Oncology & Hematology

This meta-analysis examines the ideal duration of androgen deprivation therapy for patients with prostate cancer treated with radiotherapy.

This cohort study examines the utility of the novel Incidental Meningioma: Prognostic Analysis Using Patient Comorbidity and Magnetic Resonance Imaging Tests tool for predicting the risk of incidental meningioma progression and stratifying patients for disease management.

This cohort study compares incident and prevalent prescription rates of glucagon-like peptide-1 receptor agonists among adults with at least 1 obesity-related comorbidity and newly diagnosed cancer.

This JAMA Oncology Patient Page describes the 3 main types of urinary diversions and care required after surgery to ensure an active and fulfilling life.

This study evaluates the association of the consumption of ultraprocessed foods and the risk of early-onset colorectal cancer (age <50 years) in participants of the Nurses’ Health Study II.

This Viewpoint discusses the potential repercussions of Medicaid cuts, including losses of progress in prevention, care delivery, and treatment of patients with cancer.

This multicenter nonrandomized clinical trial evaluates the efficacy and safety of lorlatinib for patients with advanced ROS1-positive non−small cell lung cancer who have not been treated with a tyrosine kinase inhibitor.

This retrospective cohort study examines the association of upfront treatment with enfortumab vedotin plus pembrolizumab with clinical outcomes for patients with advanced urothelial cancer.

In Reply We thank Zhu and Wang for their interest in the International TNT Study. In our series, 12.1% of patients were offered a watch and wait strategy, and 31.9% of these had salvage surgery for local regrowth, which occurred at a median of 34 (IQR, 24-46) weeks after treatment completion. In only 1.7% and 22.0% of the cases, respectively, local regrowth was accompanied or followed by tumor progression/recurrence elsewhere. While increasingly offered in clinical practice, nonoperative management mostly remains an opportunistic strategy for select patients rather than a planned approach primarily aiming at organ preservation. Accordingly, if followed by an R0/R1 salvage surgery, isolated local regrowth during watch and wait suggests failure of complete response assessment rather than treatment failure and true recurrence after a curative-intent strategy. In line with international consensus recommendations, we excluded isolated, R0/R1 resected, local regrowth during watch and wait from the censoring events for either local progression or event-free survival (EFS), and we do not share the concerns about this handling underestimating local events and inflating EFS. Regarding multiple imputation for missing data, we did acknowledge this as a limitation of our study. Notably, the proportion of patients with no available information for each prognostic variable was reported, overall and by treatment regimen, in the supplementary material. Of the 61.2% of patients tested for mismatch repair deficiency (dMMR)/microsatellite instability (MSI-H), 3.6% had dMMR/MSI-H tumors. Collecting information on the subsequent use of immune checkpoint inhibitors on disease progression was out of scope. Outcomes of our TNT-treated population by mismatch repair/microsatellite status will be reported in a separate article. We agree that covariate balance diagnostics after propensity vector matching are informative. Balance before matching can be assessed from the table in the manuscript. We assessed postmatching balance for categorical baseline variables by computing the proportion in each group at each level of the variable, then computing the absolute between-group difference in proportions for each pair of groups. For age at diagnosis, we compared means and 25th, 50th, and 75th percentiles across groups. The largest differences in proportions were observed for cN stage; cN2 was disproportionately represented in the RAPIDO-like and OPRA induction-like groups (52% and 53%, respectively) relative to the PRODIGE23-like (33%) and OPRA consolidation-like groups (41%), while cN1 disproportionately represented in the RAPIDO-like group relative to the PRODIGE23-like group (37% vs 52%). The next largest difference observed was in low tumor grade between the PRODIGE23-like and OPRA induction-like groups (42% vs 28%). All other differences were 11 percentage points or fewer. For age at diagnosis, the maximum between-group differences in the 25th, 50th, and 75th percentiles were 2, 3.5, and 3 years, respectively. Finally, regarding the maturity of survival estimates, we agree that the similarity of results across treatment regimens should be interpreted cautiously, and this is the reason why we emphasized 3-year rather than 5-year EFS and overall survival probabilities in the article. We do not think that interpretation would be improved by using restricted mean survival times that are less intuitive for clinicians despite their worth in settings marked by nonproportional hazards, which does not appear to be the case in our study.

This cohort study estimates the cumulative incidence of metastatic recurrence among adolescents and young adults diagnosed with earlier-stage disease and compares survival to those with metastatic disease at diagnosis.

To the Editor Audisio et al assembled an impressive, practice-reflective cohort of 1585 patients treated with total neoadjuvant therapy (TNT). Their effort is laudable and clinically informative. We offer several suggestions to strengthen interpretation.

This cross-sectional study assesses the scale and scope of terminated cancer research grants from the National Cancer Institute.

Survivors of adolescent and young adult cancer (aged 15 to 39 years at diagnosis) are a large and growing population at risk for early mortality, with death due to primary cancer recurrence/progression a large contributor to increased mortality among survivors. In JAMA Oncology, using linked data between the California Cancer Registry, Kaiser Permanente Northern California, and the Department of Health Care Access and Information, Brunson and colleagues report on patterns of metastatic recurrence among adolescents and young adults with cancer and compare the risk of death between those with metastatic recurrence and those with metastatic disease at diagnosis. These data provide valuable insights into the burden of metastatic disease among adolescents and young adults with cancer and identify cancer types for which adolescents and young adults face high risk for metastatic recurrence and associated mortality. Findings largely parallel trends in metastatic recurrent disease incidence and mortality among populations with broader age ranges, with some notable exceptions.

This Viewpoint explores radiotherapy in the the metastatic landscape and advocates a more sophisticated framework for evaluating metastasis-directed therapies.

Still

In their study, Carlino et al report their results from a phase 2 basket trial evaluating dual immune checkpoint blockade (ICB) with ipilimumab and nivolumab in patients with deficient mismatch repair (dMMR)/microsatellite instability-high (MSI-H) noncolorectal cancers. The trial enrolled 52 patients across 17 tumor types, with endometrial cancer comprising half of the cohort. Half of the patients were treatment naive, and half had received 1 prior line of therapy; only 1 had prior exposure to checkpoint inhibition. The overall objective response rate was 63%, including 5 complete responses. An additional 8 patients achieved stable disease, yielding a disease control rate of 79%. Eleven patients experienced progression, either clinically before the first imaging or at first imaging assessment. Responses were similar between treatment-naive and previously treated patients, and 20 of 26 patients with endometrial cancer achieved disease control. Immune-related adverse events were common, occurring in 75% of patients, with 23% experiencing grade 3 or higher toxicity.

This cohort study compares magnetic resonance imaging with confirmatory biopsy for patients with favorable-risk prostate cancer undergoing active surveilance.

This nonrandomized clinical trial examines the effect of nivolumab and ipilimumab as a combination treatment in patients with advanced mismatch repair–deficient/microsatellite instability–high noncolorectal cancers.

This follow-up analysis of the phase 2 HERIZON-BTC-01 trial evaluates the efficacy, patient-reported outcomes, and safety profile of zanidatamab in patients with ERBB2-amplified biliary tract cancer with a HER2 immunohistochemistry score of 3+ or 2+ after 33 months of follow-up.

This Special Communication outlines the International Cardio-Oncology Society position on immune checkpoint inhibitor–associated cardiovascular toxic effects.

To the Editor We read with great interest the recent article by Li et al, which demonstrated the potential long-term survival benefit of high-dose aumolertinib in patients with untreated epidermal growth factor recepter (EGFR)–variant non–small cell lung cancer and brain metastases. The findings are compelling, and we commend the authors for their important contribution.

In this issue of JAMA Oncology, Mehta et al compare 2 graft-vs-host disease (GVHD) prophylaxis strategies to potentially abrogate the established risk of suboptimal outcomes when using advanced-aged donors for patients undergoing allogeneic hematopoietic stem cell transplant (allo-HSCT). The historical approach of combining calcineurin inhibitors (CNIs) with other agents such as methotrexate (MTX) and mycophenolate mofetil was compared to the newer standard of posttransplant cyclophosphamide (PTCy) with a CNI. Using artificial intelligence (AI) in addition to standard statistical analyses, the authors retrospectively evaluated a large dataset of over 10 000 patients from the Center for International Blood and Marrow Transplant Research registry and concluded that PTCy perhaps offers a solution to a long-standing problem.

In Reply In the ACHIEVE study, 2 patients (3.2%) discontinued treatment due to grade 2 pneumonia. Both were never-smoking women with L858R-mutated adenocarcinoma. The first patient, a woman aged 57 years with stage IVA disease, developed chest tightness after physical activity. Radiologic examinations revealed scattered inflammatory opacities. Differential diagnosis suggested a high probability of drug-related interstitial lung disease (ILD). This event occurred 137 days after initiation of tyrosine kinase inhibitor (TKI) therapy and resolved within 20 days with oral prednisone administration. The second patient was a woman aged 73 years with stage IVB disease who presented with chest tightness and shortness of breath after physical activity. Based on imaging and medical history, ILD was the primary diagnostic consideration. This ILD event occurred 202 days after initiation of targeted therapy. Following prednisone administration, her pneumonia improved to grade 1 by week 2 and resolved completely by week 5. To ensure patient safety, the study protocol stipulates in the treatment discontinuation section (Protocol 7.8.1, line 843) that patients who develop interstitial pneumonia should permanently discontinue study treatment. In accordance with protocol requirement, treatment was permanently discontinued and both patients were withdrawn from the study, even though the ILD had recovered in both cases.

This cohort study investigates the association between older age of an unrelated donor and overall survival in patients receiving posttransplant cyclophosphamide vs conventional calcineurin inhibitor for graft-vs-host disease prophylaxis.

JAMA Oncology is committed to publishing influential original research, opinions, and reviews that advance the science of oncology and improve the clinical care of patients with cancer.