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In This Issue of JAMA Oncology
September 2019

Highlights

JAMA Oncol. 2019;5(9):1247. doi:10.1001/jamaoncol.2018.4779

Research

The optimal regimen for an anti–epidermal growth factor receptor–based maintenance treatment in patients with RAS wild-type metastatic colorectal cancer (mCRC) is unknown. Pietrantonio and colleagues conducted a randomized, phase 2 noninferiority trial to determine whether panitumumab was noninferior to panitumumab plus fluorouracil-leucovorin. Results showed a 10-month higher progression-free survival rate with combination treatment vs panitumumab alone. However, panitumumab plus fluorouracil-leucovorin had slightly increased toxic effects. Anandappa and Cunningham provide an Editorial.

Editorial

Monoclonal gammopathy of undetermined significance (MGUS) typically precedes multiple myeloma. Landgren and colleagues conducted a cross-sectional cohort study to find serologic markers to predict disease progression from MGUS to multiple myeloma. Results showed that risk factors associated with progressive MGUS were IgA isotype, 15 g/L or more monoclonal spike, skewed serum free light chains ratio, and severe immunoparesis. These findings suggest that risk groups can be stratified by serologic testing. Munshi and colleagues provide an Invited Commentary.

Invited Commentary

When a severe autoimmune event occurs during immune checkpoint inhibitor (ICI) therapy, the drug is discontinued. Simonaggio and colleagues conducted a cohort study to determine whether retreatment was safe. Results showed that the same immune-related adverse event (irAE) or a different irAE occurred in many patients. A shorter time to the initial irAE was linked to the occurrence of a second irAE. Patients who are rechallenged with immunotherapy after an initial irAE are at high risk for another irAE and should be monitored closely.

The United States Preventive Services Task Force (USPSTF) recommends low-dose computed tomography screening for lung cancer, but the screening guidelines do not take into account racial differences in smoking patterns and lung cancer risk in adult African American vs white smokers. Aldrich and colleagues evaluated the USPSTF lung cancer screening guidelines using data from the Southern Community Cohort Study to determine the accuracy of USPSTF lung cancer screening eligibility criteria. Results showed that in persons diagnosed with lung cancer, a significantly lower percentage of African American smokers was eligible for screening vs white smokers. Current USPSTF screening guidelines may be too conservative for African American smokers.

Author Audio Interview

Although anti–PD-1 (anti–programmed cell death 1) and anti–PD-L1 (anti–programmed cell death ligand 1) regimens are the preferred treatments for many cancers, patients with HIV are excluded from most registered trials. Uldrick and colleagues performed an open-label, nonrandomized, phase 1 study to assess the safety of pembrolizumab in patients with HIV and cancer. Results showed that pembrolizumab had acceptable safety in patients with cancer, HIV treated with antiretroviral therapy, and a CD4+ count of greater than 100 cells/μL; however, caution should be taken in those with HIV and Kaposi sarcoma–associated herpesvirus infection.

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