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In This Issue of JAMA Oncology
June 2018


JAMA Oncol. 2018;4(6):759. doi:10.1001/jamaoncol.2017.3227


American Cancer Society (ACS) guidelines encourage cancer survivors to maintain a healthy body weight, increase physical activity, and consume a plant-based diet. Van Blarigan et al conducted a prospective cohort study, including 992 patients with stage III colon cancer enrolled in the CALGB 89803 randomized adjuvant chemotherapy trial, and assigned each an ACS guidelines score based on body mass index, physical activity, and diet. Higher scorers had a lower risk of death and improved disease-free survival. This suggests the importance of the ACS guidelines to clinical practice. Fisch et al provide an Editorial.


Screening for Lynch syndrome (LS) currently requires several tests. Hampel et al questioned whether next-generation sequencing could provide a single test with reasonable sensitivity and specificity. Tumor DNA from 465 patients with colorectal cancer, 46 with LS, were tested. Tumor sequencing had the same or better sensitivity and specificity than standard methods for diagnosing microsatellite-unstable tumors and LS. Tumor sequencing also identified 284 colorectal cancer cases with KRAS, NRAS, or BRAF mutations that could affect therapy. These data indicate that next-generation tumor sequencing may be better than standard methods for the evaluation of microsatellite instability and LS screening.

Dasatinib is a small-molecule competitive inhibitor of KIT, PDGFR, and the Src family of kinases. It may be a potent inhibitor of mutations in the activation domains of KIT and PDGFRA that are resistant to imatinib and sunitinib. Schuetze et al enrolled 50 patients with imatinib-refractory metastatic gastrointestinal stromal tumors (GISTs) in a single-arm trial and observed them for 5 years. Estimated 6-month progression-free survival (PFS) was 29% overall and 50% in the 14 patients with activated Src. An objective tumor response was observed in 25%. Dasatinib has reasonable activity in patients with imatinib-resistant GISTs.

The World Trade Center (WTC) attacks on September 11, 2001, resulted in exposure to carcinogens. Landgren et al studied exposed white male firefighters for the diagnosis of MM and light-chain monoclonal gammopathy of undetermined significance (MGUS). Sixteen received a diagnosis of MM after September 11, 2001. Seven had light-chain MM and 5 of these were CD20 positive, which is associated with a poorer prognosis. Peripheral blood from 781 WTC-exposed firefighters was evaluated for MUGS. The age-standardized prevalence rates of MGUS and light-chain MGUS were higher than in a white male reference population. This is the first study to establish these prevalences in a well-defined population of WTC-exposed responders. Brawley provides an Editorial.

Editorial and Related Article

Murphy et al examined the prevalence of prior cancer among individuals newly diagnosed with cancer. Surveillance, Epidemiology, and End Results data (1975-2013) for 740 990 persons newly diagnosed with cancer from 2009 through 2013 were evaluated. Approximately 25% of older and 11% of younger adults with a new cancer diagnosis had a prior cancer, most in a different anatomic site. Understanding the impact of a prior cancer on response to therapy and disease outcomes is critical for the increasing number of patients with previous primary cancers. Davidson provides an Invited Commentary.

Invited Commentary