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In This Issue of JAMA Oncology
November 2017


JAMA Oncol. 2017;3(11):1445. doi:10.1001/jamaoncol.2016.4469


Many patients with head and neck squamous cell carcinoma experience recurrence, but little is known about outcome patterns. Leeman et al reviewed 1000 consecutive patients with stage III to IVB oropharyngeal, oral cavity (OCC), laryngeal, or hypopharyngeal cancers who had been definitively treated. By 5 years, local treatment failure was highest among patients with OCC. Overall survival following local regional failure did not differ between groups, but time from distant metastasis to death was significantly shorter among patients with OCC. Treatment failure and survival after recurrence of head and neck cancer are influenced by site of disease.

Preliminary data suggest that patients can benefit from treatment beyond progression with immune checkpoint inhibitor antibodies. Long et al pooled data from 2 phase 3 clinical trials to analyze whether treatment-naive patients with advanced melanoma derived clinical benefit from nivolumab treatment beyond progression. Of 85 patients who progressed but continued treatment, 28% had a target lesion reduction of greater than 30% after progression compared with baseline, with few adverse events. These results highlight issues that must be addressed when considering use of immuno-oncology drugs. Blumenthal et al provide an Editorial.


Hand-foot syndrome (HFS) causes substantial morbidity for patients receiving capecitabine. In this randomized clinical trial of 210 patients, Yap et al compared the incidence and time to onset of grade 2 or greater HFS in patients receiving pyridoxine vs placebo and sought biomarkers predictive of HFS. Patients received concurrent pyridoxine or placebo daily for a maximum of 8 cycles of capecitabine in the adjuvant or neoadjuvant vs palliative setting. Pyridoxine use did not significantly prevent or delay HFS onset. Folate levels independently predicted HFS. These data suggest that pyridoxine does not prevent HFS.

Adolescent and young adult (AYA) cancer survivors have an increased risk of secondary malignant neoplasms. Keegan et al questioned whether these would be more aggressive and associated with decreased survival compared with primary cancers in patients of the same age. Patients from 13 SEER registries were diagnosed with 14 types of first primary malignant neoplasm (PM) or second PM from 1992 to 2008. In 5 of the 14 cancers, AYAs with second PMs experienced worse survival compared with AYAs with the same PMs. Children and older adults were less adversely affected than AYAs. These data may assist in developing recommendations for cancer screening for AYA cancer survivors.

Clinical breast examination has fallen out of favor, but with mammography unavailable in resource-poor regions, breast cancer is often diagnosed through symptom presentation and at an advanced stage. Romanoff et al questioned whether a previous clinical breast examination was associated with an earlier diagnosis of breast cancer in Peru. In a cross-sectional study of 113 women diagnosed with cancer, most had self-detected disease. Women who had previously undergone a breast examination were more likely to be diagnosed with early-stage disease. When mammograms are unavailable, routine use of clinical breast examination may allow an earlier-stage diagnosis.