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In This Issue of JAMA Oncology
September 2017


JAMA Oncol. 2017;3(9):1157. doi:10.1001/jamaoncol.2016.4457


Testing for genetic predisposition for breast cancer has expanded from BRCA1 and BRCA2 mutation analysis to panel testing of many germline alterations. Couch et al questioned what levels of risk are associated with genes identified by hereditary cancer multigene panel testing. In a case-control study of 65 057 patients with breast cancer receiving germline testing, several genes were identified with high or moderately increased risk of breast cancer such as ATM and PALB2. Other variants were not associated with breast cancer risk. These data can be informative for counseling patients. Obeid et al provide an Editorial.


Mismatch repair deficiency (MRD) and microsatellite instability (MSI) have been identified as prognostic markers in gastrointestinal cancers. Smyth et al questioned whether these tumor characteristics affect survival. This secondary analysis of the MAGIC trial included 303 patients treated with surgery alone or perioperative chemotherapy and surgery for operable gastroesophageal cancer. Although MSI or MRD conveyed a survival benefit in the surgery-only cohort, there was no survival advantage when chemotherapy was a component of the regimen. Investigators postulate that MSI and MRD may be used to prioritize patients who would benefit from chemotherapy in addition to surgery.

Palliative care can benefit even patients not at imminent risk of death, but broaching the topic can be difficult. Levine and colleagues surveyed attitudes of pediatric patients and their parents toward early palliative care integration. Most of the 129 patient-parent dyads identified substantial adverse effects and suffering in the first month of cancer therapy. Few were opposed to early palliative care. These data suggest that children could benefit from palliative care intervention early in their course of disease no matter what the prognosis. Mack provides an Invited Commentary.

Invited Commentary

Limited metastatic gastric and gastroesophageal (GE) junction cancer may benefit from surgical resection. Al-Batran et al questioned whether preoperative neoadjuvant chemotherapy could benefit survival. The phase 2 AIO-FLOT3 trial included 252 patients with resectable or metastatic cancers in 3 arms: resectable (preoperative fluorouracil, leucovorin, oxaliplatin, and docetaxel [FLOT] plus surgery and 4 postoperative cycles), limited metastatic (neoadjuvant FLOT plus surgical resection according to restaging result), and extensive metastatic (FLOT plus surgery only for palliation). Median overall survival was significantly longer for patients in the limited than the extensive metastatic group. These data suggest a role for neoadjuvant chemotherapy and potential surgical resection in limited metastatic gastric and GE junction cancers.

The androgen receptor is increasingly being considered as a therapeutic target in breast cancer. The rate of androgen receptor positivity in breast cancer is 60% to 80%. Although the androgen receptor has long been targeted for the treatment of prostate cancer, little is known about the response of patients with breast cancer to androgen blockade. Kono and colleagues reviewed androgen receptor biologic characteristics and interactions and the agents that target the androgen pathway that could be useful for breast cancer therapy.

Continuing Medical Education