Medical societies ink guidelines for breast cancer care for pandemic

The American College of Radiology and several other medical societies have developed a series of recommendations for treatment and triage of breast cancer patients during the COVID-19 pandemic, offering a three-tiered framework for prioritizing patient care without losing sight of the hazards associated with clinical care. The first level, for priority A patients, consists of patients whose condition(s) are immediately life-threatening or severely symptomatic, a group that requires urgent treatment. Patients in the priority B category are those who do not require immediate treatment, but whose conditions should be treated before the pandemic is over, while priority C patients are those whose conditions allow for delay because the procedures can be safely deferred. The recommendations are directed to patients presumed to be negative for COVID-19-related illness, and the authors noted that the applicability of these guidelines is dependent on geography and the current load on health care systems in that area. Most encounters between physician and patient should be handled via telemedicine, while most imaging procedures can be at least temporarily deferred. Debra Monticiollo, president of the American College of Radiology, said in an April 13 statement, “the risk of disease progression and worse patient outcomes should be weighed against the risk of patient and staff exposure to the virus.”

Multiple drivers explained

A team at Japan’s National Cancer Center Research Institute has undertaken a detailed analysis of oncogenes with multiple driver mutations. While typically, only one driver mutation is observed in a given oncogene, there are exceptions, and the team looked at the comprehensive landscape of such exceptions. They found that multiple driver mutations did not co-occur at random, but were enriched in specific oncogenes and tended to be near each other when they did occur. In a pan-cancer analysis of nearly 61,000 samples, they identified 20 oncogenes that had multiple mutations at higher than expected frequencies. In 14 of those genes, multiple mutations occurred in multiple tumor types, while six of them were tumor-specific. “Together oncogenic [multiple mutations] are a relatively common driver event, providing the underlying mechanism for clonal selection of suboptimal mutations that are individually rare but collectively account for a substantial proportion of oncogenic mutations,” the authors wrote. They published their results in the April 9, 2020, issue of Nature.

Study points to new genetic associations for osteosarcoma

Osteosarcoma is the most prevalent bone cancer in children and adolescents, and a new study suggests that there are a number of markers associated with the disease that have yet to be described in the literature. The study, led by researchers at the U.S. National Cancer Institute (NCI) suggests that roughly one in four patients with osteosarcoma who are unselected for family history exhibited a highly penetrant germline mutation that calls for additional follow-up analysis and possible genetic counseling with cascade testing. The researchers looked for harmful and likely harmful variants in 238 known cancer-susceptibility genes in more than 1,200 osteosarcoma patients and compared the frequency of such variants with that in people in a control group. Roughly 28% of the osteosarcoma patients exhibited one or more such variants while only about 12% of controls carried such a genetic feature. The researchers further examined a subset of 166 genes known to be inherited in an autosomal dominant fashion, and picked up harmful or likely harmful variants in about 18% of the patients, a finding that was seen in only 5% of controls. Another 25% of the patients had a rare variant of uncertain significance that was predicted to be harmful. Patients whose genomes exhibited these harmful variants were younger at diagnosis on average (15.3 years vs. 16.9 years), and the youngest children in the study (10 years or younger) had the highest prevalence of harmful variants. The study was published March 19, 2020, in JAMA Oncology.

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