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Clinical trials frequently include multiple end points that mature at different times. The initial report, typically based on the primary end point, may be published when key planned co-primary or secondary analyses are not yet available. Clinical trial updates provide an opportunity to disseminate additional results from studies, published in JCO or elsewhere, for which the primary end point has already been reported.Two years of adjuvant abemaciclib combined with endocrine therapy (ET) resulted in a significant improvement in invasive disease-free survival (IDFS) and distant relapse-free survival (DRFS) that persisted beyond the 2-year treatment period in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative, node-positive, high-risk early breast cancer (EBC). Here, we report 5-year efficacy results from a prespecified overall survival (OS) interim analysis. In the intent-to-treat population, with a median follow-up of 54 months, the benefit of abemaciclib was sustained with hazard ratios of 0.680 (95% CI, 0.599 to 0.772) for IDFS and 0.675 (95% CI, 0.588 to 0.774) for DRFS. This persistence of abemaciclib benefit translated to continuous separation of the curves with a deepening in 5-year absolute improvement in IDFS and DRFS rates of 7.6% and 6.7%, respectively, compared with rates of 6% and 5.3% at 4 years and 4.8% and 4.1% at 3 years. With fewer deaths in the abemaciclib plus ET arm compared with the ET-alone arm (208 v 234), statistical significance was not reached for OS. No new safety signals were observed. In conclusion, abemaciclib plus ET continued to reduce the risk of developing invasive and distant disease recurrence beyond the completion of treatment. The increasing absolute improvement at 5 years is consistent with a carryover effect and further supports the use of abemaciclib in patients with high-risk EBC.

Il tema dell'intervento degli psicoterapeuti dove non ci sono le condizioni per proporre una psicoterapia è diventato ancora più attuale rispetto all'epoca in cui questo volume è stato pubblicato per la prima volta. Oggi sempre di più i professionisti della psiche si ingegnano a intervenire forme di trattamento diverse dalla psicoterapia, ma comunque efficaci per generare un processo di cambiamento. La nuova edizione riprende alcuni contesti già analizzati, ma con un sostanziale aggiornamento degli interventi: nella psichiatria, nell'area della disabilità, in quella pedagogica e, in particolare, nell'area giuridica, dove sono stati compiuti passi da gigante. Vengono anche indagati contesti nuovi, tra i quali spicca quello delle cure palliative, e si discute di interventi di gruppo, un'innovazione importante in un'epoca di scarse disponibilità economiche.