A combination of leucovorin, fluorouracil, and oxaliplatin (FOLFOX) is standard therapy following resection of stage III colon cancer. In a multicenter randomized trial that involved 2686 patients with resected stage III colon cancer, Alberts and colleagues assessed the potential benefit of adding cetuximab—an epidermal growth factor receptor antibody with known efficacy against metastatic colon cancer—to a modified FOLFOX regimen (mFOLFOX6). The authors found no benefit on disease-free survival from the addition of cetuximab compared with mFOLFOX6 alone. In an editorial, Segal and Saltz discuss the fallacy of assuming that drugs effective against metastatic disease will be effective in the adjuvant setting.
In a multicenter, 3-year study involving 2662 women with an elevated (intermediate) risk of breast cancer and dense breast tissue on prior mammographic examinations, Berg and colleagues found that the addition of annual screening ultrasound or a single screening MRI to annual mammography resulted not only in increased detection of incident breast cancers but also in increased false-positive findings.
To examine whether recent declines in mortality among patients hospitalized with pneumonia could be related to temporal changes in diagnostic coding, Lindenauer and colleagues analyzed data from the 2003-2009 Nationwide Inpatient Sample (representing 5 million to 8 million discharges annually) for patients with either a principal diagnosis of pneumonia or pneumonia secondary to sepsis or respiratory failure. Among the authors' findings were that hospitalization and mortality rates for patients with a principal diagnosis of pneumonia decreased, whereas hospitalizations for patients with a secondary diagnosis of pneumonia increased from 2003 to 2009. In an 404, Sarrazin and Rosenthal discuss limitations of administrative data to evaluate trends in health care outcomes.
Fluoroquinolones are associated with a number of adverse effects including ocular toxicity and tendon rupture. In an analysis of physician visit and prescription drug data (2000-2007) from a cohort of 989 591 ophthalmology patients in British Columbia, Etminan and colleagues examined the association between oral fluoroquinolone use and the risk of retinal detachment. The authors identified 4384 patients with retinal detachment and 43 840 control patients and found that compared with nonuse, current use of oral fluoroquinolones was associated with an increased risk of retinal detachment, although the absolute risk (4 per 10 000 person-years) was small.
Ms W, a 75-year-old woman, is in complete remission after surgery and postoperative chemotherapy for stage IIIC epithelial ovarian cancer. In this Clinical Crossroads article, Konstantinopoulos and Awtrey discuss the signs, symptoms, and risk factors for ovarian cancer; prognostic factors and surgical and postoperative medical management; and current recommendations for ovarian cancer screening and patient follow-up.