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In This Issue of JAMA Oncology
August 2016


JAMA Oncol. 2016;2(8):973. doi:10.1001/jamaoncol.2015.3526


Clinically actionable mutations may dictate treatment options for non–small-cell lung cancer (NSCLC). Sacher et al studied 180 patients with advanced NSCLC and found that droplet digital polymerase chain reaction (ddPCR)-based plasma genotyping exhibited perfect specificity (100%) and acceptable sensitivity (69%-80%) for the detection of epidermal growth factor receptor–sensitizing mutations in plasma with 3-day turnaround time. This study suggests that ddPCR-based plasma genotyping can detect tumor-associated mutations in the peripheral blood with the rigor necessary to direct clinical care. In an Editorial, Williams and Conley discuss the clinical application of liquid biopsies.


Although growing evidence points to highly indolent behavior of encapsulated follicular variant of papillary thyroid carcinoma (EFVPTC), most patients are treated as having conventional thyroid cancer. Nikiforov and colleagues studied 109 patients with thyroid nodules diagnosed as EFVPTC, most of whom were treated with lobectomy only and none with radioiodine. All were alive with no evidence of disease at a median follow-up of 13 years. The authors argue that thyroid tumors currently diagnosed as noninvasive EFVPTC have a low risk of adverse outcome and should be termed “noninvasive follicular thyroid neoplasms with papillary-like nuclear features.” In an Editorial, Patel discusses the evidence for this nomenclature change.


Much attention has been paid to how diet affects breast cancer outcomes, but little research has addressed the timing of food intake and its potential effect on metabolic health and cancer. Marinac and colleagues studied 2413 patients with early-stage breast cancer and found that nightly fasting less than 13 hours was associated with an increased risk of breast cancer recurrence compared with nightly fasting more than 13 hours, but was not associated with increased risk of breast cancer–specific and all-cause mortality. The authors suggest that prolonging the length of nightly fasting may affect glucoregulation, which in turn may affect breast cancer growth.

In this phase 2 clinical trial, Chen and colleagues aimed to determine correlates of benefit from dabrafenib and trametinib (CombiDT) treatment in 23 patients with BRAF inhibitor–refractory metastatic melanoma. CombiDT clinical benefit was associated with duration of prior BRAF inhibitor therapy greater than 6 months and early decrease in circulating BRAF V600 but not with baseline tumor molecular characteristics. CombiDT treatment failed to achieve significant mitogen-activated protein kinase pathway inhibition or immune infiltration in most patients.

Clinical Review & Education

Ductal carcinoma in situ (DCIS) is one of the most commonly diagnosed lesions of the breast, yet the treatment of DCIS remains controversial. Although therapy has focused on local excision, over the years radiation and systemic therapies have played a greater role. Shah and colleagues provide a review of the management of DCIS and summarize the standard-of-care options for patients with this disease.

Continuing Medical Education