JAMA news releases are made available to the public after 3 pm US Central time on the first 4 Tuesdays of each month. The Archives Journals news releases are made available to the public after 3 pm Central time on Mondays. We also provide a list of previous news releases.
THIS WEEK'S CONTENT
JAMA NEWS RELEASES
(Embargoed for Release: 3:00 p.m. CT, Tuesday, June 6, 2006)
JAMA NEWS RELEASES
STUDY COMPARES TREATMENT OPTIONS FOR PATIENTS WITH BRAIN METASTASES
PRE-MENOPAUSAL AFRICAN AMERICAN WOMEN MORE LIKELY TO HAVE CERTAIN TYPE OF BREAST CANCER
PROGRAM REDUCES HOSPITALIZATIONS AND COSTS FOR NURSING HOME RESIDENTS WITH PNEUMONIA
PRELIMINARY STUDY SHOWS PROMISE FOR TREATMENT OF RENAL CELL CANCER
JAMA REPORT (VIDEO NEWS RELEASE SCRIPT)
VIDEO: Windows Media | Quicktime
YOUNGER AFRICAN AMERICAN WOMEN MUCH MORE LIKELY THAN OLDER AFRICAN AMERICAN WOMEN, OR THAN WHITE WOMEN OF ANY AGE, TO GET SERIOUS, BASAL-LIKE BREAST CANCER
INFORMATION CONTAINED IN THESE NEWS RELEASES IS PROTECTED BY COPYRIGHT. JOURNAL ATTRIBUTION IS REQUIRED.
Please Note: The audio from the weekly JAMA VNR Report is now available as MP3 files, for use by radio stations and websites. It can be found post-embargo with the news releases at www.jamamedia.org.
Please Note: The FOR THE MEDIA Web site now has a search feature to enable media to find previous JAMA/Archives news releases on specific medical topics. This search feature link is located on the home page at www.jamamedia.org
TV Note: This week's JAMA video news release is on the link between breast cancer subtypes and race. The release will be fed Tuesday, June 6, from 9:00 - 9:30 a.m. ET on Intelsat America 6 (formerly Telstar 6), Transponder 11 (C-Band) and from 2:00 - 2:30 p.m. ET on Intelsat America 6, Transponder 11 (C-Band). For more information, call 312/464-JAMA (5262).
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 6, 2006
Media Advisory: To contact Hidefumi Aoyama, M.D., Ph.D., email: h-aoyama{at}umin.ac.jp. To contact editorial author Jeffrey Raizer, M.D., call Elizabeth Crown at 312-503-8928.
STUDY COMPARES TREATMENT OPTIONS FOR PATIENTS WITH BRAIN METASTASES
CHICAGO—Adding whole-brain radiation therapy to highly-focused radiation therapy does not improve survival for patients with cancer and brain metastases, but it may reduce the likelihood of the recurrence of brain metastases, according to a study in the June 7 issue of JAMA.
Brain metastases (lesions in the brain due to spread of cancers occurring elsewhere) occur in 20 percent to 40 percent of all patients with cancer and are generally associated with a poor prognosis, according to background information in the article. It has been believed that in brain metastases, the entire brain is “seeded” with micrometastatic disease, even when only a single intracranial lesion is detected. Consequently, whole-brain radiation therapy (WBRT), which has possible adverse effects, has been the dominant treatment. Recently, the assumption that the entire brain is seeded with micrometastases has been questioned. For patients who truly have limited intracranial disease, the potential exists that WBRT could be replaced by more focused therapeutic options such as resection (partial surgical removal) or stereotactic radiosurgery (SRS), which delivers high-dose, focal radiation, with less long-term adverse effects than WBRT. These therapies have been used with increasing frequency. It has been unclear whether adding WBRT to SRS improves survival or neurologic function compared with SRS alone.
Hidefumi Aoyama, M.D., Ph.D., of Hokkaido University Graduate School of Medicine, Sapporo, Japan, and colleagues conducted a randomized controlled trial comparing WBRT plus SRS vs. SRS alone for patients with limited (defined as 4 or less) brain metastases. The study included 132 patients enrolled at 11 hospitals in Japan between October 1999 and December 2003. Patients were randomly assigned to receive WBRT plus SRS (65 patients) or SRS alone (67 patients).
The researchers found that the median (midpoint) survival time and the 1-year actuarial (calculated) survival rate were 7.5 months and 38.5 percent in the WBRT + SRS group and 8.0 months and 28.4 percent for SRS alone. The 12-month brain tumor recurrence rate was 46.8 percent in the WBRT + SRS group and 76.4 percent for SRS alone group. Salvage (treatment after other measures have been unsuccessful) brain treatment was less frequently required in the WBRT + SRS group (n = 10) than with SRS alone (n = 29). Death was attributed to neurologic causes in 22.8 percent of patients in the WBRT + SRS group and in 19.3 percent of those treated with SRS alone. There were no significant differences in systemic and neurologic functional preservation and toxic effects of radiation.
“In conclusion, our findings demonstrated that SRS alone without up-front WBRT was associated with increased brain tumor recurrence; however, it did not result in either worsened neurologic function or increased risk of neurologic death. With respect to patient survival, the control of systemic cancer might outweigh the frequent recurrence of brain tumors. Therefore, SRS alone could be a treatment option, provided that frequent monitoring of brain tumor status is conducted,” the authors write.
(JAMA. 2006;295:2483-2491. Available pre-embargo to the media at www.jamamedia.org)
EDITORIAL: RADIOSURGERY AND WHOLE-BRAIN RADIATION THERAPY FOR BRAIN METASTASES — EITHER OR BOTH AS THE OPTIMAL TREATMENT
In an accompanying editorial, Jeffrey Raizer, M.D., of the Feinberg School of Medicine, Northwestern University, Chicago, comments on the study concerning treatment for brain metastases.
“How should clinicians interpret the findings reported by Aoyama et al and the data available in the literature? Patients who have more than 4 brain metastases should continue to be treated with WBRT. For patients with 4 or fewer brain metastases, the combination of stereotactic radiosurgery and WBRT improves local brain control but does not affect survival. Therefore, either mode is a reasonable first choice … Whether overall quality of life is positively or negatively affected is unknown, but for patients who might be cured of their cancer, omitting WBRT could avoid long-term neurotoxic effects.”
(JAMA. 2006;295:2535-2536. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 6, 2006
Media Advisory: To contact Lisa A. Carey, M.D., call Tom Hughes at 919-741-8840 or Dianne Shaw at 919-966-7834.
PRE-MENOPAUSAL AFRICAN AMERICAN WOMEN MORE LIKELY TO HAVE CERTAIN TYPE OF BREAST CANCER
CHICAGO—Pre-menopausal African American women have a higher prevalence of basal-like breast tumors than post-menopausal African American and non-African American women, which could contribute to their poorer prognosis, according to a study in the June 7 issue of JAMA.
Breast cancer is composed of an increasing number of recognized biological subtypes. The prognostic importance of this is complicated by many factors, including the observation that differences in clinical outcomes often correlate with race, according to background information in the article. Although breast cancer is less common among African American women, among those who develop it the prognosis is worse. The age-adjusted death rate in the United States from breast cancer in white women is 28.3 deaths per 100,000 compared with 36.4 deaths per 100,000 in African American women. This disparity is particularly pronounced among women younger than 50 years, in whom the death rate is 77 percent higher among African American women compared with white women. Biological differences among breast cancers may reflect genetic influences, differences in lifestyle, or nutritional or environmental exposures.
Lisa A. Carey, M.D., of the University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, N.C., and colleagues conducted a study of environmental and molecular determinants of breast cancer risk to identify breast tumor subtypes and determine associations between tumor subtypes and race, menopausal status, tumor characteristics, and survival. The Carolina Breast Cancer Study, a population-based study, included 496 incident cases of invasive breast cancer.
The researchers found that one of the more aggressive subtypes, the basal-like breast cancer subtype, was more prevalent among pre-menopausal African American women (39 percent) compared with post-menopausal African American women (14 percent) and non–African American women (16 percent) of any age, whereas the luminal A subtype was less prevalent (36 percent vs. 59 percent-54 percent, respectively). The HER2+/ER- subtype did not vary with race or menopausal status (6 percent-9 percent). In this cohort of patients diagnosed between 1993-96, breast cancer–specific survival differed by subtype, with shortest survival among HER2+/ER- and basal-like subtypes. The basal-like subtype is sensitive to chemotherapy, however unlike the other subtypes there are currently no targeted treatment options for this subtype.
“The high prevalence of basal-like tumors in younger African American women could contribute to their higher breast cancer mortality. Additional studies of long-term survival among patients with specific breast cancer subtypes are needed. Clinical trials aimed at identifying therapeutic approaches to the management of basal-like breast cancer are also needed, especially for young African American women,” the authors conclude.
(JAMA. 2006;295:2492-2502. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For funding/support information, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 6, 2006
Media Advisory: To contact Mark Loeb, M.D., M.Sc., call Veronica McGuire at 905-525-9140, ext. 22169.
PROGRAM REDUCES HOSPITALIZATIONS AND COSTS FOR NURSING HOME RESIDENTS WITH PNEUMONIA
CHICAGO—A program that includes having chest x-rays performed in the nursing home reduced the number of nursing home residents hospitalized because of pneumonia and other lower respiratory tract infections, according to a study in the June 7 issue of JAMA.
Pneumonia and other lower respiratory tract infections are common among residents of nursing homes. These infections are among the most frequent reasons for transferring residents to a hospital, according to background information in the article. Hospitalization can lead to a reduction in quality of life, a decline in functional status, falls, and other hazards. The economic costs associated with such hospital transfers are substantial. Given the potential hazards to residents and the burden on the health care health system, a strategy for treating residents with pneumonia on-site in the nursing home may be beneficial. However, the effectiveness of providing on-site care has been uncertain.
Mark Loeb, M.D., M.Sc., of McMaster University, Hamilton, Ontario, Canada, and colleagues developed a clinical pathway, or program, for treating nursing home residents with pneumonia or other lower respiratory tract infections on-site in the nursing home to determine if the program would reduce hospitalizations and health care costs. The randomized trial included 680 residents aged 65 years or older, who met a standardized definition of lower respiratory tract infection, in 22 nursing homes in Hamilton, Ontario, Canada. The residents received either usual care or treatment according to the program that was devised, which included use of oral antimicrobials, portable chest radiographs, oxygen saturation monitoring, rehydration, and close monitoring by a research nurse.
Thirty-four residents (10 percent) of 327 residents in the clinical pathway group were hospitalized compared with 76 (22 percent) of 353 residents in the usual care group. Adjusting for the clustering of residents in nursing homes, the weighted average admission rate was 8 percent in the clinical pathway group vs. 20 percent in the usual care group, with an average difference of 12 percent. The average number of hospital days per resident was 0.79 in the clinical pathway group vs. 1.74 in the usual care group, with an average difference of 0.95 days per resident.
The death rates in both study groups were similar. There were 24 deaths (8 percent) among residents enrolled in the clinical pathway group and 32 deaths (9 percent) among residents in the usual care group. There were no significant differences in changes in health-related quality of life or functional status measures. The clinical pathway resulted in an overall cost savings of U.S. $1,016 per resident treated.
“These data have important implications for the delivery of health care services for both long-term care facilities and acute care hospitals. Treating nursing home residents with pneumonia with the clinical pathway can reduce the burden to emergency departments and inpatient hospital units, particularly during influenza season, when many nursing home residents with pneumonia are frequently sent to the hospital,” the authors write.
(JAMA. 2006;295:2503-2510. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: For financial disclosure and funding/support information, please see the JAMA article.
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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Embargoed for Release: 3:00 p.m. CT, Tuesday, June 6, 2006
Media Advisory: To contact Robert J. Motzer, M.D., call Joanne Nicholas at 212-639-3573. To contact editorial author Boris Pasche, M.D., Ph.D., call Elizabeth Crown at 312-503-8928.
PRELIMINARY STUDY SHOWS PROMISE FOR TREATMENT OF RENAL CELL CANCER
CHICAGO—A preliminary study suggests that sunitinib may be a promising agent for treatment of metastatic renal cell cancer, currently a disease without highly effective treatment options, according to an article in the June 7 issue of JAMA.
There is an urgent need for more active agents for the treatment of metastatic (spread of cancer from point of origin to another part of the body) renal cell carcinoma (RCC). The 5-year survival rate for metastatic RCC is estimated to be less than 10 percent, according to background information in the article. RCC is highly resistant to chemotherapy, and only a limited subset of patients (20 percent or less) benefit from cytokine (proteins from the immune system) therapy (high-dose interleukin-2 [IL-2] and/or interferon-alfa). Overall median survival following progression after cytokine therapy is approximately 10 to 13 months, and no effective treatment is available for patients whose disease progresses after an initial response, or who do not respond to cytokine therapy.
A better understanding of the genetic abnormalities associated with clear-cell RCC has helped identify new targets for therapy, and subsequently the development of a new therapy, the oral medication sunitinib, which had positive results in an initial study.
Robert J. Motzer, M.D., of Memorial Sloan-Kettering Cancer Center, New York, and colleagues conducted a multicenter phase 2 trial to confirm the antitumor efficacy of sunitinib in 106 patients with metastatic clear-cell RCC whose disease was refractory (unresponsive) to 1 prior cytokine therapy.
Patients were enrolled between February and November 2004, with follow-up continuing until disease progression, unacceptable toxicity, or withdrawal of consent. Patients received repeated 6-week cycles of sunitinib, 50 mg per day given orally for 4 consecutive weeks followed by 2 weeks off per treatment cycle.
“The results of this trial confirm that sunitinib given once daily according to a 4 weeks on/2 weeks off schedule has substantial antitumor effects against metastatic clear-cell RCC. Of the 105 evaluable patients, 36 patients achieved partial response (34 percent), and a median progression-free survival of 8.3 months as evaluated by the independent third-party core imaging laboratory (resulting in a value considerably longer than expected in this clinical setting),” the authors write.
The most common adverse events experienced by patients were fatigue 30 (28 percent) and diarrhea 21 (20 percent).
“The results of this trial demonstrate the efficacy of sunitinib as a single agent in second-line therapy for patients with cytokine-refractory metastatic clear-cell RCC. The initial observation of antitumor activity for sunitinib has been confirmed in a larger trial. Sunitinib as a first-line therapy for metastatic clear-cell RCC is currently being investigated vs. interferon-alfa in a randomized phase 3 study,” the researchers conclude.
(JAMA. 2006;295:2516-2524. Available pre-embargo to the media at www.jamamedia.org)
Editor's Note: Research support for this trial was provided by Pfizer Inc. For the financial disclosures of the authors, please see the JAMA article.
EDITORIAL: A NEW STRATEGY IN THE WAR ON RENAL CELL CANCER
In an accompanying editorial, Boris Pasche, M.D., Ph.D., of the Northwestern University Feinberg School of Medicine, Chicago, comments on the findings of Motzer et al.
“This trial represents another example of rational cancer therapy based on cancer-specific molecular alterations. Objective responses were observed in 34 percent of patients. Given the dismal track record of chemotherapy in the treatment of RCC, this is nothing short of remarkable. These results extend and confirm the results of a previous phase 2 study conducted on a smaller number of patients and establish sunitinib as a bona fide therapeutic agent in this disease.”
“Postapproval trials will be needed to demonstrate clinical benefit, such as increased survival or improvement in disease-related symptoms. The short median progression-free survival (8.3 months) highlights the fact that sunitinib is far from a magic bullet. Nonetheless, it represents a new class of drug with a promising future for the treatment of this deadly disease. In the war on cancer, it is a small victory against one of the most ferocious enemies.”
(JAMA. 2006;295:2537-2538. Available pre-embargo to the media at www.jamamedia.org)
For More Information: Contact the JAMA/Archives Media Relations Department at 312/464-JAMA (5262) or email: mediarelations{at}jama-archives.org.
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JAMA REPORTS
VIDEO: Windows Media | Quicktime
YOUNGER AFRICAN AMERICAN WOMEN MUCH MORE LIKELY THAN OLDER AFRICAN AMERICAN WOMEN, OR THAN WHITE WOMEN OF ANY AGE, TO GET SERIOUS, BASAL-LIKE BREAST CANCER
VIDEO:
NAT SOT UP FULL FOR :03
Lorie playing board game with son
AUDIO:
“Alright. Ha!”
VIDEO:
B-ROLL
Lorie playing board game with son
AUDIO:
29-YEAR OLD LORIE WILLIAMS IS LOVING LIFE WITH HER SON, BUT LAST FALL, SHE THOUGHT LIFE WAS OVER. SHE FOUND A LUMP IN HER BREAST DURING A SELF-EXAM, AND LATER LEARNED IT WAS BREAST CANCER.
VIDEO:
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Super: Lorie Williams
Had breast cancer
Runs :07
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“I had a feeling that I was going to die, that’s kind of what I felt like, that it was a death sentence for me.”
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Bite runs over “scared”
C/U Mammogram films on light board
GFX/JAMA Cover
Younger African American women walking down street
AUDIO:
SHE HAD A RIGHT TO BE SCARED. SHE HAD THE BASAL-LIKE KIND OF BREAST CANCER, ONE OF THE MOST SERIOUS FORMS. AND ACCORDING TO A NEW STUDY IN JAMA, THE JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, YOUNGER AFRICAN AMERICAN WOMEN ARE TWICE AS LIKELY TO HAVE THIS KIND OF BREAST CANCER.
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Super: Lisa Carey, M.D.
University of North Carolina
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“They have more of the aggressive basal kind. They have less of the easier-to-treat kind.”
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Dr. Carey at computer
Mammogram films on light board
FULL SCREEN GRAPHIC
Title: Basal-Like Breast Cancer
Premenopausal African American Women 39%
Postmenopausal African American Women 14 %
White Women 16%
AUDIO:
DR. LISA CAREY OF UNIVERSITY OF NORTH CAROLINA’S LINEBERGER COMPREHENSIVE CANCER CENTER IS ONE OF THE STUDY AUTHORS. SHE AND HER COLLEAGUES STUDIED NEARLY FIVE-HUNDRED CASES OF BREAST CANCER, AND FOUND THAT AMONG PREMENOPAUSAL AFRICAN AMERICAN WOMEN, THIRTY-NINE PERCENT HAD THE AGGRESSIVE, BASAL-LIKE KIND, COMPARED TO FOURTEEN PERCENT OF POSTMENOPAUSAL AFRICAN AMERICAN WOMEN, OR SIXTEEN PERCENT OF WHITE WOMEN OF ANY AGE.
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Lisa Carey, M.D.
University of North Carolina
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“We actually don’t know why younger African American women are more prone to this kind of aggressive form of breast cancer. That actually is a challenge for us.”
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Dr. Carey and colleague in lab at computer
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THE GOOD NEWS IS THAT THIS FINDING TEACHES RESEARCHERS MORE ABOUT BASAL-LIKE CANCER, AND WILL HOPEFULLY LEAD TO BETTER PREVENTION AND TREATMENT. MEANWHILE, DR. CAREY HAS THIS MESSAGE.
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Lisa Carey, M.D.
University of North Carolina
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“The one way we know to improve your likelihood of surviving breast cancer is to get screened.”
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Lorie playing soccer with son and husband
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LORIE HAD CHEMOTHERAPY, SURGERY AND RADIATION, AND SHE’S NOW CANCER FREE. HER EARLY DETECTION HELPED SAVE HER LIFE.
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Lorie Williams
Had breast cancer
Runs :11
AUDIO:
“Do your self breast exam, don’t be afraid to do it on your own. Don’t be afraid to ask questions, don’t be afraid to be proactive about your own health care.”
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Lorie playing soccer with son and husband
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THIS IS MAVIS PRALL WITH THE JAMA REPORT.
