We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editorial |

Antitumor Activity in Metastatic Disease Does Not Predict Efficacy in the Adjuvant Setting

Neil H. Segal, MD, PhD; Leonard B. Saltz, MD
JAMA. 2012;307(13):1431-1432. doi:10.1001/jama.2012.410.
Text Size: A A A
Published online


The model for drug development in solid tumor malignancies in general, and in colon cancer in particular, has been first to identify a new agent that is effective in patients with refractory disease, and then to use that agent (alone if it is active enough, or in combination with the older agent or regimen if it is not) for patients with metastatic disease and demonstrate improved overall survival, progression-free survival, or both in a randomized trial against the previous standard. That new agent or new agent-containing combination is then used in a randomized trial in the adjuvant setting with the hope of improving the cure rate after definitive surgery. This approach is time-honored and is based on rational expectations, an acceptable apportionment of risk tolerance among patients at various stages of their diseases, and even some positive test results. But what if this strategy is wrong?

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

2 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles