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In This Issue of JAMA Oncology
March 2017


JAMA Oncol. 2017;3(3):291. doi:10.1001/jamaoncol.2016.1676


In this randomized clinical trial, Melisko and colleagues evaluated the safety of intravaginal testosterone cream (IVT) or estradiol-releasing vaginal rings in 69 patients with early-stage breast cancer receiving aromatase inhibitors and experiencing urogenital atrophy. The researchers measured estradiol (E2) assay variability at baseline and weeks 4 and 12 and surveyed sexual quality of life. Persistent E2 elevation was found in only 4 patients. Vaginal atrophy and sexual interest and dysfunction improved for all patients. The authors concluded that either product could be considered reasonable to use for patients experiencing urogenital atrophy. Reeder-Hayes and Muss provide an Editorial.


In the 2013 Choosing Wisely (CW) campaign, the American Society of Clinical Oncology discouraged overuse of expensive antiemetics in patients with low risk of chemotherapy-induced nausea and vomiting. In this observational study of 678 220 adults receiving chemotherapy, Encionsa and Davidoff estimated the prevalence, trends, determinants, and costs of antiemetic use before and after publication of the recommendation. They found that the odds of antiemetic use decreased for the 6 months after the publication of the CW recommendations but increased again after another 6 months, suggesting that the CW campaign had only a short-term impact. An Editorial by Check and Basch explores the reasons for this.


Associations between vitamin D levels and prevention of breast cancer recurrence are frequently discussed, but prospective data are lacking. In this case-cohort analysis of the Pathways Study, Yao and colleagues investigated the association of serum vitamin D levels at the time of diagnosis with breast cancer survival in 1666 women. The authors found that serum 25-hydroxyvitamin D concentrations were independently associated with better outcomes, including overall survival. This study provides evidence of vitamin D’s potential benefits for breast cancer progression and mortality.

In this systematic review and meta-analysis, Devji et al estimated the relative efficacy and safety of systemic therapies for advanced, treatment-naive, BRAF-mutated melanoma. In 16 articles reporting 15 randomized clinical trials (RCTs) of targeted agents (BRAF or MEK) or immune checkpoint (cytotoxic T-lymphocyte–associated antigen 4 [CTLA-4] or programmed cell death 1 [PD-1]) inhibitors involving 6662 patients, BRAF/MEK and PD-1 inhibition were associated with improved overall survival vs all treatments except CTLA-4/granulocyte macrophage colony–stimulating factor, and there was no significant difference in OS between BRAF/MEK and PD-1 inhibition. The authors thus suggest PD-1 inhibitors as a priority option for first-line therapy especially when a rapid response is not needed.

Adults with acute myeloid leukemia (AML) commonly require intensive care unit (ICU) support. This cohort study by Halpern and colleagues examined the risk factors, mortality, length of stay, and cost associated with ICU admission in patients with AML. Using information from 43 249 patients with AML in the University HealthSystem Consortium database, the authors found that both fixed demographic and systemic factors, as well as modifiable clinical variables, were associated with ICU admission. Likewise, ICU admission was associated with high mortality and cost increases. Identifying modifiable risk factors for ICU can lead to intervention strategies that may lower both mortality and costs.