JAMA Oncology最新文献

{"title":"Risk Prediction Model for Development of Heart Failure or Cardiomyopathy After Breast Cancer Treatment.","authors":"Ana Barac,Jiling Chou,Nawar Shara,Lie H Chen,Jiaxiao Shi,Rowan T Chlebowski,Amrita Mukherjee,Reina Haque,Arnold L Potosky","doi":"10.1001/jamaoncol.2025.4178","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4178","url":null,"abstract":"ImportanceWomen receiving breast cancer (BC) treatment are at risk for heart failure or cardiomyopathy (HF/CM). No standard method exists to identify women at risk who might benefit from preventive cardiac strategies and surveillance during and after treatment.ObjectiveTo develop and validate a model predicting the 10-year risk of developing HF/CM in women receiving systemic treatment for invasive early-stage BC to inform cardiac risk management.Design, Setting, and ParticipantsThis longitudinal cohort study of patients cared for in Kaiser Permanente Southern California, a vertically integrated health care system. The goal of the study was to predict the 10-year HF/CM risk using multivariable elastic-net Cox proportional hazards models. Women aged 18 to 79 years with newly diagnosed invasive local or regional BC from 2008 to 2020, with a median follow-up of 5.2 years, were included. The cohort was randomly split into derivation (60%) and validation (40%) cohorts. Data were analyzed from April 2024 to May 2025.ExposuresHF/CM risk predictors included age at BC diagnosis, race and ethnicity, area-level socioeconomic status, local and systemic BC treatments, cancer stage, obesity, and history of hypertension, diabetes, hyperlipidemia, smoking, and other CV conditions.Main Outcome and MeasuresIncident HF/CM events. Women were categorized into low-, moderate-, and high-risk groups based on the tertiles of the risk score in the derivation cohort.ResultsOf 26 044 women included in the total cohort, the median (IQR) age was 61 (52-68) years. The risk model had good calibration and high accuracy in predicting HF/CM risk in the 3 subgroups, with HF/CM risk in the validation cohort matching the estimates from the derivation for identifying women at low risk (1.7%; 95% CI, 1.1%-2.4%) and high risk (19.4%; 95% CI. 17.3%-21.5%) of HF/CM at 10 years. The model's discrimination ability was good, based on the time-dependent area under the curve of 0.79 at 10 years in the validation cohort.Conclusions and RelevanceThis risk prediction model among women with early-stage BC was able to prospectively identify those at risk of HF/CM over a 10-year period based on the selected BC treatment and clinical variables available at BC diagnosis. The model can be used to inform risk-guided cardiac management for these women.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"136 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339191","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":"Power Limits in Body Mass Index, Activity, and Cancer Risk.","authors":"Lanwei Guo","doi":"10.1001/jamaoncol.2025.4172","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4172","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"69 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339188","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":"Power Limits in Body Mass Index, Activity, and Cancer Risk-Reply.","authors":"Lenat Joffe,Sedigheh Mirzaei,Lucie M Turcotte","doi":"10.1001/jamaoncol.2025.4175","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4175","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"20 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339189","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":"National Trends in Dexrazoxane and Cardiovascular Health Care Utilization for Children With Acute Myeloid Leukemia.","authors":"Daniel J Zheng,Gary Hettinger,Jonathan D Bender,Alexis C Boulter,Lusha Cao,Caitlin W Elgarten,Brian T Fisher,Cody Gathers,Yuan-Shung V Huang,Jennifer Ko,Kasey J Leger,Yimei Li,Regina Myers,Hari K Narayan,Jose Ortiz,Alix E Seif,Eleana Vasileiadi,Richard Aplenc,Kelly D Getz","doi":"10.1001/jamaoncol.2025.4365","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4365","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"51 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339190","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":"Can We Use Credit Data to Assess Cancer Financial Hardship?","authors":"Christopher T Su,Scott D Ramsey,Veena Shankaran","doi":"10.1001/jamaoncol.2025.4371","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4371","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"43 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339192","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":"Unexpected Results of Induction Chemotherapy vs Adjuvant Chemotherapy.","authors":"Melvin L K Chua,Darren W T Lim","doi":"10.1001/jamaoncol.2025.4092","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4092","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"130 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296092","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":"Artificial Intelligence-Detected Tumor-Infiltrating Lymphocytes and Outcomes in Anti-PD-1-Based Treated Melanoma.","authors":"Mark Schuiveling,Isabella A J van Duin,Laurens S Ter Maat,Janneke C van der Weerd,Rik J Verheijden,Franchette van den Berkmortel,Christian U Blank,Gerben E Breimer,Femke H Burgers,Marye Boers-Sonderen,Alfons J M van den Eertwegh,Jan Willem B de Groot,John B A G Haanen,Geke A P Hospers,Ellen Kapiteijn,Djura Piersma,Gerard Vreugdenhil,Hans Westgeest,Anne M R Schrader,Josien P W Pluim,Paul J van Diest,Mitko Veta,Karijn P M Suijkerbuijk,Willeke A M Blokx","doi":"10.1001/jamaoncol.2025.4072","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4072","url":null,"abstract":"ImportanceEasy and accessible biomarkers associated with response to immune checkpoint inhibition (ICI)-treated melanoma are limited.ObjectiveTo evaluate artificial intelligence (AI)-detected tumor-infiltrating lymphocytes (TILs) on pretreatment melanoma metastases as a biomarker for response and survival in patients treated with ICIs.Design, Setting, and ParticipantsThis multicenter cohort study included patients with advanced melanoma treated with first-line anti-programmed cell death 1 protein (PD-1) with or without anti-cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) between January 2016 and January 2023 at 11 melanoma treatment centers in the Netherlands. Data were analyzed from January to July 2025.ExposureAll patients received first-line anti-PD-1 with or without anti-CTLA-4.Main Outcomes and MeasuresThe percentage of TILs inside manually annotated tumor area in hematoxylin-eosin-stained pretreatment metastases was determined using the Hover-NeXt model trained and evaluated on an independent melanoma dataset containing 161 835 pathologist-verified manually annotated cells. The primary outcome was objective response rate (ORR); secondary outcomes were progression-free survival (PFS) and overall survival (OS). Correlation with manual TILs, scored according to the guidelines stated by the Immuno-Oncology Biomarkers Working Group, was evaluated with Spearman correlation coefficients. Logistic regression and Cox proportional regression were conducted, adjusted for age, sex, disease stage, ICI type, BRAF status, brain metastases, lactate dehydrogenase level, and performance status.ResultsOf 1202 included patients with advanced cutaneous melanoma, 445 (37.0%) were female and 757 (63.0%) were male, and the median (IQR) age was 67.0 (57.0-74.0) years. The median follow-up was 36.3 months (95% CI, 34.0-39.1). Metastatic melanoma specimens were available for 1202 patients, of whom 423 received combination therapy. The median (range) TIL percentage was 9.9% (0.3%-69.4%). A 10% increase in TILs was associated with increased ORR (adjusted odds ratio, 1.40; 95% CI, 1.23-1.59), PFS (adjusted hazard ratio, 0.85; 95% CI, 0.79-0.92), and OS (adjusted hazard ratio, 0.83; 95% CI, 0.76-0.91). Results were consistent for both patients treated with anti-PD-1 monotherapy and patients treated with combination treatment with anti-PD-1 plus anti-CTLA-4. When comparing manual TIL scoring with AI-detected TILs, associations with response and survival were consistently stronger for AI-detected TILs.Conclusions and RelevanceIn this cohort study, among patients with advanced melanoma, higher levels of AI-detected TILs on pretreatment hematoxylin-eosin slides were independently associated with improved ICI response and survival. Given the accessibility of TIL scoring on routine histology, TILs may serve as a biomarker for ICI outcomes. To facilitate broader validation, the Hover-NeXt architecture and model weights are publicly available.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"47 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296087","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":"Radiotherapy With a 12-Gene Expression Assay for Ductal Carcinoma In Situ: A Randomized Clinical Trial.","authors":"Seema A Khan,Justin Romanoff,Constantine Gatsonis,Habib Rahbar,Ruth Carlos,Sunil Badve,Jean Wright,Ralph L Corsetti,Constance D Lehman,Derrick W Spell,Linda K Han,John R Bumberry,Ilana Gareen,Bradley S Snyder,Lynne I Wagner,Kathy D Miller,Christopher Comstock,Joseph A Sparano","doi":"10.1001/jamaoncol.2025.4079","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4079","url":null,"abstract":"ImportanceBreast ductal carcinoma in situ (DCIS) requires personalized treatment given its variable natural history. This study reports the first prospective oncologic outcomes of radiotherapy decisions as guided by 12-gene molecular assay, the DCIS score (DS).ObjectiveTo assess surgical outcomes following preoperative breast magnetic resonance imaging (MRI) in women with DCIS and estimate 5-year and 10-year ipsilateral breast event (IBE) rates in participants given DS-based postoperative radiotherapy recommendations after local excision (WLE).Design, Setting, and ParticipantsWomen with screen-detected DCIS who were eligible for WLE were enrolled to a single-arm, multicenter trial conducted at 75 institutions within the Eastern Cooperative Oncology Group-American College of Radiology Imaging Network (March 2015 to April 2016) and received a preoperative breast MRI-guided surgical treatment. Those who underwent successful WLE were advised to omit radiotherapy for low DS (<39) and receive radiotherapy for intermediate/high DS (≥39). Those achieving WLE as final treatment and successful DS assay (n = 171) were included in a prespecified analysis. Participants were followed up every 6 months for DCIS or invasive IBE, and 5-year IBE rates were analyzed from July to November 2023.InterventionDS-based postoperative radiotherapy recommendations.Main Outcomes and MeasuresFive-year IBE rates, with 95% CIs.ResultsAmong the 339 participants, the mean (SD) age was 59.1 (10.1) years. A total of 171 women (50.4%) received WLE for pure DCIS with free surgical margins and had DS data available. A total of 159 (93.0%) adhered to DS-based radiotherapy recommendations; 7 of 82 patients (8.5%) with a low DS underwent radiotherapy, and 5 of 89 patients (5.6%) with an intermediate/high DS declined radiotherapy. Over median (range) follow-up of 5 (0.5-5.0) years, 8 of 171 women experienced IBEs (4.8%; 95% CI, 2.4%-9.4%). IBE rates were similar for participants with a low DS(5.1%; 95% CI, 1.9%-12.9%) and participants with an intermediate/high DS (4.5%; 95% CI, 1.7%-11.7%). Among the 159 women who had adhered to DS-based radiotherapy recommendations, IBE rates were similar for participants with a low DS (5.5%; 95% CI, 2.1%-14.1%) and intermediate/high DS (4.8%; 95% CI, 1.8%-12.3%).Conclusions and RelevanceThe findings of this prespecified analysis of a clinical trial suggest that DS-guided radiotherapy post-WLE for DCIS shows markedly lower 5-year IBE rates (approximately 5%) for intermediate/high DS than previously reported data following WLE alone. Despite a limited sample size, these data potentially provide support for radiotherapy use in patients with intermediate/high DS, and omission when DS is low, although confirmatory studies are needed.Trial RegistrationClinicalTrials.gov Identifier: NCT02352883.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"11 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296089","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":"Unexpected Results of Induction Chemotherapy vs Adjuvant Chemotherapy-Reply.","authors":"Hai-Qiang Mai","doi":"10.1001/jamaoncol.2025.4095","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.4095","url":null,"abstract":"","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"32 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296115","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":"Guidelines for Next-Generation Sequencing in Sarcoma Diagnosis and Treatment: A Consensus Review.","authors":"César Serrano,Sebastian Bauer,Jean-Yves Blay,Paolo G Casali,Carlo M Cicala,Angelo P Dei Tos,Antonia Digklia,Hans Gelderblom,Antoine Italiano,Robin L Jones,Bernd Kasper,Anastasios Kyriazoglou,Francois Le Loarer,Javier Martín-Broto,Andrea Napolitano,Piotr Rutkowski,Silvia Stacchiotti,William Tap,David Thomas,Khin Thway,Claudia Valverde,Winette T A van der Graaf,Eva Wardelmann,Judith V M G Bovée","doi":"10.1001/jamaoncol.2025.3608","DOIUrl":"https://doi.org/10.1001/jamaoncol.2025.3608","url":null,"abstract":"ImportanceSarcomas comprise a heterogeneous group of malignant neoplasms that include genomically simple (driven by recurrent genetic alterations) and genomically complex (characterized by extensive genomic rearrangements) subtypes. Regardless, sarcomas exhibit a remarkably low mutational burden. In this context, there is a growing demand for the use of next-generation sequencing (NGS)-based technologies to aid in the clinical management of patients with sarcoma. However, a broad, clinically impactful implementation faces inherent challenges associated with their rarity, heterogeneity, and limited molecular understanding.ObservationsFrom a diagnostic standpoint, there is a lack of prospective studies comparing up-front, indiscriminate use of NGS fusion panels in all new cases suggestive of sarcoma diagnosis in comparison with a use only indicated by a sarcoma-expert pathologist during the assessment. Therefore, although a significant proportion of sarcomas harbor specific molecular alterations, not all cases require NGS for a definitive diagnosis given that most sarcoma subtypes display classic histologic features. From a therapeutic perspective, current evidence does not support routine clinical use of NGS in all patients with sarcoma due to the small number of actionable alterations and the limited evidence for clinical benefit achieved with NGS-matched treatments. Although certain entities and molecular backgrounds demonstrate potential advantages, the consensus group emphasizes that indication of targeted agents for treatment is largely based on the specific subtype, and therefore, an accurate diagnosis is indispensable.Conclusions and RelevanceEvidence supporting the routine, nonselective use of NGS in patients with sarcoma is currently limited. Given the complexity, the decision to perform an NGS panel, as well as the interpretation and use of its results for diagnostic or therapeutic purposes, should take place only in sarcoma-expert institutions, including a multidisciplinary review. The results of multigene panels performed in nonexpert sarcoma centers cannot replace the pathology review or the recommendation of NGS-guided therapies without prior evaluation by sarcoma experts.","PeriodicalId":14850,"journal":{"name":"JAMA Oncology","volume":"2 1","pages":""},"PeriodicalIF":28.4,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296111","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}