Tobacco 21 — its time has come

Source: vtdigger.org
Author: Nevin Zablotsky, DMD

As we approach the holiday season I am reminded of the gifts of love we share with our families, as well as the New Year’s resolutions we make and try to keep after Jan. 1 history.

I am a periodontist having practiced in Burlington and South Burlington for the past 40 years. In that time I have treated patients that have been severely compromised by tobacco. Some have lost teeth from advanced periodontal disease and some have lost parts of their tongue and jaw due to oral cancer, leaving them significantly compromised functionally as well as well as emotionally. I have had to advise teenagers and their families that their tobacco chewing habit had caused significant enough changes in their mouth to warrant a biopsy of the involved area. This caused great stress to them as they waited a week to find out the results. Some may think that it takes many years for tobacco use to compromise one’s health, but teenagers can die a horrible death from tobacco use if they are one of the unlucky ones who is genetically predisposed to oral cancer.

Over the years, I have traveled throughout Vermont teaching about tobacco and nicotine addiction to elementary, junior and senior high school students. I feel that I have a good sense of what kids are thinking about these subjects. The elementary school students seem to understand that cigarettes are bad for them. When one talks to the middle school kids, there are some that are beginning to think that cigarettes and smokeless tobacco use is cool, and when speaking to high school students, there is a larger percentage of them that have begun to use a variety of these products, ranging from cigarettes and cigars, to hookahs, to a variety of e-cigarettes, with the newest product, Juul, going viral. This product has become so much of a problem local schools have sent letters to parents warning them of its sudden increase in usage .

It is legal for anyone over 18 to purchase all of these tobacco and nicotine products. Here are some facts to chew on.

About 95 percent of adult smokers begin smoking before they turn 21. Two-thirds of 10th grade students and nearly half of eighth grade students say it is easy to get cigarettes. More 18- and 19-year-olds using in high school means younger kids have daily contact with students who can legally purchase tobacco products.

I am often told that when one reaches the age of 18 they are mature enough to vote, or join the military, so therefore they are mature enough to decide on using tobacco products.

Tobacco use costs the military about $1.6 billion annually in lost productivity and health care expenses tied to respiratory problems, cardiovascular disease and slower healing, according to the Department of Defense data. That’s expected to climb to $19 billion during the next 10 years and result in 175,000 premature deaths. The Air Force bans tobacco in recreation facilities, and the Navy banned tobacco on all submarines. The Vermont National Guard also stated that they would abide by Tobacco 21 legislation if it passed, again citing readiness and fitness.

An argument has been made that tobacco retailers’ businesses will be irreparably harmed if tobacco 21 is implemented. Studies show that its impact over the first 5-8 years will be between one quarter and one half of a percent.

Vermont law does not allow the sale of alcohol to anyone under 21, and the new marijuana law passed last year also restricts its usage to those over 21. Given the proven health risks of tobacco use, why does the present law allow tobacco usage at age 18?

It has been calculated that 10,000 kids now under 18 and alive in Vermont will ultimately die prematurely from the smoking habit they began in their teenage years.

Six states have passed tobacco 21 legislation. This includes Massachusetts and Maine, with New York likely to join this group. Do we really want kids coming from our surrounding states coming here to get their cigarettes or e-cigarettes?

Even Altria and R.J. Reynolds, two of the largest tobacco companies in the world have stated that the age of sale should be 21.

So as we approach the new year I want to appeal to our representatives, to resolve to pass tobacco 21 in the 2019 legislative session, and remind them about how much suffering they can prevent. The decisions they make will have major consequences for generations to come. What a great resolution to keep. What a great holiday gift for us all.

Note: This commentary is by Nevin Zablotsky, DMD, a retired periodontist who practiced in South Burlington and the Coalition for a Tobacco Free Vermont.

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December, 2018|Oral Cancer News|

Oral cancer prognostic signature identified

Source: www.eurekalert.org
Author: press release

Researchers in Brazil have identified a correlation between oral cancer progression and the abundance of certain proteins present in tumor tissue and saliva. The discovery offers a parameter for predicting progression of the disease – whether cervical lymph node metastasis is present, for example – and points to a strategy for overcoming the limitations of clinical and imaging exams. It could also help guide the choice of an ideal treatment for each patient.

The study began in the discovery phase with a proteomic analysis of tissue from different tumor areas using 120 microdissected samples. In the verification phase, prognostic signatures were confirmed in approximately 800 tissue samples by immunohistochemistry and in 120 samples by targeted proteomics.

The study was supported by São Paulo Research Foundation – FAPESP and conducted at the National Energy and Materials Research Center (CNPEM) in partnership with the São Paulo State Cancer Institute (ICESP), the University of Campinas’s Piracicaba Dental School (FOP-UNICAMP), the Institute of Computing from the same university, the University of São Paulo’s Mathematics and Computer Science Institute (ICMC) in São Carlos, and the Dental School of the West Paraná University (UNIOESTE), in addition to other institutions in Brazil and abroad.

“The data led to robust results that are highly promising as guides to defining the severity of the disease. We suggested potential markers of the disease in the first phase of the study and verified these markers in the second phase, enhancing the reliability of the findings and showing that these markers are effective in classifying patients with cervical lymph node metastasis,” said Adriana Franco Paes Leme, a researcher at CNPEM’s National Bioscience Laboratory (LNBio) and the corresponding author of the article published in Nature Communications.

Mouth cancer, also known as oral squamous cell carcinoma (OSCC), is the most common type of malignant head and neck tumor. Prevalence and mortality are high, with some 300,000 new cases diagnosed per year worldwide and 145,000 deaths. Although it is relatively easy to detect, typically when a dentist notices an oral lesion, the disease is usually diagnosed when it is already at an advanced stage.

“We worked on the study for five years until we achieved this breakthrough,” Paes Leme told. “It was divided into two phases. In the first, we used discovery proteomics to identify and quantify tumor tissue proteins. The second phase of the study consisted of analyses using immunohistochemistry and targeted proteomics, for when you know precisely which proteins you want to quantify.”

Proteomics focuses on the identification, localization and functional analysis of the proteins in a sample, which may consist of tissue or cells, for example. The proteins are quantified, post-translational modifications are detected, and their activity and interactions are assessed.

Bioinformatics and machine learning
The study funded by FAPESP had two phases. In the first phase, the researchers used laser microdissection and proteomics to map the proteins in mouth cancer tissue and correlate them with the clinical characteristics of patients. This analysis permitted the identification of several proteins, such as CSTB, NDRG1, LTA4H, PGK1, COL6A1, ITGAV, and MB, with differing levels of abundance depending on tumor area and links to key clinical outcomes.

In the second phase, after identifying and quantifying proteins in the 120-odd tumor tissue samples, the researchers deployed two protein verification strategies.

“One strategy consisted of gauging the abundance of the selected proteins in independent tissue samples using immunohistochemistry with antibodies. The other consisted of monitoring the same preselected targets in patients’ saliva,” Paes Leme said.

Saliva was chosen because this cancer is located in the mouth, where proteins could be secreted by neoplastic cells. “Saliva is a promising source of markers, as well as being a fluid obtained by noninvasive collection,” she explained. “We verified the proteins in saliva from 40 patients. Technical triplicates were analyzed to achieve the highest possible confidence level for the results in this phase of the study.”

After analyzing the saliva samples, the researchers used bioinformatics and machine learning techniques to arrive at prognostic signatures, verifying which of the proteins or peptides selected in the first phase could distinguish between patients with and without cervical lymph node metastasis.

“In addition, we had valuable information about the clinical evolution of the patients who took part in the study as volunteers by donating samples of their saliva,” Paes Leme said.

From this result, it was possible to identify three specific peptides – LTA4H, COL6A1, and CSTB – that can be used as a signature to classify patients with and without cervical lymph node metastasis, offering the potential to help doctors overcome the limitations of clinical exams and guide personalized treatment strategies.

Affordable biosensors
The scientists are now working on a new study designed to use translational techniques to build affordable biosensors capable of detecting prognostic signatures in patients’ saliva.

Peptides currently have to be identified and quantified by mass spectrometry and proteomics, which are costly techniques and not often available in clinics and hospitals.

“We want to develop a simpler and cheaper method that can easily be used by health professionals to assess the progression of the disease on the basis of tests that can be performed in a dentist’s or doctor’s office, or in clinical labs. In the study we’ve just published, we were able to identify this prognostic signature by mass spectrometry. We now plan to develop a biosensor with a focus on the use of this signature so that it can be adopted for clinical use and help guide treatment decisions”, Paes Leme said.

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December, 2018|Oral Cancer News|

Immunotherapy extends the life of head and neck cancer patients

Source: Pharmatimes.com
Date: 12/3/18
Author: Anna Smith

A new immunotherapy can greatly extend the lives of a proportion of people with advanced head and neck cancer, with some living for three years or more, reports a major new clinical trial.

The study, by The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, found that the drug – MSD’s Keytruda (pembrolizumab) – has been shown to have significant benefits for patients, with 37% of those who received it surviving for a year or more, compared with only 26.5% of those on standard care.

The drug was evaluated in a trial of nearly 500 patients with very advanced head and neck cancer that had spread around the body and already become resistant to platinum chemotherapy, the first-line treatment for the disease.

Some 247 patients were randomised to receive Keytruda and 248 to standard of care – chemotherapy or the targeted agent Erbitux (cetuximab).

When chemotherapy or targeted therapies stop working, treatment options for people with advanced head and neck cancer are limited, and they are normally expected to survive for less than six months.

Patients in the Keytruda arm survived for a median of 8.4 months, compared to 6.9 months with standard treatment. However, a minority of patients responded extremely well to Keytruda – 36 patients saw their cancer partially or completely disappear, and some are still cancer free three years after first receiving the drug.

“Our findings show that the immunotherapy pembrolizumab extends the life of people with advanced head and neck cancer overall, and in a group of patients has really dramatic benefits. It is also a much kinder treatment than those currently approved,” said Professor Kevin Harrington, professor of Biological Cancer Therapies at The Institute of Cancer Research, London, and consultant at The Royal Marsden NHS Foundation Trust.

“I would like to see pembrolizumab approved for use in the clinic, so that people with advanced head and neck cancer can be offered the chance of a longer life and improved quality of life.

“There is also an urgent need to work out how we can identify in advance which patients are likely to benefit, given that some of these people may do much better than they do on standard treatment.”

The trial was sponsored and funded by MSD, and the results are published in The Lancet.

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December, 2018|Oral Cancer News|

Australian doctor helps restore cancer patient’s jaw using 3D printed mandible

Source: neoskosmos.com
Author: staff

Anelia Myburgh, a 31-year-old woman from Melbourne who lost most over her upper jaw and teeth to cancer has been offered a second chance in life thanks to Maxillofacial Surgeon George Dimitroulis, who customised a 3D printed jaw.

The fitted 3D mandible featuring a titanium frame, has changed Ms Myburgh’s life who had been left embarrassed and self-conscious, let alone unable to experience basic functions like eating or talking normally.

It all starter in April 2017, when she was diagnosed with jaw cancer after she noticed a small bump above her teeth, which was causing them to move and decided to have it checked with the dentist.

While a team of specialists reassured her it was fine, the test results that came a week later proved it was cancer which resulted in Ms Myburgh undergoing immediate lie-saving surgery to remove most of her upper jaw and part of her lips.

The patient was then left with only two teeth at the back of each side of her mouth and a deformed face.

People’s reactions – who sometimes stopped to take photos of her – made her avoid leaving her home and covering her face with a surgical mask if she had to.

“We communicate with our mouths, we eat with our mouths, if you don’t have a mouth we can’t really live in a way a person takes for granted,” Ms Myburgh told Nine News.

It wasn’t until she started researching possible treatment online that she stumbled upon Dr Dimitroulis’ work and previous successful procedures he had performed on patients using 3D technology.

Dr Dimitroulis assessed the case and decided to move forward with creating a 3D mandible for Ms Myburgh that would also allow teeth to be implanted.

The surgery only lasted a few hours and as seen on Nine News, Ms Myburgh’s new teeth look and feel like normal.

The doctors also took skin from the her forearm to recreate her lip.

“I can now enjoy life and meals with my friends,” the finance worker told Nine News.

“I’m slowly gonna get that burger!”

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December, 2018|Oral Cancer News|

Study: Immunotherapy better than chemotherapy for subtype of head and neck cancer

Date: November 30th, 2018
Source: Scienmag

A randomized clinical trial involving 97 medical centers in 20 countries, including Moores Cancer Center at UC San Diego Health, found that treating patients who have chemotherapy-resistant head and neck cancer with the immunotherapy drug pembrolizumab is more effective and less toxic than standard chemotherapy, reports an international team of researchers in the November 30 online issue of The Lancet.

Previous research had shown that pembrolizumab (Keytruda) was safe and effective for treating patients with recurrent or metastatic head and neck squamous cell carcinoma whose disease had progressed while on or after receiving standard chemotherapy. Data from this clinical trial called KEYNOTE-040, a phase III study sponsored by Merck & Co., the manufacturer of the drug, takes the research a step further by comparing the immunotherapy drug head-to-head to three go-to chemotherapy drugs currently used as standard treatment: methotrexate, docetaxel and cetuximab.

“We compared pembrolizumab against standard of care to see if it fulfilled the promise of early data for patients who are unlikely to do well on standard therapy,” said Ezra Cohen, MD, professor of medicine at University of California San Diego School of Medicine and corresponding author on the study.

“In this trial, patients who received pembrolizumab alone had a higher response rate compared to those receiving standard chemotherapy while those responses lasted, on average, one-and-a-half years. Furthermore, the median survival at one year was markedly better. I feel it is safe to say that these types of therapies should be the new standard therapy for people with cancer that recurs and is resistant to therapy.”

Pembrolizumab is an antibody that inhibits the abnormal interaction between the molecule PD-1 on immune cells and the molecule PD-L1 on tumor cells, allowing the immune cells to activate and attack tumors. Similar results were recently published for another anti-PD-1 drug, nivolumab (Opdivo). Both drugs should be considered by treating physicians for patients with this disease, said Cohen.

The study also pointed to potential biomarkers that can guide oncologists to determine which patients are most likely to respond to these anti-PD-1 drugs.

“It’s fairly clear that patients whose tumors express PD-L1 are most likely to benefit from this type of immunotherapy drug,” said Cohen, associate director for translational science at Moores Cancer Center and an internationally recognized physician-scientist who specializes in novel cancer therapies. “In this trial, overall survival was driven by PD-L1 expression. Only patients whose tumors expressed PD-L1 had a response to pembrolizumab and those responses tended to be durable.”

Over a 17-month period, 247 patients were randomized to receive pembrolizumab and 248 patients were randomly selected by their physicians to receive one of the three standard therapies. The median overall survival for patients receiving immunotherapy was 8.4 months and 6.9 months for patients treated with standard care. Patients received treatment until their cancer progressed, they developed unacceptable toxicity, they withdrew or their physician removed them.

The median duration of response was 18.4 months in the pembrolizumab group, compared with five months in the standard therapy group.

Twelve months after initiating the trial, 37 percent of patients receiving pembrolizumab were alive compared to 26.5 percent of patients on standard therapy.

###

Co-authors include: Denis Soulières, Centre Hospitalier de l’Université de Montréal; Christophe Le Tourneau, Institut Curie, INSERM U900 Research Unit, Versailles-Saint-Quentinen-Yvelines University; José Dinis, Instituto Português de Oncologia do Porto Francisco Gentil; Lisa Licitra, Fondazione IRCCS Istituto Nazionale dei Tumori; Myung-Ju Ahn, Samsung Medical Centre; Ainara Soria, Hospital Universitario Ramón y Cajal; Jean-Pascal Machiels, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain; Nicolas Mach, Hôpitaux Universitaires de Genève; Ranee Mehra, Fox Chase Cancer Center; Barbara Burtness, Yale University School of Medicine and Yale Cancer Center; Pingye Zhang, Jonathan Cheng, Ramona F Swaby, Merck & Co; and Kevin J Harrington, The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, National Institute of Health Research Biomedical Research Centre.

This research was funded by Merck Sharp & Dohme, a subsidiary of Merck & Co. The funder contributed to study design, data collection, data analysis, data interpretation, and the writing of The Lancet paper. The funder maintained the study database. All authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

Disclosure: Cohen reports grant support to the institution from Merck Sharp & Dohme for clinical research related to the submitted work and serving an advisory role for AstraZeneca, Bristol-Myers Squibb, Eisai, Merck, Human Longevity and Pfizer, all outside the submitted work.

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December, 2018|Oral Cancer News|

Israeli company set to begin testing new radiation cancer therapy

Source: www.forbes.com
Author: Robin Seaton Jefferson

An Israeli medical technology company is set to begin testing its new radiation cancer therapy in leading medical centers in Italy. The Alpha DaRT (Dіffusіng Alpha-emіtters Radіatіon Therapy) device delivers high-precision alpha radiation that is released when radioactive substances decay inside the tumor and kills cancer cells while sparing the surrounding healthy tissue, the company says.

The company hopes to get approval from the European Commission by next year for the therapy.

Early results from an ongoing pre-clinical trial on patients with squamous cell carcinoma (SCC) tumors at the Rabin Medical Center in Israel and the IRST (Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori) in Italy showed a reduction in all tumor sizes and more than 70 percent of the tumors completely disappearing within a few weeks after treatment, NoCamels reported.

The therapy has already been tested on more than 6,000 animals and has been found “to be effective and safe for various indications, including tumors considered to be resistant to standard radiotherapy.” according to the breakthrough innovation news site NoCamels.

Alpha Tau Medical was founded in 2016 to focus on research and development as well as commercialization of its Alpha DaRT cancer treatment. The therapy was initially developed in 2003 by Professors Itzhak Kelson and Yona Keisari at Tel Aviv University.

According to the National Cancer Institute (NCI), cancers that are known collectively as head and neck cancers, or squamous cell carcinomas of the head and neck, usually begin in the squamous cells that line the moist, mucosal surfaces inside the head and neck (for example, inside the mouth, the nose, and the throat).

Head and neck cancers account for about 4% of all cancers in the United States, are more than twice as common among men as they are among women, and are more often diagnosed among people over age 50.

Cancers of the head and neck are further categorized by the area of the head or neck in which they begin including the oral cavity, pharynx (throat), larynx, paranasal sinuses and nasal cavity, and salivary glands. They can include hypopharyngeal cancer, laryngeal cancer, lip and oral, cavity cancer, metastatic squamous neck cancer with occult primary, nasopharyngeal cancer, oropharyngeal cancer, paranasal sinus and nasal cavity cancer, salivary gland cancer.

The Alpha DaRT treatment can be applied under local anesthesia in a short single session and can be combined with chemotherapy and immunotherapy to increase effectiveness, according to Alpha Tau Medical. The company reports Alpha DaRT can even trigger anti-tumor immunity for the elimination of distant metastases, NoCamels reported.

Clinical trials for Alpha DaRT will be conducted at the Sapienza University of Rome, which is initiating Alpha Tau’s clinical trial protocol for squamous cell carcinomas of the skin and oral cavity, and the IFO (Istituti Fisioterapici Ospitalieri), which is conducting its first study of Alpha DaRT for the treatment of cutaneous and mucosal malignant neoplasia (CMN).

Alpha Tau is also collaborating with key cancer physicians worldwide to investigate the Alpha DaRT as a treatment for other cancers, including pancreatic, breast and prostate, NoCamels reported.

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November, 2018|Oral Cancer News|

Scientists Confirm There’s Nothing But Misinformation On Anti-Vax Sites

Source: Huffington Post, LIFE
Author: Agata Blaszczak-Boxe
Date: 11/04/18

Many websites that promote unscientific views about vaccinations use pseudoscience and misinformation to spread the idea that vaccines are dangerous, according to a new study.

For example, of the nearly 500 anti-vaccination websites examined in the study, nearly two-thirds claimed that vaccines cause autism, the researchers found. However, multiple studies have shown that there is no link between vaccines and autism.

About two-thirds of the websites used information that they represented as scientific evidence, but in fact was not, to support their claims that vaccines are dangerous, and about one-third used people’s anecdotes to reinforce those claims, the scientists found.

Some websites also cited actual peer-reviewed studies as their sources of information, but they misinterpreted and misrepresented the findings of these studies.

“So the science itself was strong, but the way it was being interpreted was not very accurate,” said study author Meghan Moran, an associate professor in Johns Hopkins University Bloomberg School’s Department of Health, Behavior and Society. “It was being distorted to support an anti-vaccine agenda.”

In the study, the researchers looked at websites with content about childhood vaccines. They used four search engines to find the sites — Google, Bing, Yahoo and Ask Jeeves — and searched for terms including “immunization dangers” and “vaccine danger” as well as other phrases. Their final sample of 480 anti-vaccination websites included a mix of personal websites, blogs, Facebook pages and health websites. The researchers examined the content of the websites, looking for vaccine misinformation, the sources of the misinformation and the types of persuasive tactics that the sites used to convince people that vaccines are dangerous.

In examining the websites, the researchers also observed a lot of misunderstanding and misinterpretation of epidemiological principles, Moran told Live Science.

For example, epidemiologists know that correlation does not imply causation. “Just because two things happen at the same time, that doesn’t mean that one is causing the other,” Moran said. But some of the websites presented timelines that showed that, as rates of immunization went up over a certain period of time, so did autism diagnoses, Moran said.

Although it is true that both have increased over the same period, the anti-vaccine websites frequently implied that “it must be that the immunizations were causing autism, which we know is not true,” Moran said.

Another tactic commonly employed by the websites in the study was the use of anecdotes and stories of parents of children with autism, the researchers said. Because such stories are easy for other parents to connect to, they help to make the anti-vaccine agenda that these sites are promoting appear “a lot more vivid and powerful,” Moran said.

Some of the sites also included information promoting positive health behaviors, the researchers said. For example, 18.5 percent of them promoted eating healthy, about 5 percent promoted eating organic food and 5.5 percent recommended breast-feeding.

The biggest takeaway from the findings is that researchers and health officials “need to communicate to the vaccine-hesitant parent in a way that resonates with them and is sensitive to their concerns,” Moran said in a statement. “In our review, we saw communication for things we consider healthy, such as breast-feeding, eating organic, the types of behavior public health officials want to encourage. I think we can leverage these good things and reframe our communication in a way that makes sense to those parents resisting vaccines for their children.”

The new findings were presented today (Nov. 3) at the American Public Health Association’s Annual Meeting in Chicago.

 

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November, 2018|Oral Cancer News|

New guidelines from NCCN help people with mouth cancers understand treatment options

Source: www.heraldmailmedia.com
Author: press release

The National Comprehensive Cancer Network® ( NCCN ®) has published the first of three guidelines for patients with head and neck cancers, focused on oral cavity (mouth and lip) cancers. The guidebook offers treatment explanations based on the recommendations from the NCCN Clinical Practice Guidelines in Oncology ( NCCN Guidelines ®) used by clinicians, put into plain language with accompanying glossary and background. This free online resource is also available in print through Amazon.com for a nominal fee. The publication was made possible thanks to funding through the NCCN Foundation ®, and sponsorship from the Head and Neck Cancer Alliance ( HNCA ) and Support for People with Oral and Head and Neck Cancer ( SPOHNC ).

“These guidelines will help to decrease the anxieties associated with a cancer diagnosis,” explained Mary Ann Caputo, Executive Director, SPOHNC. “You will learn and empower yourself with the necessary knowledge of the disease and its treatment. These tools will enable one to go forward with a strong conviction of moving on and living a full life.”

“When I was first diagnosed, I was surprised, overwhelmed and scared. I was completely focused on the treatment for my cancer, and so initially I was less aware of all the information shared with me during my medical appointments about my particular diagnosis,” said Jason Mendelsohn, HNCA Board Member and Survivor. “These guidelines are a great resource that patients, their caregivers, and families can read when they’re ready and able to focus on everything they need to know. We believe they will be a great resource for head and neck cancer patients everywhere.”

Ellie Maghami, MD, FACS, Chief and Professor, Division of Otolaryngology/Head and Neck Surgery, City of Hope National Medical Center, and Member, NCCN Guidelines Panel for Head and Neck Cancers says Mendelsohn’s experience is one she’s seen again and again. She emphasized that while smoking and other tobacco use is by far the most common cause of mouth cancer, it can happen to anybody.

“It’s not just an old person’s disease or just a smoker’s disease,” said Dr. Maghami. “For instance, incidences of tongue cancer — which is a type of oral cancer — are on the rise in non-smoking young people.” She also explained that HPV, despite its common link to throat cancer, is actually responsible for fewer than five percent of tongue cancer occurrences.

The NCCN Guidelines for Patients explain that there are several different types of cancers that can originate in all different parts of the mouth. They are generally treated first by surgery, including immediate reconstruction as needed and followed by rehabilitation of speech and swallow functions. It can be beneficial to receive treatment at a high-volume cancer center with highly-experienced specialists who frequently treat these rarer types of cancers. The NCCN Guidelines® also recommend enrollment in clinical trials whenever possible, and advocate for asking questions and seeking second opinions.

As with most cancers, early detection can make a huge difference. According to Dr. Maghami, these cancers are often caught early, thanks to the high visibility of the mouth location.

“It’s relatively easy to do a self-exam for oral cavity cancers. If you see something in your mouth that looks abnormal or feels strange for more than a few days, talk to a doctor about it.”

NCCN Guidelines for Patients currently cover disease types that account for approximately 90% of all cancer diagnoses. Patient guidelines for both Non-Invasive and Metastatic Breast Cancer have been recently updated, along with those for Colon and Prostate Cancer. The next two books in the Head and Neck series will cover oropharynx and nasopharynx cancers. The NCCN Guidelines for Patients: Thyroid Cancer already exists as a separate publication. All patient guidelines are available for free online at NCCN.org/patients or by app.

“Patients need reliable, accurate, up-to-date information presented in an easy to understand fashion,” said Dr. Maghami. “And that’s exactly what NCCN provides.”

NCCN Guidelines for Patients and NCCN Quick Guide™ sheets DO NOT replace the expertise and clinical judgment of the clinician.

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November, 2018|Oral Cancer News|

Call for closer links between GPs and dentists

Source: www.onmedica.com
Author: Adrian O’Dowd

GPs must work more closely and liaise better with dentists if the rising number of patients with oral cancer are to be helped properly, according to a new action plan.

The action plan launched by trade union the British Dental Association (BDA) calls for better coordination between health professionals, checks to ensure patients have regular dental check-ups, and better detection and prevention of the disease.

The document Oral Cancer: A Plan for Action was launched in Edinburgh by BDA Scotland at a Stand Up to Oral Cancer event held to coincide with Mouth Cancer Action Month in November.

New cases of oral cancer in the UK have reached 8,302 per year and this has increased by 49% in the last decade. Cancer Research UK estimates that incidence rates for oral cancers will rise by a further 33% in the UK by 2035.

In the UK last year, 2,722 people died after developing oral cancer. The 10-year survival rate is between 19% and 58%, depending on where the cancer strikes and how early it is diagnosed.

The plan focuses on prevention, early detection and having better referral pathways to ensure good links between dentists, GPs and pharmacists.

It follows the publication of the Scottish Government’s Oral Health Improvement Plan (OHIP) earlier this year, which proposed extending the dental recall interval for some patients to 24 months – a move strongly opposed by the BDA.

Anas Sarwar MSP (member of the Scottish Parliament) has tabled a motion in the Scottish Parliament calling for sustainable and innovative approaches to oral cancer treatment, and expressing concern over the potential impact of the OHIP.

BDA Scotland said it wanted a strategic focus on early detection, prevention and joining-up services, with measures including sufficient resources for alcohol treatment and smoking cessation programmes, and a catch-up programme to offer 140,000 older school-aged boys access to the vaccination programme for the cancer-causing Human Papillomavirus (HPV).

David Cross, vice-chair of the BDA’s Scottish Council said: “Dentists are on the front line of a battle against some of the fastest rising cancers in Scotland. Early detection is key, but now risks becoming a casualty of a cost-cutting exercise.

“People in otherwise good health are succumbing to this disease. Telling our ‘lower risk’ patients to come back in two years will only handicap efforts to meet a growing threat, while putting further pressure on NHS cancer services.

“Oral cancer now claims three times as many lives in Scotland as car accidents. Rather than chasing quick savings we need to see concrete plans and real investment to help turn the tables on this devastating but preventable disease.”

The BDA is working with the BMA and Community Pharmacy Scotland on the plan and is developing partnerships and links with other organisations such as ASH (Action on Smoking and Health) Scotland.

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November, 2018|Oral Cancer News|

Standard chemotherapy treatment for HPV-positive throat cancer remains the most effective, study finds

Source: www.eurekalert.org
Author: press release, University of Birmingham

A new study funded by Cancer Research UK and led by the University of Birmingham has found that the standard chemotherapy used to treat a specific type of throat cancer remains the most effective.

The findings of the trial, which aimed to compare for the first time the outcomes of using two different kinds of treatment for patients with Human papillomavirus (HPV)-positive throat cancer, are published today (November 15th) in The Lancet.

Throat cancer is one of the fastest rising cancers in Western countries. In the UK, incidence was unchanged between 1970 and 1995, then doubled between 1996 and 2006, and doubled again between 2006 and 2010. The rise has been attributed to HPV, which is often a sexually transmitted infection. Most throat cancers were previously caused by smoking and alcohol and affected 65 to 70 year old working class men. Today, HPV is the main cause of throat cancer and patients are middle class, working, have young children and are aged around 55.

HPV-positive throat cancer responds well to a combination of cisplatin chemotherapy and radiotherapy, and patients can survive for 30 to 40 years, but the treatment causes lifelong side effects including dry mouth, difficulty swallowing, and loss of taste.

The De-ESCALaTE HPV study, which was sponsored by the University of Warwick, compared the side effects and survival of 164 patients who were treated with radiotherapy and cisplatin, and 162 who were given radiotherapy and cetuximab. The patients were enrolled between 2012 and 2016 at 32 centres in the UK, Ireland, and the Netherlands. Patients were randomly allocated to be treated with radiotherapy and either cisplatin or cetuximab. Eight in ten patients were male and the average age was 57 years.

Importantly, the results found that there was very little difference between the two drugs in terms of toxicity in patients and side effects such as dry mouth, however, there was a significant difference in the survival rates and recurrences of cancer in patients taking part in the trial.

They found that the patients who received the current standard chemotherapy cisplatin had a significantly higher two-year overall survival rate (97.5%) than those on cetuximab (89.4%). During the six-year study, there were 29 recurrences and 20 deaths with cetuximab, compared to 10 recurrences of cancer and six deaths in patients who were treated with the current standard chemotherapy cisplatin.

And cancer was three times more likely to recur in two years following treatment with cetuximab compared to cisplatin, with recurrence rates of 16.1 per cent versus six per cent, respectively.

Study lead Professor Hisham Mehanna, Director of the University of Birmingham’s Institute of Head and Neck Studies and Education, said: “Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as cisplatin chemotherapy with radiotherapy and caused fewer side effects but there has been no head-to-head comparison of the two treatments.

“Cetuximab did not cause less toxicity and resulted in worse overall survival and more cancer recurrence than cisplatin.

“This was a surprise – we thought it would lead to the same survival rates but better toxicity. Patients with throat cancer who are HPV positive should be given cisplatin, and not cetuximab, where possible.”

Dr Emma King, Cancer Research UK Associate Professor in head and neck surgery at the University of Southampton, said: “Studies like this are essential for us to optimise treatments for patients. We now know that for HPV-positive throat cancer, the standard chemotherapy treatment remains the most effective option.

“However, we must keep testing new alternatives to ensure patients always have access to cutting-edge and kinder treatments. Chemotherapy and radiotherapy can leave head and neck cancer patients with long term pain and difficulties swallowing, so we should always strive to minimise side effects.”

Professor Janet Dunn from the University of Warwick, whose team ran the De-ESCALaTE HPV trial, said: “In the current trend for de-escalation of treatment, the results of the De-ESCALaTE HPV trial are very important as they were not as we expected. They do highlight the need for academic clinical trials and are an acknowledgement of the key role played by Warwick Clinical Trials Unit at the University of Warwick as the co-ordination and analysis centre for this important international trial.”

The patients on the De-ESCALaTE trial Steering Committee endorsed the importance of research findings.

Malcom Babb, who is also President of the National Association of Laryngectomee Clubs, said: “From a patient perspective, De-ESCALaTE has been a success by providing definitive information about the comparative effectiveness of treatment choices.”

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November, 2018|Oral Cancer News|