This Week in JAMA FREE

A JAMA THEME ISSUE

Edited by Robert A. McNutt, MD, MPH, Boris Pasche, MD, PhD, and Phil B. Fontanarosa, MD, MBA

Buys and colleagues report results from the ovarian component of the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial in which women at average risk of ovarian cancer were randomly assigned to receive annual cancer antigen 125 (CA-125) testing and transvaginal ultrasound or usual care. The investigators found that compared with usual care, screening with CA-125 and transvaginal ultrasound was not associated with reductions in ovarian cancer mortality during 13 years of follow-up.

Knowledge of the cancer risks associated with specific gene mutations in Lynch syndrome would improve patient counseling. In an analysis of data from 537 families with Lynch syndrome, Bonadona and colleagues Article determined age-specific cumulative estimates of overall and tumor-specific cancer risks associated with Lynch syndrome–associated mutations in MLH1, MLH2, and MSH6. Among their findings was that MSH6 mutations are associated with lower cancer risks. In an editorial, Xicola and Llor Article discuss risk assessment in Lynch syndrome.

Reulen and colleagues analyzed data from the British Childhood Cancer Survivor Study—a population-based cohort with a median 24.3 years of follow-up—to assess survivors' risks of subsequent primary neoplasms. Among their findings was that the absolute excess risk of developing a subsequent primary neoplasm was 16.8 per 10 000 person-years and the greatest excess risk for those older than 40 years was for digestive and genitourinary neoplasms.

Kesselheim and colleagues reviewed publicly available summary reports of the basis of approval for orphan and nonorphan drugs approved for cancer-related conditions between 2004 and 2011. They found that compared with pivotal trials used to support approval of nonorphan cancer drugs, pivotal trials of orphan cancer drugs were more likely to be smaller and to use nonrandomized, unblinded trial designs and surrogate end points to assess efficacy.

A subset of melanomas have amplifications or activating mutations of KIT—a transmembrane receptor tyrosine kinase. In a phase 2, open-label study of 28 patients with metastatic melanoma whose tumors harbored KIT mutations or amplification, Carvajal and colleagues found that treatment with imatinib mesylate—a small molecule inhibitor of KIT—was associated with a partial or complete response in 4 patients.

Adjuvant chemotherapy improves survival among patients with resected colorectal cancer, but the optimal timing from surgery to initiation of chemotherapy is not known. In a systematic review and meta-analysis of data from studies that assessed the relationship between timing of adjuvant chemotherapy and survival in colorectal cancer patients, Biagi and colleagues found that overall survival decreased by 14% for every 4-week delay in initiation of adjuvant chemotherapy.

“We are partners with our suffering patients in a secret. They are not different. They are the same.” From “Way Back When.”

The debate over prostate-specific antigen testing, a new retinoblastoma treatment, and studies of telomere length and cancer risk are featured in this issue.

Strategic approaches for therapeutic cancer vaccines

Cancer drug approval: balancing access and evaluation

Development and pricing incentives

Transcription factors as anticancer drug targets

Join Eric Widera, MD, Wednesday, June 15, from 2 to 3 PM eastern time to discuss handling of finances for cognitively impaired elders. To register, go to http://www.ihi.org/AuthorintheRoom.

How would you treat a young athlete who sustained a sports-related concussion? Go to www.jama.com, read the case, and submit a response by July 3 for possible posting.

For your patients: Information about melanoma.