medwireNews: This roundup covers three articles published in JAMA Oncology, with subjects including genetic predictors of resected pancreatic ductal adenocarcinoma (PDAC) outcomes, the efficacy of ipilimumab in cervical cancer associated human papillomavirus (HPV), and the effect of the US Affordable Care Act (ACA) on cancer screening.
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Applying immunohistochemistry and next-generation sequencing to samples from 356 PDAC patients who underwent surgery between 1995 and 2013, Brian Wolpin (Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA) and co-authors have shown that alterations in three of the four main genetic drivers of PDAC – KRAS, CDKN2A, and TP53 – are associated with worse disease-free survival (DFS), overall survival (OS), or both.
The number of mutated driver genes was also a predictor of poor outcomes, such that patients with alterations in all four drivers (including SMAD4) had a shorter DFS and OS than those with zero to two mutated drivers.
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Single-agent ipilimumab shows “minimal” clinical activity in women with recurrent or metastatic HPV-related cervical cancer, say Amit Oza (Princess Margaret Cancer Centre, Toronto, Ontario, Canada) and fellow researchers who investigated the anti-CTLA-4 agent in a phase I/II trial.
Participants in the run-in cohort received ipilimumab 3 mg/kg every 3 weeks for four cycles, while those in the phase II cohort were given the drug at a dose of 10 mg/kg on the same schedule, with those achieving at least stable disease eligible to receive four maintenance cycles every 12 weeks.
Of 34 evaluable patients, one achieved a partial response and 10 had stable disease, giving an objective response rate of 2.9%, which fell short of the prespecified rate of 20.0%.
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US researchers have found “a small but positive impact” of the ACA on the uptake of recommended screening for breast and colorectal cancer (CRC), procedures for which the ACA eliminates patient cost-sharing.
Although they did not assess screening per se, Quoc-Dien Trinh (Brigham and Women’s Hospital, Boston) and team anticipated, and indeed found, an increase in the incidence of early-stage breast cancer and early-stage CRC when comparing incidence rates in the first 9 months of 2013 (pre-ACA) with the last 9 months of 2014 (post-ACA). The corresponding incidence rate ratios were 1.025 and 1.132.
They conclude: “Recent proposals for repealing the ACA would increase the uninsured population by tens of millions. This could easily erase these modest gains.”
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