually should be performed using intensity-modulated radiotherapy techniques. A variety of palliative and radical fractionation schedules are available to treat patients with poor performance and/or pulmonary status. The salvage therapy for a local recurrence after successful primary management is complex and likely requires both multidisciplinary input and shared decision-making with the patient.Conclusions and RelevanceEvidence-based guidance on the management of various unresectable LA-NSCLC scenarios is provided by the ARS AUC to optimize multidisciplinary patient care for this challenging patient population.
{"title":"American Radium Society Appropriate Use Criteria for Unresectable Locally Advanced Non–Small Cell Lung Cancer","authors":"George Rodrigues, Kristin A. Higgins, Andreas Rimner, Arya Amini, Joe Y. Chang, Stephen G. Chun, Jessica Donington, Martin J. Edelman, Matthew A. Gubens, Puneeth Iyengar, Benjamin Movsas, Matthew S. Ning, Henry S. Park, Andrea Wolf, Charles B. Simone","doi":"10.1001/jamaoncol.2024.0294","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0294","url":null,"abstract":"ImportanceThe treatment of locally advanced non–small cell lung cancer (LA-NSCLC) has been informed by more than 5 decades of clinical trials and other relevant literature. However, controversies remain regarding the application of various radiation and systemic therapies in commonly encountered clinical scenarios.ObjectiveTo develop case-referenced consensus and evidence-based guidelines to inform clinical practice in unresectable LA-NSCLC.Evidence ReviewThe American Radium Society (ARS) Appropriate Use Criteria (AUC) Thoracic Committee guideline is an evidence-based consensus document assessing various clinical scenarios associated with LA-NSCLC. A systematic review of the literature with evidence ratings was conducted to inform the appropriateness of treatment recommendations by the ARS AUC Thoracic Committee for the management of unresectable LA-NSCLC.FindingsTreatment appropriateness of a variety of LA-NSCLC scenarios was assessed by a consensus-based modified Delphi approach using a range of 3 points to 9 points to denote consensus agreement. Committee recommendations were vetted by the ARS AUC Executive Committee and a 2-week public comment period before official approval and adoption. Standard of care management of good prognosis LA-NSCLC consists of combined concurrent radical (60-70 Gy) platinum-based chemoradiation followed by consolidation durvalumab immunotherapy (for patients without progression). Planning and delivery of locally advanced lung cancer radiotherapy usually should be performed using intensity-modulated radiotherapy techniques. A variety of palliative and radical fractionation schedules are available to treat patients with poor performance and/or pulmonary status. The salvage therapy for a local recurrence after successful primary management is complex and likely requires both multidisciplinary input and shared decision-making with the patient.Conclusions and RelevanceEvidence-based guidance on the management of various unresectable LA-NSCLC scenarios is provided by the ARS AUC to optimize multidisciplinary patient care for this challenging patient population.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"72 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547841","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}
Pub Date : 2024-04-05DOI: 10.1001/jamaoncol.2024.0734
Tamás Fazekas, Sung Ryul Shim, Giuseppe Basile, Michael Baboudjian, Tamás Kói, Mikolaj Przydacz, Mohammad Abufaraj, Guillaume Ploussard, Veeru Kasivisvanathan, Juan Gómez Rivas, Giorgio Gandaglia, Tibor Szarvas, Ivo G. Schoots, Roderick C. N. van den Bergh, Michael S. Leapman, Péter Nyirády, Shahrokh F. Shariat, Pawel Rajwa
ImportanceProstate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway.ObjectiveTo systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)–based screening with systematic biopsy strategies.Data SourcesPubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023).Study SelectionRandomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening.Data ExtractionNumber of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted.Main Outcomes and MeasuresThe primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa.Data SynthesisThe generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication.ResultsData were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; P ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; P ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; P = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; P = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; P = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; P = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; P = .22).Conclusion and relevanceThe results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.
{"title":"Magnetic Resonance Imaging in Prostate Cancer Screening","authors":"Tamás Fazekas, Sung Ryul Shim, Giuseppe Basile, Michael Baboudjian, Tamás Kói, Mikolaj Przydacz, Mohammad Abufaraj, Guillaume Ploussard, Veeru Kasivisvanathan, Juan Gómez Rivas, Giorgio Gandaglia, Tibor Szarvas, Ivo G. Schoots, Roderick C. N. van den Bergh, Michael S. Leapman, Péter Nyirády, Shahrokh F. Shariat, Pawel Rajwa","doi":"10.1001/jamaoncol.2024.0734","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0734","url":null,"abstract":"ImportanceProstate magnetic resonance imaging (MRI) is increasingly integrated within the prostate cancer (PCa) early detection pathway.ObjectiveTo systematically evaluate the existing evidence regarding screening pathways incorporating MRI with targeted biopsy and assess their diagnostic value compared with prostate-specific antigen (PSA)–based screening with systematic biopsy strategies.Data SourcesPubMed/MEDLINE, Embase, Cochrane/Central, Scopus, and Web of Science (through May 2023).Study SelectionRandomized clinical trials and prospective cohort studies were eligible if they reported data on the diagnostic utility of prostate MRI in the setting of PCa screening.Data ExtractionNumber of screened individuals, biopsy indications, biopsies performed, clinically significant PCa (csPCa) defined as International Society of Urological Pathology (ISUP) grade 2 or higher, and insignificant (ISUP1) PCas detected were extracted.Main Outcomes and MeasuresThe primary outcome was csPCa detection rate. Secondary outcomes included clinical insignificant PCa detection rate, biopsy indication rates, and the positive predictive value for the detection of csPCa.Data SynthesisThe generalized mixed-effect approach with pooled odds ratios (ORs) and random-effect models was used to compare the MRI-based and PSA-only screening strategies. Separate analyses were performed based on the timing of MRI (primary/sequential after a PSA test) and cutoff (Prostate Imaging Reporting and Data System [PI-RADS] score ≥3 or ≥4) for biopsy indication.ResultsData were synthesized from 80 114 men from 12 studies. Compared with standard PSA-based screening, the MRI pathway (sequential screening, PI-RADS score ≥3 cutoff for biopsy) was associated with higher odds of csPCa when tests results were positive (OR, 4.15; 95% CI, 2.93-5.88; <jats:italic>P</jats:italic> ≤ .001), decreased odds of biopsies (OR, 0.28; 95% CI, 0.22-0.36; <jats:italic>P</jats:italic> ≤ .001), and insignificant cancers detected (OR, 0.34; 95% CI, 0.23-0.49; <jats:italic>P</jats:italic> = .002) without significant differences in the detection of csPCa (OR, 1.02; 95% CI, 0.75-1.37; <jats:italic>P</jats:italic> = .86). Implementing a PI-RADS score of 4 or greater threshold for biopsy selection was associated with a further reduction in the odds of detecting insignificant PCa (OR, 0.23; 95% CI, 0.05-0.97; <jats:italic>P</jats:italic> = .048) and biopsies performed (OR, 0.19; 95% CI, 0.09-0.38; <jats:italic>P</jats:italic> = .01) without differences in csPCa detection (OR, 0.85; 95% CI, 0.49-1.45; <jats:italic>P</jats:italic> = .22).Conclusion and relevanceThe results of this systematic review and meta-analysis suggest that integrating MRI in PCa screening pathways is associated with a reduced number of unnecessary biopsies and overdiagnosis of insignificant PCa while maintaining csPCa detection as compared with PSA-only screening.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"127 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140352317","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}
Pub Date : 2024-04-04DOI: 10.1001/jamaoncol.2024.0191
Anna Jo Bodurtha Smith, Elizabeth A. Howell, Emily M. Ko
This Viewpoint highlights the need for recognition that ovarian cancer affects women from racial and ethnic minority groups worldwide and that the rates of ovarian cancer are increasing in those populations while decreasing among White women.
{"title":"Ovarian Cancer Isn’t Just a White Woman’s Disease","authors":"Anna Jo Bodurtha Smith, Elizabeth A. Howell, Emily M. Ko","doi":"10.1001/jamaoncol.2024.0191","DOIUrl":"https://doi.org/10.1001/jamaoncol.2024.0191","url":null,"abstract":"This Viewpoint highlights the need for recognition that ovarian cancer affects women from racial and ethnic minority groups worldwide and that the rates of ovarian cancer are increasing in those populations while decreasing among White women.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"257 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2024-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140349207","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}
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