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21-Gene Recurrence Score and Survival Outcomes in the Phase III Multicenter TAILORx Clinical Trial

Sherry X. Yang, John Yu, and Molin Wang

Background: Recurrence score (RS) based on a 21-gene genomic assay is frequently used to estimate risk of distant recurrence for choice of adjuvant chemotherapy in breast cancer. It remains unclear whether RS is an independent prognostic factor for breast cancer–specific survival (BCSS) and overall survival (OS) in the TAILORx trial population. Methods: We evaluated the association of RS with BCSS and OS plus recurrence-free interval (RFI) and invasive disease–free survival (DFS) using multivariable Cox proportional hazards regression analysis, adjusting for clinicopathologic measures, in 8,916 patients with hormone receptor–positive, HER2-negative, node-negative breast cancer. Likelihood ratio (LR) test was used to assess the relative amount of prognostic information provided by RS to BCSS, OS, RFI, and DFS, comparatively. Results: Event rates for BCSS, OS, RFI, and DFS were 1.7%, 5.2%, 5.6%, and 12.6%, respectively, by up to 11.6 years of follow-up. Compared with low-range RS (0–10), patients with midrange (11–25) and high-range (26–100) RS had inferior BCSS (adjusted hazard ratio [aHR], 5.12 [95% CI, 2.09–16.92] and 8.03 [95% CI, 2.91–28.47], respectively) and RFI (aHR, 1.68 [95% CI, 1.23–2.36] and 3.05 [95% CI, 2.02–4.67], respectively), independent of clinicopathologic factors. High-range score was associated with an increased risk of DFS (aHR, 1.56 [95% CI, 1.20–2.04]) but not significantly associated with OS (aHR, 1.44 [95% CI, 0.95–2.18]). Midrange score was associated with neither DFS (aHR, 1.15 [95% CI, 0.96–1.38]) nor OS (HR 1.14 [95% CI, 0.87–1.52]). LR-χ2 values were 83.0 and 65.1 for RFI and BCSS, respectively, and 17.5 and 33.6 for OS and DFS, respectively (P<.0001). Conclusions: RS is an independent measure for BCSS and recurrence prognoses relative to OS in early-stage breast cancer. It carries more prognostic information for breast cancer–specific outcomes.

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Patient-Reported Quality of Life at Diagnosis in Adolescent and Young Adults With Cancer

Goldy C. George, Clark Andersen, Xiaohui Tang, Elizabeth Rodriguez, Midhat Jafry, Maria C. Swartz, Sairah Ahmed, Carlos H. Barcenas, J. Andrew Livingston, Michael E. Roth, and Michelle A.T. Hildebrandt

Background: The overall landscape of health-related quality of life (HRQoL) has not been thoroughly investigated in adolescents and young adults (AYAs) with cancer. Data are also lacking on how well HRQoL at the time of cancer diagnosis can prognosticate long-term survival in AYA survivors. Patients and Methods: We included 3,497 survivors of AYA cancer (age 15–39 years at diagnosis) who completed the Short-Form 12 Health Survey (SF-12) HRQoL questionnaire at diagnosis. Physical component summary (PCS) and mental component summary (MCS) scores were generated, with scores <50 representing poor HRQoL. Differences in HRQoL by patient characteristics and tumor type were investigated using violin plots and t tests/analysis of variance. The effect of HRQoL on overall survival was assessed using Kaplan-Meier plots and Cox proportional hazards models. Results: Overall mean PCS and MCS scores in this racially/ethnically diverse cohort (64% White, 19% Hispanic, 10% Black, and 7% other race/ethnicity) were 43.6 and 46.7, respectively. Women with breast cancer reported the most favorable PCS (50.8), and those with cervical cancer reported the lowest MCS (42.8). Age at diagnosis was associated positively with PCS (P<.001) and inversely with MCS (P<.001). Females had higher PCS yet lower MCS than males (both P<.001). Marginalized racial and ethnic populations reported lower PCS than White patients (P<.001). Physical and mental HRQoL were prognostic and associated with increased risk of poor survival (hazard ratio, 1.95; 95% CI, 1.72–2.21 for physical HRQoL, and 1.26; 95% CI, 1.13–1.40 for mental HRQoL). Conclusions: Physical and mental HRQoL at diagnosis vary across patient characteristics in AYA cancer survivors. Poor HRQoL at diagnosis may be a prognosticator of diminished overall survival among AYA cancer survivors.

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Chemotherapy-Induced Peripheral Neuropathy in Patients With Gastroesophageal Cancer

Merel J.M. van Velzen, Marieke Pape, Mirjam A.G. Sprangers, Jessy Joy van Kleef, Bianca Mostert, Laurens V. Beerepoot, Marije Slingerland, Elske C. Gootjes, Ronald Hoekstra, Lonneke V. van de Poll-Franse, Nadia Haj Mohammad, and Hanneke W.M. van Laarhoven

Background: Chemotherapy for various stages of gastroesophageal cancer (GEC) is often neurotoxic. Chemotherapy-induced peripheral neuropathy (CIPN) impairs health-related quality of life (HRQoL). This study investigates the incidence and severity of CIPN and its association with HRQoL in patients with GEC. Patients and Methods: Patients who received chemoradiotherapy or chemotherapy for GEC were identified from the Netherlands Cancer Registry. Patient-reported data (measured using the EORTC QLQ-CIPN20 and EORTC QLQ-C30) were collected through the Prospective Observational Cohort Study of Esophageal-Gastric Cancer Patients (POCOP) at baseline and at 3, 6, 9, 12, 18, and 24 months after treatment initiation. Linear mixed effects models were constructed to assess CIPN and the correlation between CIPN and HRQoL was analyzed using Spearman’s correlation. Results: A total of 2,135 patients were included (chemoradiotherapy: 1,593; chemotherapy with curative intent: 295; palliative chemotherapy: 247). In all 3 treatment groups, CIPN significantly increased during treatment (adjusted mean score of CIPN at 6 months: chemoradiotherapy, 8.3 [baseline: 5.5]; chemotherapy with curative intent, 16.0 [baseline: 5.6]; palliative therapy, 25.4 [baseline: 10.7]). For chemoradiotherapy, the adjusted mean score continued to increase after treatment (24 months: 11.2). For chemotherapy with curative intent and palliative therapy, the adjusted mean score of CIPN decreased after treatment but did not return to baseline values. CIPN was negatively correlated with HRQoL in all treatment groups, although significance and strength of the correlation differed over time. Conclusions: Because of the poor prognosis of GEC, it is essential to consider side effects of (neurotoxic) treatment. The high prevalence and association with HRQoL indicate the need for early recognition of CIPN.

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Volume 22 (2024): Issue 5 (Jul 2024)

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Artificial Intelligence and Oncology

Daniel M. Geynisman

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Breast Cancer, Version 3.2024, NCCN Clinical Practice Guidelines in Oncology

William J. Gradishar, Meena S. Moran, Jame Abraham, Vandana Abramson, Rebecca Aft, Doreen Agnese, Kimberly H. Allison, Bethany Anderson, Janet Bailey, Harold J. Burstein, Nan Chen, Helen Chew, Chau Dang, Anthony D. Elias, Sharon H. Giordano, Matthew P. Goetz, Rachel C. Jankowitz, Sara H. Javid, Jairam Krishnamurthy, A. Marilyn Leitch, Janice Lyons, Susie McCloskey, Melissa McShane, Joanne Mortimer, Sameer A. Patel, Laura H. Rosenberger, Hope S. Rugo, Cesar Santa-Maria, Bryan P. Schneider, Mary Lou Smith, Hatem Soliman, Erica M. Stringer-Reasor, Melinda L. Telli, Mei Wei, Kari B. Wisinski, Kay T. Yeung, Jessica S. Young, Ryan Schonfeld, and Rashmi Kumar

Breast cancer is treated with a multidisciplinary approach involving surgical oncology, radiation oncology, and medical oncology. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Breast Cancer include recommendations for clinical management of patients with carcinoma in situ, invasive breast cancer, Paget’s disease, Phyllodes tumor, inflammatory breast cancer, and management of breast cancer during pregnancy. The content featured in this issue focuses on the recommendations for overall management of systemic therapy (preoperative and adjuvant) options for nonmetastatic breast cancer. For the full version of the NCCN Guidelines for Breast Cancer, visit NCCN.org.

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Highlights of the NCCN Oncology Research Program

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Molecular Tests in Pancreatic Cancer: Critical Role of Molecular Testing, Expanding Access, and Adherence to the NCCN Guidelines for Pancreatic Cancer

Nirag Jhala, Jeffrey Petersen, and Darshana Jhala

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NCCN Guidelines® Insights: Melanoma: Cutaneous, Version 2.2024

Featured Updates to the NCCN Guidelines

Susan M. Swetter, Douglas Johnson, Mark R. Albertini, Christopher A. Barker, Sarah Bateni, Joel Baumgartner, Shailender Bhatia, Christopher Bichakjian, Genevieve Boland, Sunandana Chandra, Bartosz Chmielowski, Dominick DiMaio, Roxana Dronca, Ryan C. Fields, Martin D. Fleming, Anjela Galan, Samantha Guild, John Hyngstrom, Giorgos Karakousis, Kari Kendra, Maija Kiuru, Julie R. Lange, Ryan Lanning, Theodore Logan, Daniel Olson, Anthony J. Olszanski, Patrick A. Ott, Merrick I. Ross, Luke Rothermel, April K. Salama, Rohit Sharma, Joseph Skitzki, Emily Smith, Katy Tsai, Evan Wuthrick, Yan Xing, Nicole McMillian, and Sara Espinosa

The NCCN Guidelines for Cutaneous Melanoma (termed Melanoma: Cutaneous) provide multidisciplinary recommendations for diagnostic workup, staging, and treatment of patients. These NCCN Guidelines Insights focus on the update to neoadjuvant systemic therapy options and summarize the new clinical data evaluated by the NCCN panel for the recommended therapies in Version 2.2024 of the NCCN Guidelines for Cutaneous Melanoma.

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