By Geraldine Carroll, ASCO Publishing

In 40 pioneering years, the Journal of Clinical Oncology has not only become one of the world’s most cited publications in the field, its breakthrough research has inspired the careers of the oncology professionals now driving the stunning advances in cancer care that are charted in its pages and have made JCO the single most credible and authoritative resource for disseminating clinical oncology research.¹

To mark its 40^th anniversary in 2023, the journal has been publishing its top 40 articles based on citations, along with a “flashback foreword” written by a current JCO editor that puts the article into perspective.

“What’s remarkable to me as we’re looking back at some of the highest-cited papers over the last 40 years is how much has changed in oncology,” said Jonathan W. Friedberg, MD, MMSc, JCO editor-in-chief and director of the Wilmot Cancer Institute at the University of Rochester.

“Moving away from conventional cytotoxic therapy when we only had a few different drugs that we were mixing and matching to the current era of precision medicine, immunotherapy, the understanding of the heterogeneity of cancer and really remarkably improved outcomes compared to previous studies,” Dr. Friedberg explained. “I think that one of the things that is most impactful to me about this anniversary is how it is parallel to the success and real explosion of activity in medical oncology.”

Manuscripts That Inspired Career Paths

Reflecting on the journal’s influence, Dr. Friedberg, a lymphoma expert, recalled a pivotal study that was published during his fellowship that would have a major influence on him and the field for over two decades. The study details the results of a single-arm clinical trial of single-agent rituximab in relapsed indolent B-cell non-Hodgkin lymphoma.² “Rituximab has proved to be a critically important drug in the B-cell lymphomas and many other diseases,” Dr. Friedberg said. “It’s one of the first oncologic blockbuster drugs and the first immunotherapy approved for cancer.”

Jeffrey Peppercorn, MD, MPH, editor-in-chief of JCO Oncology Practice, a breast medical oncologist, and the director of the Massachusetts General Hospital Cancer Center Supportive Care and Survivorship Program, said a 2003 study published in JCO that tested sequential vs. combination chemotherapy in metastatic breast cancer helped shape his understanding of the importance of patient-centered outcomes in cancer care.³

The study established the principle that is still used today of single-agent sequential chemotherapy, which yields the same survival and improved quality of life compared to combination therapy. “Of course, this was before the era of precision oncology, so we are now adding targeted therapies and immunotherapy to chemotherapy, but as a paper that came out during my oncology fellowship, this manuscript hammered home to me the importance of patient-centered outcomes of survival and quality of life as priority considerations compared to seductive but, in most circumstances, less important outcomes such as response alone,” said Dr. Peppercorn. “In every aspect of cancer care and in virtually every disease setting, we have seen advances in treatment and improved patient outcomes documented in the pages of JCO.”

For Gilberto Lopes, MD, editor-in-chief of JCO Global Oncology (JCO GO) and chief of the Division of Medical Oncology at the University of Miami Sylvester Comprehensive Cancer Center, reading print editions of the journal is a mainstay. “JCO is the one journal I still like to receive in print, and I read every issue from beginning to end,” he said.  He noted that a 2007 study on the cost effectiveness of adjuvant trastuzumab in patients with HER2+ breast cancer inspired his interest in health economics and policy.⁴

“The manuscript inspired me to engage in health economics and policy research and led me to develop my first project in the field, culminating in a short article on health economics in JCO, and an evaluation of the indirect costs and benefits associated with adjuvant trastuzumab in JCO as well,” Dr. Lopes said.⁵ Today, JCO continues to guide him in his role as editor-in-chief of JCO GO. “JCO is a great model for how to have a robust journal in oncology that upholds scientific rigor while navigating changes in publishing, digital media, science, and medicine.”

James M. Ford, MD, FASCO, the founding editor-in-chief of JCO Precision Oncology and a medical oncologist and geneticist at Stanford Health, has known about JCO since its inception. He was in medical school at Yale University, where JCO’s founding editor-in-chief, Joseph R. Bertino, MD, was one of his mentors.  “I published one of my very first papers when I was in medical school in 1989 in JCO,” Dr. Ford said.  Twenty-five years later, Dr. Ford’s study on the use of multi-gene panels for genetic testing for hereditary cancer risk was one of JCO’s most cited articles of 2014.⁶ “More generally, during my clinical training as a fellow and in clinic ever since, the papers in JCO are always my guiding light in terms of new clinical findings and how we practice,” Dr. Ford said.

Jeremy L. Warner, MD, MS, FAMIA, FASCO, a professor at Brown University and deputy editor of HemOnc.org, became the editor-in-chief of JCO Clinical Cancer Informatics (JCO CCI) in June this year. He fondly remembers a weekly seminar during his fellowship with Stephen A. Cannistra, MD, before Dr. Cannistra began his 10-year editorship of JCO in 2011. “In this seminar, we would present a case each week and then review a seminal paper related to the diagnosis, prognosis, or treatment of the patient,” Dr. Warner said. “Many of these papers were from JCO and became the foundation of my knowledge base developed during fellowship.” Since then, Dr. Warner has held a deep appreciation for the journal’s attention to clinical care, which, as outlined in his recent editorial, will guide his own approach for JCO CCI: “I also really appreciate the focus of JCO on clinical care. This focus is something that I want to bring to JCO Clinical Cancer Informatics.”⁷

Looking Ahead

Focusing on the future, Dr. Friedberg said there has never been a more important time in medical publishing for a rigorous review process and the infrastructure journals provide to ensure that content is appropriately vetted.  “We are in a transformational era in medical publishing right now. So many forces are changing the landscape ranging from artificial intelligence, ChatGPT… to new economic models informed by changes in policy in the federal government level, really shifting the ways that journals will be able to fund themselves,” he said.

Additionally, the ability for journals to do more multimedia and online content will require editors to think of new publication strategies. “This also allows us to do things that we couldn’t do before,” Dr. Friedberg said. “I think the first area that we are focused on is ensuring that we are providing content in ways that people want that content and how they can access it.”

That mission is sure to sustain the journal in its next 40 groundbreaking years.

References

1. Miller KD, Friedberg JW. JCO Turns 40. J Clin Oncol. 2023;41:1-2.
2. McLaughlin P, Grillo-López AJ, Link BK, et al. Rituximab chimeric anti-CD20 monoclonal antibody therapy for relapsed indolent lymphoma: half of patients respond to a four-dose treatment program. J Clin Oncol. 1998;16:2825-33.
3. Sledge GW, Neuberg D, Bernardo P, et al. Phase III trial of doxorubicin, paclitaxel, and the combination of doxorubicin and paclitaxel as front-line chemotherapy for metastatic breast cancer: an Intergroup trial (E1193). J Clin Oncol. 2003;21:588-92.
4.  Liberato NL, Marchetti M, Barosi G. Cost effectiveness of adjuvant trastuzumab in human epidermal growth factor receptor 2-positive breast cancer. J Clin Oncol. 2007;25:625-33.
5. de Lima Lopes G Jr, Gluck S. Health economics in the Journal of Clinical Oncology and an evaluation of the indirect costs and benefits associated with adjuvant trastuzumab. J Clin Oncol. 2007;25:3382-3; author reply 3383.
6. Kurian AW, Hare EE, Mills MA, et al. Clinical evaluation of a multiple-gene sequencing panel for hereditary cancer risk assessment. J Clin Oncol. 2014;32:2001-9.
7. Warner JL. Looking Back and Looking Forward: My Themes for the Continued Success of JCO Clinical Cancer Informatics. JCO Clin Cancer Inform. 2023;7:e2300107.