Monthly Archives: July 2013

Cancer survivor advocating for men’s HPV awareness

Source: The Tampa Tribune (tbo.com)
By Mary Shedden | Tribune Staff
Published: July 28, 2013  
 

LUKE JOHNSON/STAFF

David Hastings, the co-owner of Gulport’s Habana Café, has testified in front of Florida legislators and officials at the Centers for Disease Control and Prevention, since becoming a volunteer patient advocate with the Oral Cancer Foundation.

 

Seven years ago, David Hastings got the worst news of his life. He had oral cancer, and a grueling series of radiation and chemotherapy treatments would be necessary if he wanted to survive.

Undergoing months of the “barbaric” treatment was awful, he said, but so was the knowledge that five different doctors couldn’t explain how a 56-year-old with no history of smoking or heavy drinking ended up with such an aggressive cancer.

“If something is trying to kill you, don’t you want to find out what it is?” the Gulfport accountant and business owner asked over and over.

It took months, but Hastings learned his cancer was linked to HPV, the sexually transmitted virus long known for its connection to deadly cervical cancers. The answer was elusive because few scientists at that time were looking at the virus and male cancers, he said.

Today, doctors know that about 5,600 cases of oral cancer diagnosed each year are tied to the human papillomavirus, a number increasing at a rate faster than that of tobacco- or alcohol-related oral cancers. That’s likely because more hospitals and cancer centers, including Moffitt Cancer Center, are able to test for the male HPV cancer connection on site.

Still, in June, when actor Michael Douglas announced that his stage 4 cancer was linked to oral sex with women, the news spurred nervous giggles, gossipy speculation and a lot of “who knew?” comments across the country.

The public reaction shows how much remains to be learned about the deadly disease, said Hastings, a volunteer patient advocate with the Oral Cancer Foundation.

Since 2006, the co-owner of Gulport’s Habana Café has testified in front of Florida legislators and officials at the Centers for Disease Control and Prevention.

He estimates he now spends about two hours a day educating people about HPV and oral cancer. The self-described “staunch Republican,” who keeps a framed photo of himself posing with President Ronald Reagan in his office, said his advocacy is not political.

“I became so vocal because there was a total lack of education to the public and front-line doctors,” said Hastings, now 65 and cancer-free.

Douglas’ announcement also shows how much significant science around these cancers has emerged in just the past few years, said Anna Giuliano, director of Moffitt’s Center for Infection Research in Cancer.

“The scientific literature keeps growing and growing,” said Giuliano, one of the doctors who was unable seven years ago to definitively tell Hastings how he contracted oral cancer, despite her own experience in HPV research.

Researchers, including Giuliano and others based at Moffitt, today are leading multiple international studies aimed at identifying who is most at risk for HPV cancers, why, and the treatment options for men with HPV-related cancers.

At Moffitt, research looking at the history of men with HPV-related cancers has been underway since 2005, Giuliano said. Her grants initially focused on male genital cancers, but now include oral cancers.

The most recent findings were published this month in the medical journal The Lancet.

HPV is the most common sexually transmitted virus in the United States, the CDC says. Almost every sexually active person – straight, gay or bisexual – will be exposed in his or her lifetime. But many will never develop cancer.

Hastings, a “product of the ’60s” who believes he was infected decades ago, long before he met his wife of 20 years, said men of his generation need to know this.

“My cancer was not caused by tobacco or alcohol. It was caused by a virus,” he said. “Men need to pay attention.”

These infection rates, and the extreme risks of HPV-related cervical cancers, prompted a lot of the initial research two decades ago. Giuliano said initial HPV research focused on women, but evidence is building concerning HPV-related cancers and men.

“In the background has been the question, ‘What about the guys?’ ” she said.

Also, a lot of attention has been paid to HPV vaccination, Giuliano said. The CDC and others see it as the most effective way to prevent future infections, and recommend it for anyone younger than 26 years.

Giuliano said the research now underway at Moffitt looks long-term at adults who missed the opportunity to get the vaccine. For example, researcher Andy Trotti is building on the growing understanding that HPV-related oncology patients have higher survival rates than men with other types of oral cancer.

Trotti, of the Radiation Treatment Oncology Group, wonders if HPV cancer patients can be given a less-aggressive treatment and face a similar chance of long-term survival.

Hastings, who has vivid memories of his treatment, said he welcomes research that could reduce the severity of the treatment. The radiation burns your throat and the ability to taste is gone within a week. Sores develop, as does constant nausea. Taking pain pills or attempting to swallow lukewarm liquids bordered on torture, he said.

“That research is so important for our generation,” he said.

Advancements like this are critical, and results have been swift when compared to other cancer research, Giuliano said. But that’s still not enough.

“Between the two groups, we hopefully can in the next few years make a great difference,” she said.

 

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

 

Study shows wide variation in head and neck cancer care

Source: www.cancerresearchuk.org
Author: staff

Just three in every hundred head and neck cancer patients in England receive the ideal standard of care, according to a new study. The National Head and Neck Cancer Audit found wide variations in care, with just 3.1 per cent of patients receiving every element of care deemed important by experts.

Sara Osborne, head of policy at Cancer Research UK, said it was “disappointing” to see such variation in care for patients with head and neck cancers. But the figures also show there has been an improvement in survival rates among head and neck cancer patients over the last two years, despite variations in care.

The Ideal Patient Pathway contains seven elements of “holistic and integrated care” such as nutritional, speech and language and dental assessments and chest scans or x-rays before surgery. It also involves people’s disease being discussed by a multi-disciplinary team including specialist surgeons, oncologists, speech therapists and nursing staff.

Researchers examined data submitted by all head and neck cancer teams in England and Wales, relating to the care of 8,100 patients between November 2011 and October 2012. They found that the largest group of patients (24.7 per cent) received three elements of the Ideal Patient Pathway, with some aspects delivered more consistently than others.

For example, 96.4 per cent of surgical head and neck cancer patients had their case discussed by a multi-disciplinary team, but just 18.8 per cent had an assessment with a speech and language therapist before surgery.

The findings are published in the National Head and Neck Cancer Audit eighth Annual Report 2012, commissioned by the Healthcare Quality Improvement Partnership.

According to the data, there has been an improvement in survival rates among head and neck cancer patients over the last two years. The figures show that the number of patients who survived a year from their diagnosis rose from 84.4 per cent in 2010 to 87.5 per cent in 2012.

The authors cautioned against attributing this solely to improvements in the delivery of patient care, but said it is an encouraging trend that should be explored in more detail.

The audit’s lead clinician Mr Richard Wight said: “We are delighted to report again the involvement of the head and community in actively contributing to audit, which forms a key part in promoting better care.

“The new focus on the Ideal Patient Pathway has been encouraged by patient representatives. This analysis supports continuing improvement and provides assurance to commissioners of head and neck cancer care.”

Dr Emma King, Cancer Research UK head and neck cancer surgeon, said: “We all must strive towards every patient receiving the ‘ideal pathway’. This data will help us identify problem areas that need to be addressed in order to achieve this.”

Cancer Research UK’s Sara Osborne added: “It’s now up to the new Strategic Clinical Networks to provide clinical support to address any variation in care for all head and neck cancer patients wherever they are in the country.”

Vitamin E may have adverse effect in head and neck cancer

Source: www.newsfix.ca
Author: Robert Cervin

According to a clinical trial, vitamin E supplements may increase the risk of a secondary tumor in those with head and neck cancer.
Previous studies have suggested that a low dietary intake of antioxidants such as vitamins E and C might be linked to an increased risk of cancer. But there is no clear evidence that taking supplements decreases the risk.

Researchers in Quebec, Canada, report on a trial of vitamin E and beta-carotene, which is related to vitamin A, in patients with head and neck cancer. The patients took either supplements or placebo during radiation therapy and afterwards. The beta-carotene was stopped after a year, because a trial showed that those taking it who also smoked had an increased risk of getting lung cancer.

The current trial showed that those on vitamin E were at increased risk of developing a second cancer while they were on the supplement, compared to those on placebo. But their risk was lower once the supplements had stopped. Overall, there was no difference between the two groups after eight years. These patients were at high risk anyway, so it is not really clear whether the results can be generalized to the whole population. There is clearly more research to be done before we can be clear whether vitamins can help in the fight against cancer.

News on cancer breakthroughs: Curb your enthusiasm

By: Christopher Johnson, MD
Source: KevinMD.com
Date: July 20, 2013

 

Hardly a day goes by when some news outlet does not report, often breathlessly, some new breakthrough in cancer research. We need to turn a skeptical eye on most of these reports, particularly those that contain information about very preliminary research findings. The always astute Gary Schweitzer gives a good perspective on this in his HealthNewsReview.org; it’s a good site to bookmark if you follow the medical news.

cells

The key thing to remember is that many, many substances have been found to attack and kill cancer cells in the laboratory. The cartoon above, from the wonderful site xkcd, illustrates the problem. This is generally how promising anti-cancer agents are first identified: we test them against cancer cells growing in a dish. These are called in vitro (“in glass”) studies. But once a potential cancer treatment is found there is a long way to go. First of all, can the concentrations of the agent that showed cancer-killing activity in the dish be safely achieved in the body? And, if they can, does the agent still show that ability in the incredibly complex system of the body? Often such in vivo (“in life”) studies are first done in experimental animals before they are tried in humans.

The testing process in humans is long and complicated. By convention it is divided into several phases. These are worth knowing about because the media will often enthusiastically report results from phase I trials, which represent very preliminary findings. Here are the phases and what they mean:

• Phase I trials: Researchers test a new drug or treatment in a small group of people for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.

• Phase II trials: The drug or treatment is given to a larger group of people to see if it is effective and to further evaluate its safety.

• Phase III trials: The drug or treatment is given to large groups of people to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.

There are also what are called Phase IV trials. These are important, too. They monitor what happens with the drug after it is released by the FDA for clinical use following successful Phase III trials. It is not uncommon for problems to be noticed after it has been used for a while, primarily because now there is a larger group of people getting it than were included in the Phase III trials.

So when you read about some new cancer breakthrough, check to see if these results are in vitro studies, animal studies, or early (i.e. before Phase III) trials in humans. Cancer treatment advances are big news, and the media tends to hype them quite a bit. The medical researchers themselves are often guilty of this, too, which is understandable — all of us would like discoveries we make to be ground-breaking.

If you are interested in more detail about how clinical trials work you can find it at the National Institutes of Health.

Christopher Johnson is a pediatric intensive care physician and author of Your Critically Ill Child: Life and Death Choices Parents Must Face, How to Talk to Your Child’s Doctor: A Handbook for Parents, and How Your Child Heals: An Inside Look At Common Childhood Ailments.  He blogs at his self-titled site, Christopher Johnson, MD.

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
July, 2013|Oral Cancer News|

HPV vaccine might shield women against throat cancer

Source: healthfinder.gov
Author: staff

Young women who are vaccinated against the human papillomavirus (HPV) not only protect themselves from cervical cancer, but from throat cancer as well, a new study suggests. Many of the increasing number of throat cancers, seen mostly in developed countries, are caused by HPV infection and the HPV vaccine might prevent many of these cancers, the researchers say.

“We found the women who had the HPV vaccine had much less infection than the women who hadn’t,” said lead researcher Dr. Rolando Herrero, at the International Agency for Research on Cancer in Lyon, France.

“In fact, there was a 90 percent reduction in the prevalence of HPV infection in the women who received the vaccine compared to the women who had not,” he said.

HPV infection is strongly associated with cancer of the oral cavity, Herrero noted. “We think that it is possible that the prevention of the infection will also lead to the prevention of these cancers,” he explained.

The HPV vaccine has enormous benefit, said Herrero, “because of the cervical cancer prevention and the anal cancer prevention, and it can even prevent infections in their sexual partners.”

Herrero said boys, too, should be vaccinated to protect them from oral cancers. Oral cancer is much more prevalent among men than in women, he pointed out.

A 2011 study in the Journal of Clinical Oncology showed that in the United States, HPV-positive oral cancers increased from 16 percent of all oral cancers in the 1980s to 70 percent in the early 2000s. And according to the Oral Cancer Foundation, nearly 42,000 Americans will be diagnosed with oral and throat cancer in 2013, and more than 8,000 people will die from these conditions.

HPV-linked throat cancer recently came to the public’s attention when the British newspaper The Guardian reported that actor Michael Douglas’ recent bout with the disease might have been caused by oral sex.

For the new study, Herrero’s team randomly assigned more than 7,400 women aged 18 to 25 to either receive the HPV vaccine or a vaccine against hepatitis A, as a comparison.

Women in the HPV vaccine group were given Cervarix, one of two vaccines available for HPV prevention. (The other is Gardasil.)

Four years later, the researchers found the HPV vaccine was 93 percent effective in preventing throat cancer. Among women who received the HPV vaccine, only one patient showed an oral HPV infection, compared with 15 in the hepatitis A vaccine group, the researchers found.

The HPV vaccine costs $130 a dose and because three shots are required, the total cost is about $390, according to the U.S. Centers for Disease Control and Prevention. There are government programs that can help offset these costs for some patients, the agency noted.

Because HPV is a sexually transmitted infection, the vaccine is most effective when given before someone is sexually active. Eighty percent of people will test positive for HPV infection within five years of becoming sexually active, said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center, in New York City.

That’s why the CDC recommends the vaccine for adolescent girls and boys starting at age 11.

The new report was published in the July issue of the online journal PLoS One.

“The study is really preliminary information,” said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital, in New York City. “It will provide a basis to begin to study how the vaccine will help to protect against throat cancer,” she noted.

“It’s going to take a while to study those who have been vaccinated to determine that they are protected against throat cancer. This is just the beginning,” she said.

Sources:
Rolando Herrero, M.D., Ph.D., prevention and implementation group, International Agency for Research on Cancer, Lyon, France;
Marc Siegel, M.D., associate professor of medicine, NYU Langone Medical Center, New York City;
Elizabeth Poynor, M.D., gynecologic oncologist and pelvic surgeon, Lenox Hill Hospital, New York City; July 2013,

Study: A third of throat cancers linked to HPV infection

Source: www.upi.com
Author: staff

Human papillomavirus, the major cause of cervical cancer, also infects a third of throat cancer patients, U.S. and British researchers say.

Aimee R. Kreimer of the National Cancer Institute, part of the National Institutes of Health, and Ruth C. Travis of University of Oxford, and numerous colleagues in several countries identified 638 study participants. Of the study participants, 180 had oral cancers, 135 oropharynx cancers – part of the pharynx – 247 hypopharynx/larynx cancers and 300 patients had esophageal cancers. The study also involved 1,599 controls.

There are more than 100 types of HPV and most people recover easily but two strains — HPV-16 and HPV-18 — cause most cervical and oral cancers. Pre-diagnostic plasma samples from patients were collected, on average, six years before diagnosis. Control participants were analyzed for antibodies against multiple proteins of HPV16 as well as HPV6, HPV11, HPV18, HPV31, HPV33, HPV45 and HPV52.

At the end of the study period the researchers checked for the presence of antibodies to one of HPV’s key proteins, known as E6. The protein disables the cells’ protection system that prevents cancer, but detecting the antibodies indicates HPV overcame the defenses.

The study, published in the Journal of Clinical Oncology, found 34.8 of those with throat cancer had the antibodies, compared with 0.6 percent of those who were cancer-free. The findings indicated HPV-16 infection might be a significant cause of oropharyngeal cancer, in the middle part of the pharynx, behind the mouth, and includes the back one-third of the tongue, the soft palate, the side and back walls of the throat and the tonsils.

Recently, actor Michael Douglas caused a stir when he said throat cancer might be linked to oral sex.

HPV Vaccine Found to Help with Cancers of Throat

Source: NY Times

By: Donald G. McNeil Jr.

A vaccine that protects women against cervical cancer also appears to protect them against throat cancers caused by oral sex, and presumably would protect men as well, according to a study released Thursday.

Rates of this throat cancer have soared in the past 30 years, particularly among heterosexual middle-aged men. About 70 percent of oropharyngeal cancers are now caused by sexually transmitted viruses, up from 16 percent in the 1980s. The epidemic made headlines last month when the actor Michael Douglas told a British newspaper that his throat cancer had come from performing oral sex.

Oncologists have assumed that the human papillomavirus vaccine, which is used to prevent cervical cancer, would also prevent this other type of cancer, but this was the first study to provide evidence.

“This is a very nice paper,” said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center in New York, who was not involved in the study. “We expected this — that’s why we want everyone to vaccinate both boys and girls. But there’s been no proof.”

The study, supported by the National Cancer Institute, found that Cervarix, made by GlaxoSmithKline, provided 93 percent protection against infection with the two types of human papillomavirus that cause most of the cancers.

“We were surprised at how big the effect was,” said Dr. Rolando Herrero, head of prevention for the World Health Organization’s International Agency for Research on Cancer, and the study’s lead author. “It’s a very powerful vaccine.”

The study was done with 5,840 women in Costa Rica who were ages 18 to 25 and sexually active when it began. Four years after being vaccinated, each gave a mouthwash gargle sample that picked up cells from deep in the throat. Only one woman who had received the vaccine was infected with the viruses HPV 16 or HPV 18, the cancer-causing types; 15 women who had gotten a placebo vaccine were infected.

Dr. Herrero explained some of the study’s limitations: when it began, it was concerned only with cervical cancer, so no men were enrolled. The women were initially tested to make sure they had no cervical infections, but were not tested for throat or anal infections. They gave oral samples only once, so it was not possible to say how many had persistent infections; most people clear HPV infections on their own, so only a tiny fraction lead to cancer. Four years is not long enough to know how many cancers would develop — but finding out for sure would require waiting 20 years or more, and ethical guidelines require that all women in the trial get regular examinations and that any suspicious lesions be destroyed before they turn cancerous. Also, only Cervarix, and not Merck’s similar Gardasil vaccine, was tested.

However, Dr. Herrero said, men would “probably” get the same protection as the women did, because the vaccine produces identical antibody levels in both sexes.

Dr. Posner said the large discrepancy in infection rates between those who got the vaccine and those who got placebo suggested that the data was “very reliable” even though the infections were detected far too early to produce cancers.

“What we don’t know,” he said, “is how long-term the protection is, or if re-vaccination is necessary.”

While cancers caused by smoking or drinking usually occur in the mouth, those caused by oral sex usually occur at the base of the tongue or deep in the folds of tonsillar tissue, and are hard to detect. They are more common among heterosexual men than among women or gay men; experts believe that is because vaginal fluid contains more virus than the surface of the penis.

Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in these cancers, said the study was “very encouraging.”

“But remember,” he added. “It only works if you’re vaccinated prior to contracting the infection. Once you’re 40 and have had multiple sexual partners, it’s not going to help.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

July, 2013|Oral Cancer News|

Leaders in Dentistry: Dr. Ezra Cohen

Source: Dr. Bicuspid
By: Donna Domino, Features Editor
Date: July 17, 2013

Ezra Cohen, MD, University of Chicago.
May 21, 2013 — DrBicuspid.com is pleased to present the next installment of Leaders in Dentistry, a series of interviews with researchers, practitioners, and opinion leaders who are influencing the practice of dentistry.

We spoke with Ezra Cohen, MD, an associate professor of medicine and the co-director of the head and neck cancer program at the University of Chicago, and the associate director for education at the university’s Comprehensive Cancer Center. Dr. Cohen specializes in head and neck, thyroid, and salivary gland cancers, and is an expert in novel cancer therapies who has conducted extensive research in molecularly targeted agents in the treatment of these cancers.

His research interests include discovering how cancers become resistant to existing treatments and overcoming these mechanisms and ways to combine radiotherapy with novel agents. Here Dr. Cohen discusses trends in the incidence, detection, and treatment of oral and head and neck cancers.

DrBicuspid.com: What’s the significance of your recent finding that there may be five distinct subgroups of the human papillomavirus (HPV)?

Dr. Cohen: The purpose of the research was trying to define molecular subgroups of head and neck cancer (HNC) to inform therapy and outcomes a lot more than we do now as defined by stage and anatomic site. We were taking advantage of a cohort of patients that we treated in a similar fashion at the University of Chicago with a chemotherapy regimen that we commonly use here. The patients had tumors banked and the specimens were carefully clinically annotated, so we had information on response, outcome, and toxicity.

Because many of these patients had participated in clinical trials, we could draw upon all this clinical data and begin to coordinate the data with molecular profiling. We noticed that five subgroups served the classification best. If we went to more subgroups, it did not help to differentiate the patients with respect to outcome; if we went to fewer subgroups, we were leaving out important categories.

What really made us stop and realize that this was real was that HPV-positive patients and HPV-negative patients segregated into their own groups quite nicely. We of course validated the entire algorithm on different datasets, and we showed that, indeed, on other datasets the five subgroups still held and the outcomes were still different between those subgroups. So we felt reassured that this wasn’t just a spurious finding based on a limited number of samples and limited datasets, that these subgroups are real.

When we looked at specific genes or groups of genes that made up the subgroups, we were then able to see some very important patterns. The predominantly HPV-negative subgroup looked like they classified into one that was driven by hypoxia, one that was driven by stem cell or mesenchymal type of features that we are calling basal, and one that was driven by cell cycle or epidermal growth factor receptor (EGFR)-related genes that we are calling the classical HNC.

HPV positives segregated primarily into two subgroups: one that appeared to express a lot of immune-related genes and one that was actually similar to the basal HPV-negative group. What is interesting is that the latter HPV group actually did worse and was closer in terms of outcome to the basal subgroup in the predominantly HPV-negative group. We have known that obviously not all HPV-positive patients do well. So maybe here is a classifier that we can apply prospectively to begin to segregate patients into groups of those that will do well and those that may be amenable to specific therapies such as EGFR inhibitions, hypoxia modulations, or immune modulation, depending on the subgroup.

A report published in January in the Journal of the National Cancer Institute noted that the rate of HPV-related oropharyngeal cancers is rising, but there is no etiological data on what’s causing the increase. What do you think is causing the increase?

We are still trying to figure that out, but there are some things we can be confident about and some things we have to surmise. We can be confident that the number of HPV-positive and tobacco-unrelated cancer patients are definitely increasing. Also, no doubt these are sexually transmitted entities and that HPV oropharynx cancer is a sexually transmitted disease. The epidemiology strongly favors that and there likely is an immune-host component to this — the ability to eliminate the virus completely versus allowing the virus to integrate into DNA. What we do not know is why. Why are we seeing an increase in the incidence? Why do people not clear the virus? And in the subgroup of those patients, do they eventually develop cancer?

There is a parallel with oral herpes infections and the rise of HPV oropharynx cancer. There is a parallel with a change in sexual practices to more oral sexual activity versus other forms of sexual activity. And there is a parallel to a younger age of sexual activity where, because of concerns about contraception and sexually transmitted diseases, oral sexual activity may be preferred in younger individuals versus older people who are having sex to conceive.

Those may be demographic factors that are beginning to favor the emergence of HPV-positive cases. And, of course, these are things that have been going on for decades, not just now, because the virus takes 20 to 30 years to produce cancer. These are exposures that happened 20 years ago. They are trends that would parallel what we are seeing in terms of hosts that are not clearing the virus.

There may be modulating factors. We know that males are more likely to harbor the infection than females and that males have a much higher incidence — a 3-to-1 ratio — of HPV-related oropharynx cancer than females. There may be something hormone-related or differences in the immune systems that somehow protects females from developing oropharynx cancer. There may be an interaction with smoking, and some have cited an interaction with marijuana and the development of this cancer. How those may play a role in the ability of the immune system to clear this virus we still have to elucidate. But clearly there are host factors that in some individuals do not allow clearance of this virus, and we do not understand those completely.

Are you seeing more HNC and oral cancer cases in your facility? If so, why?

We are definitely seeing more oropharynx cancers. It could be a combination of factors. We are a tertiary care center that has an interest in HNC and the numbers are truly rising. We are seeing more young patients with tongue cancer who do not have the typical risk factors. That is a disease that worries us quite a bit, not only because we really cannot explain the biology, but our data indicate these patients have worse outcomes.

Researchers have found that parts of the genome are missing in cancer patients. Has there been any information related to oral cancer patients? A recent study of head and neck cancer patients showed that in one patient, 5,000 genes had at least one mutation, and 1,300 had at least two. But the researchers said most were “passengers” — that is, mutations alongside another mutation that acts as a “driver.” What do you think is the significance of these findings?

Without doubt it is true. When we sequence cancers, including oral and HNC, we can see a lot of mutations. The challenge is trying to figure out which ones are important. We call those drivers because they affect the biology of the cancer. So the presumption is if you inhibit a driver, you will have a therapeutic effect on the cancer. If you modify a passenger, you are unlikely to see a therapeutic benefit.

It is certainly true in oral and HNC. We think one gene that is commonly mutated in tobacco-related HNC is p53. We think that is an important gene in the biology of these cancers because it is a common mutation in 50% to 60% of these cancers, and because it is a gene that affects so many critical pathways in the carcinogenic process. It tends to happen very early; even before cancers develop, we see evidence of p53 mutations. That is an example of a gene we think is indeed a driver. On the other hand, there are mutations in many other genes, but we are just not sure how important they are.

What is the greatest challenge in successfully treating head and neck cancers?

Head and neck cancer is an important disease in the way we view cancer and our approaches to it because of two factors. It is a disease in which in a majority of patients we are at least going to consider curative therapy. That does not apply to lung, pancreatic, esophageal cancer, and most cancers that we treat.

The other thing is if you think about what defines us as human beings, especially social animals, so much of it occurs above the clavicle. They involve structures that are profoundly affected not only by the disease but by the treatment. So when you think about it in that context, HNC becomes a cancer that most affects quality of life and that has the greatest financial and social implications of any cancer we know of. So choosing the appropriate therapy on an individual basis for HNC really becomes critical. I cannot overemphasize that. This is a cancer in which the patient has to be cognizant of where they are going for treatment, what type of treatment they will get, and the experience of the center because cure and function are at stake.

A study compared outcomes in patients treated in multidisciplinary centers and with collaboration prior to therapy, and the differences were dramatic. There is evidence that outcomes are better. I think it is a critical component. Not just having multidisciplinary conferences — the content of the conference is important, but one surrogate of that is likely the experience of the center. A radiation oncologist, medical oncologist, and surgeon who treat five of these a year is likely to be much different than somebody who treats hundreds of these a year.

Where do you think we will see the next big breakthrough for oral cancer, in treatment or prevention?

I think the next wave of breakthroughs will be predicated on what we are learning in the molecular biology of this disease. That will lead to the development of agents specifically for HNC and the molecular alterations, which will lead to better patient selection for therapies and, ultimately, better outcomes. But screening and prevention are critical, especially for oral cancer because this is a disease we should be able to screen for quite readily. For cancers of the oropharynx, hypopharynx, and larynx, those are a little bit more difficult to screen for, but for oral cancer, screening and prevention are very important.

There are also ongoing efforts for different compounds that hopefully try to prevent a second cancer from developing or a preneoplastic lesion from turning into a cancer. Nothing has been approved yet, but there are a lot of efforts going on around the country.

What role can dental professionals play in improving the detection of oral cancer?

It is the hygienist who often spends more time with patients, so we have to train those individuals, as well as primary care physicians, to implement oral cancer screening. But clearly the dental office is a key component, and it really should be the individual that spends the most time with a patient, and for most practices that is probably the hygienist.

What kinds of research are you doing now?

Research naturally flows out of the classification. We are developing protocols specifically for HP- positive versus HPV-negative patients. We will look at this classification in a prospective manner to see if it is validated. We are of course integrating novel agents based on what we understand about the molecular biology. We feel very strongly that the PI3 kinase is an important pathway in many cancers, and we think it is a very important pathway in HPV-positive cancers. We are developing and have ongoing clinical trials that specifically target that pathway to see if indeed these agents will be effective.

We also have a large chemoprevention effort using an approach that was developed at the University of Chicago to inhibit early blood vessel growth in preneoplastic lesions using the drug vandetanib, which is commercially available. We are very encouraged by the preclinical data, and hopefully we’ll have something to offer patients to actually prevent the cancer from occurring in the first place.
* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

July, 2013|Oral Cancer News|

Living with the long-term consequences of cancer treatment

There are 400,000 people alive up to 20 years after diagnosis. But not all return to full health once treatment is over, and they need support.
By: Lesley Smith
Source: guardian.co.uk
Date: Tuesday 16 July 2013 05.00 EDT

Doctor Examining Patient's Throat

‘GPs must be better equipped to monitor and recognise the potential long-term consequences of cancer treatment.’ Photograph: LWA-Dann Tardif/CORBIS

The cancer story is changing. What was once feared as a death sentence is now an illness that many people survive. As survival rates increase, so too will the number of people living with the legacy of cancer and its treatment.

Last month Macmillan Cancer Support revealed that by 2020 almost half of the population in the UK will be diagnosed with cancer at some point in their lives. This has risen by more than a third in the past 20 years due to the improvement in overall life expectancy.

While the number of people getting cancer is rising, there is also good news.

Improvements in when the disease is diagnosed and the kinds of treatment and care available mean more people are surviving cancer than ever before. In England alone, there are currently 400,000 people alive 10 to 20 years after they were diagnosed with cancer, according to research by Macmillan and the National Cancer Intelligence Network.

Unfortunately, not all cancer patients return to full health once their treatment is over.

Some are left with debilitating health problems as a direct result of their cancer and its treatment, and these people often feel abandoned. They are no longer cancer patients in the eyes of the healthcare system and sometimes do not know who to turn to for help.

This is an important issue, which fails to get the attention it deserves. To help put the spotlight on the long-term consequences of treatment, on Friday Macmillan will launch a new report, “Cured – but at what cost?”. The report will look in detail at the distressing issues that can affect many cancer patients, such as chronic fatigue, bowel and urinary incontinence, pain, depression and sexual difficulties, following their treatment.

The NHS is woefully unprepared to help the rapidly growing number of people with these problems, especially when they occur in older age, when other health and social needs are more common. So what is the solution?

There are things that cancer patients can do to help manage their own recovery, but they need support to do so. Giving every cancer patient at the end of treatment a recovery package, developed by the National Cancer Survivorship Initiative, is the single most important thing the NHS can do to help. A recovery package will identify their needs and suggest a plan of action, including advice on keeping active, signs and symptoms to look out for and what to do if any arise, how to handle returning to work and managing any financial issues.

For people with complex and severe consequences of cancer and its treatment, better specialist services offering expert care are needed.

Once someone is no longer visiting hospital on a frequent basis for cancer treatment, their local GP can play an important role in their recovery and ongoing health. GPs must be better equipped to monitor and recognise the potential long-term or late onset consequences of cancer treatment, such as osteoporosis or heart disease, so that they can provide advice and treatment, or refer people for specialist help if necessary.

We want more and more people to survive cancer and to ensure that they have a good quality of life. This can only happen if more recognition is given to minimising and treating long-term effects, and if the health system better prepares people to cope with the many lasting changes that cancer and its treatment can bring.

Lesley Smith is the consequences of treatment programme manager at the National Cancer Survivorship Initiative

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

July, 2013|Oral Cancer News|

Researchers find overactive protein among mouth cancer patients

Source: http://www.ibtimes.co.uk/
Author: B.S. Akshaya

An overactive protein in mouth cancer encourages tumours to grow fast and scientists claim that the protein will help them to find an effective treatment for the disease. Cancer Research UK scientists have discovered FRMD4A, a protein that is overactive among mouth cancer patients. They claim that just deactivating the protein will help save many lives.

A study conducted on mice revealed that when FRMD4A protein is turned on, it helps the cancer cells to group and stick together, but when the protein is deactivated the stickiness of the cell is lost and ultimately it causes cancer cells to die.

Scientists have already found some potential drugs that could help them deactivate the protein. “What’s really exciting about this research is that we already have potential drugs that can be used to target this protein or compensate for the effects that it is having,” said Dr Stephen Goldie, researcher at Cancer Research UK, in a statement.

“These drugs could offer new options to patients where surgery and chemotherapy have not worked or could be used alongside them. We now need to start trials with these treatments, but we hope this could make a real difference to people with mouth cancer in the future,” he added.

Mouth cancer starts anywhere in the oral cavity area like in the cheek lining area, the floor of the mouth, gums or the roof of the mouth (palate). Symptoms of this cancer are chewing problems, mouth sores, speech difficulty, swallowing difficulty and swollen lymph nodes in the neck and weight loss, according to the National Center for Biotechnology Information (NCBI)

Mouth cancer is the 12th most common cancer among men in the UK. Mouth cancer incidence is strongly related to age, though the patterns by age are quite different for men and women. Age-specific incidence rates increase sharply from around age 45 and peak at ages 60-69, before falling in the over-70s in men. In women, mouth cancer occurs in and around 45 and it peaks in the 80s.

In 2009, nearly 6,000 people were diagnosed with mouth cancer in the UK. Among them, 4,097 (66%) were men and 2,139 (34%) were women, according to the Cancer Research UK report. Only around 50 per cent of people with this type of cancer survive for at least five years. But now there is hope as scientists have found that the FRMD4A protein plays a major role in mouth cancer. They claim that they have to develop some more drugs that could help them deactivate the protein.

“We hope that our approach would be more effective and specific than treating the pathway that FRMD4A is involved in, but we now need to test new potential drugs to see if this will work in patients,” said Dr Goldie.

“This research offers a number of approaches that we can now explore to help treat these cancers, including blocking the protein directly. These cancers often return and spread so it’s vital we find new ways to treat them more effectively,” said Dr Julie Sharp, senior science information manager, at Cancer Research UK, in a statement.

July, 2013|Oral Cancer News|