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In This Issue of JAMA Oncology
July 2017


JAMA Oncol. 2017;3(7):875. doi:10.1001/jamaoncol.2016.4445


The OPTIMIZE-2 randomized clinical trial explored whether zoledronic acid every 12 weeks was noninferior to zoledronic acid every 4 weeks in patients with breast cancer metastatic to bone who had previously received a standard regimen of zoledronic acid and/or pamidronate. In 416 women, at 1 year of follow-up there was no difference between groups in skeletal-related events or time to first skeletal-related event, and the safety profiles were similar. Hortobagyi et al concluded that the every 4 weeks regimen was noninferior for patients experiencing 1 or more skeletal-related events and may be convenient and cost-effective. Fornier provides an Editorial.


Some treatments for autoimmune disease have been associated with increased risk of a secondary malignant neoplasm. Ertz-Archambault et al performed a case-control study and medical record review of 40 011 patients with a diagnosis of autoimmune disease and identified those who also had a diagnosis of acute myeloid leukemia or myelodysplastic syndrome. Azathioprine exposure was associated with increased risk for myeloid neoplasm. There was no association found with use of anti–tumor necrosis factor agents. These data provide useful information about hematologic malignant neoplasm risks associated with anti-inflammatory drug use.

Painful bony metastases are a problem for patients with many different cancers. McDonald et al performed a secondary analysis of 238 patients from the NCIC Clinical Trials Group Symptom Control Trial SC.23 to assess quality of life (QOL) after a single 8-Gy radiotherapy dose for 1 or 2 bone metastases. Some patients had pain reduction and better QOL at day 10 after radiotherapy, with further QOL improvements at day 42 in clinical responders. The authors suggest that all patients with painful bony metastasis be offered an 8-Gy radiotherapy dose regardless of prognosis. Thomas provides an Editor’s Note.

Editor’s Note

Breast cancer is a weakly immunogenic tumor, and strategies to increase the cancer-specific immune response may have benefit. Salazar et al tried to enhance immunogenicity of malignant skin lesions with topical imiquimod, a toll-like receptor 7 agonist, in refractory chest wall disease. This single-arm study gave 14 patients nab-paclitaxel and imiquimod for 12 weeks. There were 5 partial and 5 complete responses; response duration was limited. Lack of response was associated with increased programmed death 1 expression on T cells and elevated levels of myeloid-derived suppressor cells in the peripheral blood.

Clinical Review & Education

Multiple myeloma is the second most common hematologic malignant neoplasm in the United States. Multiple myeloma treatment has changed over the past decade due to the introduction of several new active drugs for this disease. Some of these agents, particularly immunomodulatory drugs and proteasome inhibitors, have been shown to induce cardiac and vascular toxic effects. Li and colleagues review the incidence, clinical characteristics, and potential mechanisms of cardiac complications due to treatment of multiple myeloma.

Continuing Medical Education