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In This Issue of JAMA Oncology
August 2017

Highlights

JAMA Oncol. 2017;3(8):1011. doi:10.1001/jamaoncol.2016.4451
Research

Adverse event (AE) reporting in clinical trials has undergone a sea change with the advent of patient-reported outcomes. Basch et al assessed the feasibility of collecting patient-reported AEs in large multicenter oncology clinical trials. A total of 285 patients from 9 multicenter trials enrolled. Adherence to self-reporting was high at baseline and declined slightly over time. Investigators reported fewer AEs than did patients. These findings demonstrate that patient AE self-reporting is feasible and may be more precise than data captured by the clinical team. Qureshi et al provide an Editorial.

Editorial and Related Article

The evaluation of programmed cell death 1 ligand (PD-L1) expression on tumors or immune infiltrates in tumors as a marker of drug response has been controversial. To assess whether the monoclonal antibodies used to assess PD-L1 expression vary, leading to discordant data, Rimm et al compared 4 immunohistochemical assays for PD-L1 expression. Three performed similarly, while 1 was an outlier. The antibodies and pathology readings had a high concordance for PD-L1 expression on tumor but lower concordance on tumor immune infiltrates. These data suggest areas where the assessment of PD-L1 expression can be further standardized. Sica and Ramalingam provide an Invited Commentary.

Invited Commentary

A boost of radiation therapy to the tumor bed is increasingly common in patients being treated for ductal carcinoma in situ (DCIS), but does it improve local control? Moran et al evaluated 4131 patients with newly diagnosed DCIS who received whole-breast radiotherapy with or without a boost. Follow-up was at least 5 years. Although individuals with high-risk factors were more likely to be boosted, after accounting for confounding factors, receiving a boost was significantly associated with reduced incidence of ipsilateral breast tumor recurrence. These data suggest a benefit of radiotherapy boost for all patients with DCIS, although longer follow-up is needed.

The prognosis of breast cancer is constantly changing with more effective therapies coming to the clinic each year. Martin et al questioned whether the prognosis of breast cancer brain metastases has changed over recent years (2010-2013) by studying the outcome of 968 patients who had brain lesions at diagnosis. The incidence of brain metastasis at diagnosis was highest for patients with human epidermal growth factor receptor 2–positive and triple-negative breast cancer. The median survival of all patients with brain metastases at diagnosis was 10 months. More research is needed into new effective treatments for these patients.

As many children are surviving cancer and living to have children of their own, the question arises of the effect on their children’s health. Anderson et al used the North Carolina Central Cancer Registry to identify 2598 childhood cancer survivors who had given birth and compared them with 12 990 age-matched women with no cancer history. The cancer survivors had a significantly increased prevalence of preterm births, low birth weight, and cesarean delivery. These data suggest that young women who are survivors of cancer might benefit from additional surveillance during pregnancy.

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