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In This Issue of JAMA Oncology
December 2016


JAMA Oncol. 2016;2(12):1519. doi:10.1001/jamaoncol.2015.3554

This randomized clinical trial sought to determine whether neratinib plus paclitaxel improves progression-free survival compared with trastuzumab plus paclitaxel as first-line therapy in recurrent and/or metastatic ERBB2-positive breast cancer. A total of 479 women received neratinib (240 mg/d orally) or trastuzumab (4 mg/kg then 2 mg/kg weekly), each combined with paclitaxel (80 mg/m2 on days 1, 8, and 15 every 28 days). There was no statistically significant difference in median progression-free survival. Awada and colleagues concluded that neratinib-paclitaxel is not superior to trastuzumab-paclitaxel in terms of progression-free survival for this population. Pegram provides an Editorial.

Editorial and Author Audio Interview

In a national database analysis of 816 children with medulloblastoma, ages 3 to 8 years, Kann and colleagues sought to examine how postoperative radiotherapy care patterns are changing and what the survival implications are in light of these changes. The authors found that the rate of postoperative radiotherapy deferral increased from 2004 to 2012. The analysis suggests that postoperative radiotherapy deferral is associated with worse survival in this age group. The authors concluded that postoperative radiotherapy deferral seems to be increasing nationally despite this association with overall survival. In an Invited Commentary, Paulino and Jaboin discuss the implications of these findings.

Invited Commentary

This follow-up of a randomized clinical trial evaluated whether bone marrow (BM) or peripheral blood (PB) should be used for hematopoietic cell transplantation from unrelated donors. At 5 years after transplantation, 102 BM and 93 PB participants had the same survival rates and were evaluated with Mental Health Inventory Psychological Well-Being scores and Lee chronic graft-vs-host disease symptom scores. Both scores were significantly better for BM recipients, and they were also more likely to be employed. Lee and colleagues concluded that BM should be the standard of care for these procedures.

Wyatt and colleagues sought to reveal genomic alterations underpinning resistance to the androgen receptor (AR) antagonist enzalutamide in metastatic castration-resistant prostate cancer. Integrated genomic profiling was performed on cell-free DNA from 65 patients treated with enzalutamide. The investigators identified aberrations associated with both primary resistance (AR amplification, multiple AR mutations, RB1 loss) and acquired resistance (AR-L702H and AR-T878A mutations, PI3K pathway alterations, CTNNB1 mutations). These findings can provide important insights into enzalutamide response and resistance.

This study sought to determine whether the increasing incidence of human papillomavirus (HPV)-related oropharyngeal squamous cell carcinoma (OPSCC), observed primarily in middle-aged patients, also occurs in elderly patients. Zumsteg and colleagues queried the Surveillance, Epidemiology, and End Results database between 2002 and 2012 to compare changes in incidence and survival trends in OPSCC with selected tobacco-related cancers and an HPV-related cancer; 13 313 patients 65 years and older (80% male) were included. The investigators found that the incidence of oropharyngeal cancer increased in this population, whereas smoking-associated head and neck cancers decreased. In light of these findings, the authors argue for prospective clinical trials to focus on this patient population.