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Nivolumab Plus Stereotactic Body Radiotherapy Fails To Improve Outcomes in Head and Neck Cancer

Source: https://www.cancertherapyadvisor.com

 

CHICAGO—Although the addition of stereotactic body radiation therapy (SBRT) to nivolumab did not increase toxicity, it did not lead to any improvement in response rates or survival outcomes among patients with metastatic head and neck squamous cell carcinoma (HNSCC), according to an oral presentation at the American Society of Clinical Oncology 2018 Annual Meeting on Friday, June 1.

Researchers sought to determine whether or not SBRT to a single lesion plus nivolumab would improve abscopal responses (tumor regression in non-irradiated lesions) and other outcomes among this patient population.

In this phase 2 interventional study (ClinicalTrials.gov Identifier: NCT02684253), researchers randomly assigned 53 patients with metastatic HNSCC to receive nivolumab alone every 2 weeks or with SBRT between the first and second doses of nivolumab. The 2 study arms did not have any significant differences in terms of age, EBV/HPV viral status, primary site, or median lines of previous chemotherapy. The median follow-up was 12.8 months.

Results showed that the overall response rate (ORR) was 26.9% (95% CI, 13.7-46.1) compared with 22.2% (95% CI, 10.6-40.8) in the nivolumab alone arm and nivolumab plus SBRT arm, respectively (P = .94). Patients receiving nivolumab alone did not have an evaluable median duration of response (DOR) compared with 9.3 months (95% CI, 55.2-not reached [NR]) among patients in the SBRT arm.

The 1-year overall survival rate was 64% (95% CI, 47-88) in the nivolumab alone arm compared with 53% (95% CI, 36-79) in the nivolumab plus SBRT arm (P = .79); median progression-free survival (PFS) was 1.9 months (95% CI, 1.78-NR) compared with 2.4 months (95% CI; 1.0-11.4) with nivolumab plus SBRT (P = .8).

Treatment-related grade 3 and worse adverse effects were reported in 15% of patients who received nivolumab alone and in 11% of patients who received SBRT plus nivolumab (P = .96).

The authors concluded that “While safe, the addition of SBRT to nivolumab in M1 HNSCC failed to improve ORR, PFS, or OS. This is the first randomized evaluation of the abscopal response in any tumor histology.”

June, 2018|Oral Cancer News|

History of the Anti-Vaccine Movement – When Did the Anti-Vaccine Movement Really Start?

February 8th, 2018
By: Vincent Iannelli, MD
Source: https://www.verywellfamily.com

It is likely a surprise to many people that there has always been an anti-vaccine movement. It isn’t something new that was created by Jenny McCarthy and Bob Sears.

18th Century Anti-Vaccine Movement

In fact, the anti-vaccine movement essentially predates the first vaccine.

Edward Jenner’s first experiments with a smallpox vaccine began in 1796.

Even before that, variolation as a technique to prevent smallpox was practiced for centuries in many parts of the world, including Africa, China, India, and the Ottoman Empire.

In fact, Onesimus, his African slave, taught Cotton Mather about the technique in 1706.

Lady Mary Wortley Montagu introduced inoculation to England, having learned about the practice in Turkey. As she encouraged others to inoculate and protect their children against smallpox, including the Royal Family, there was much debate. It is said that “Pro-inoculators tended to write in the cool and factual tones encouraged by the Royal Society, with frequent appeals to reason, the modern progress of science and the courtesy subsisting among gentlemen. Anti-inoculators purposely wrote like demagogues, using heated tones and lurid scare stories to promote paranoia.”

Were those the first vaccine debates?

19th Century Anti-Vaccine Movement

Eventually, Edward Jenner’s smallpox vaccine replaced variolation.

Even though this was much safer than the previous practice and smallpox was still a big killer, there were still those who objected.

Much of the resistance may have come because getting the smallpox vaccine in the UK in the 19th century was compulsory—you had to vaccinate your children or you would be fined, and the fines were cumulative.

The Anti-Vaccination League was created shortly after the passage of the Vaccination Act of 1853.

Another group, the Anti-Compulsory Vaccination League, was founded after the passage of the Vaccination Act of 1867, which raised the age requirements for getting the smallpox vaccine from 3 months to 14 years old.

There were anti-vaccination leagues in the United States, too.

That they actually called them “anti-vaccine” is one of the only big differences between these groups and the modern anti-vaccine movement.

Anti-vaccine groups in the 19th Century typically:

  • said that vaccines would make you sick
  • blamed medical despotism, “a hard, materialistic, infidel thing” for creating the vaccination acts
  • warned about poisonous chemicals in vaccines, namely carbolic acid in the smallpox vaccine
  • said that Jenner’s smallpox vaccine didn’t work
  • pushed alternative medical practices, including herbalists, homeopaths, and hydropaths, etc.
  • used their own literature to scare people away from vaccines

They even had some celebrities join the anti-vaccine movement, including George Barnard Shaw, who also believed in homeopathy and eugenics.

20th Century Anti-Vaccine Movement

Anti-vaccine groups didn’t change much in the 19th and early 20th Century.

That’s perhaps not too surprising, as after Jenner’s smallpox vaccine, it would be almost 100 years before another vaccine was developed—Louis Pasteur’s vaccine against rabies in 1885.

And it was more than 50 years before the American Academy of Pediatricsformally approved the use of a pertussis vaccine (1943).

Over the next few decades, the other vital vaccines that we know today were developed, including the DPT vaccine, polio vaccines, and MMR, etc.

Of course, the anti-vaccine movement was alive and well during this time, using all of the same tactics.

In 1973, John Wilson and M. Kulenkampff reported on 50 children seen over 11 years at the Hospital for Sick Children in London. He reported on a clustering of neurological complications in the first 24 hours of the kids getting their DPT shot, even though his team didn’t actually see the children for months or years later.

In 1974, they reported the findings of 36 of these children in the Archives of Diseases in Childhood.

As with a later report by Wakefield, media coverage of this small study led to fear of vaccines and lower immunization rates. John Wilson even appeared on “This Week,” a prime-time TV show in the UK. The consequences were not unexpected. In addition to a large outbreak in England, with at least 100,000 cases and 36 deaths, there were pertussis outbreaks and deaths in Japan, Sweden, and Wales after this study. Pertussis deaths in the UK were likely underreported, though, and some experts think that the actual number of childhood deaths was closer to 600.

While many people think that Lea Thompson’s “DPT: Vaccine Roulette” in 1982 helped create the modern anti-vaccine movement, it should be clear that others had a hand.

This was also the time that Dr. Robert Mendelsohn, a self-proclaimed “medical heretic” and one of the first anti-vaccine pediatricians, became infamous for writing “The Medical Time Bomb of Immunization Against Disease” and making the rounds on the talk shows of the day. Mendelsohn also was against adding fluoride to water and “coronary bypass surgery, licensing of nutritionists, and screening examinations to detect breast cancer.”

Lea Thompson’s show did prompt Barbara Loe Fisher and a few other parents to form the group Dissatisfied Parents Together (DPT). And from there we got her book, “A Shot in the Dark,” that had such a great influence on Dr. Bob Sears, and the eventual formation of the National Vaccine Information Center.

And since excerpts of “DPT: Vaccine Roulette” even ran nationally on the Today Show, it likely influenced a lot more people.

Next came accusations that the DPT vaccine caused SIDS. And that the hepatitis B vaccine causes SIDS. Barbara Loe Fisher was in the middle of many of these accusations, even testifying before Congress.

And while she was certainly not the first anti-vaccine celebrity, this was the time (1990) when Lisa Bonet of The Cosby Show fame went on The Donahue Show and said that vaccines could “introduce alien microorganisms into our children’s blood and the long-term effects which could be trivial or they could be quite hazardous – and they could just be allergies or asthma or sleep disorders or they could be cancer, leukemia, multiple sclerosis, sudden infant death syndrome. It’s very scary and it’s very serious, and I think because I felt wrong doing it…that’s why I didn’t do it. You know we have to think twice. You know why are our kids getting these diseases?”

A few years later, in 1994, the first deaf Miss America was crowned, with her mother blaming the DPT vaccine for her child’s deafness. Like many other vaccine-injury stories, Heather Whitestone’s story wasn’t what it seemed. Her pediatrician quickly came forward and set the record straight—she was deaf because of a life-threatening case of Hib meningitis and the subsequent treatment with an ototoxic antibiotic. It took several days for the media to run the corrected story, though.

Born in 1973, it would be another 15 years before the first Hib vaccine was approved and began to be routinely given to children. The DPT vaccine, which has never been shown to cause hearing problems, had nothing to do with Heather Whitestone’s deafness. It certainly didn’t stop anti-vaccine groups from using her initial story and the media coverage to scare parents about vaccines, though.

This is about the same time that Katie Couric did a segment on the NBC News show Now with Tom Brokaw and Katie Couric about DPT “hot lots.”

But of course, things didn’t really get moving in the modern anti-vaccine movement until the 1998 press conference for Andrew Wakefield’s study, when he said that “that is my feeling, that the risk of this particular syndrome developing is related to the combined vaccine, the MMR, rather than the single vaccines.”

ABC’s 20/20 even got in on the anti-vaccine misinformation, raising “serious new questions about a vaccine most children are forced to get” in their 1999 episode “Who’s Calling the Shots?”

The media didn’t take as big an interest in the fact that:

  • a series of lawsuits in England which were brought against the manufacturers of the DPT vaccines claiming they caused children to develop seizures and brain damage all found that the DPT vaccines did not cause vaccine injuries
  • a 1991 IOM report which concluded that the evidence doesn’t indicate a causal relationship between DPT and SIDS and there was insufficient evidence to suggest a causal relationship between DPT and chronic neurological damage and many other disorders
  • many cases of alleged vaccine encephalopathy secondary to the DPT vaccine were in fact caused by Dravet syndrome

It should even be considered “media malpractice” that they didn’t correct all of the misinformation in the Vaccine Roulette piece.

21st Century Anti-Vaccine Movement

The anti-vaccine groups in the 21st Century aren’t that much different from their 19th Century counterparts. They still:

  • say that vaccines will make you sick
  • blame Big Pharma
  • warn about poisonous chemicals and toxins in vaccines, although they continue to shift which chemicals they worry about, moving from thimerosal to formaldehyde and aluminum, etc.
  • say that Jenner’s smallpox vaccine didn’t work and neither do any of the other ones
  • push alternative medical practices, including herbalists, homeopaths, chiropractic, naturopaths, and other holistic providers
  • use their own literature to scare people away from vaccines

One difference is that instead of a few people writing pamphlets with their anti-vaccine ideas, like they did in Boston in 1721, now anyone can reach a lot more people by starting their own website or blog, posting in message boards, writing a book, or getting on TV, etc.

Another is that even more than the late 20th Century, we saw a great rise in the media scaring parents about vaccines in the last 10 or 15 years, including:

  • Jenny McCarthy on Larry King Live
  • Holly Pete on Larry King Live
  • Jenny McCarthy on Oprah in 2007
  • Jenny McCarthy in Time magazine in 2009
  • Matt Lauer interviewing Andrew Wakefield on Dateline in 2009
  • Katie Couric and HPV in 2013
  • Barbara Loe Fisher discussing “Forced Vaccinations” on Lou Dobbs in 2009
  • Matt Lauer and his hour-long Dateline episode, A Dose of Controversy, with Andrew Wakefield himself
  • Robert DeNiro on the Today Show in 2016

This is also the time when we saw the rise of the celebrity anti-vaccine spokesperson and the pandering pediatricians.

And we should have seen them coming. We were less than a week into the year 2000 when Cindy Crawford appeared on Good Morning America with her celebrity pediatrician, Dr. Jay Gordon.

But what’s really different today? Although the great majority of people still vaccinate their kids, clusters of intentionally unvaccinated children are certainly on the rise. And it is these clusters of unvaccinated kids and adults that are leading to a rise in outbreaks of vaccine-preventable diseases that are getting harder to control.

One thing that may be different now is that more people have grasped on to the Natural is the new Medicine movement. From amber necklaces and essential oils to sports magnets and homeopathic “medicines” on pharmacy shelves, these things go hand in hand with the modern anti-vaccine movement.

In addition to pandering pediatricians who push non-standard, parent-selected, delayed protection vaccine schedules, we now have more and more chiropractors, naturopaths, holistic pediatricians, and integrative pediatricians who might advise a parent to skip vaccines altogether. And with Dr. Oz on TV pushing a lot of these types of holistic remedies on TV every day, it probably does seem like an OK thing to do.

Big natural remedy websites that also push everything from organic food to medical conspiracy theories also provide a lot of fodder for anti-vaccine folks. Many others push fear about chemicals, so it isn’t surprising that it would be easy to scare parents about vaccines.

But still, it is important to keep in mind that these things have not become mainstream, it is just that the anti-vaccine movement has become a big business. From selling vitamins, supplements, e-books, e-courses, and holistic treatments to pushing for new laws ensuring that kids can stay intentionally unvaccinated and unprotected, they are the very vocal minority.

Of course, that doesn’t make them right.

Get Educated. Get Vaccinated. Stop the Outbreaks.

May, 2018|Oral Cancer News|

When Is Insurance Not Really Insurance? When You Need Pricey Dental Care.

May 21, 2018
By: David Tuller
Source: https://khn.org

I’m 61 years old and a San Francisco homeowner with an academic position at the University of California-Berkeley, which provides me with comprehensive health insurance. Yet, to afford the more than $50,000 in out-of-pocket expenses required for the restorative dental work I’ve needed in the past 20 years, I’ve had to rely on handouts — from my mom.

This was how I learned all about the Great Divide between medicine and dentistry — especially in how treatment is paid for, or mostly not paid for, by insurers. Many Americans with serious dental illness find out the same way: sticker shock.

For millions of Americans — blessed in some measure with good genes and good luck — dental insurance works pretty well, and they don’t think much about it. But people like me learn the hard way that dental insurance isn’t insurance at all — not in the sense of providing significant protection against unexpected or unaffordable costs. My dental coverage from UC-Berkeley, where I have been on the public health and journalism faculties, tops out at $1,500 a year — and that’s considered a decent plan.

Dental policies are more like prepayment plans for a basic level of care. They generally provide full coverage for routine preventive services and charge a small copay for fillings. But coverage is reduced as treatment intensifies. Major work like a crown or a bridge is often covered only at 50 percent; implants generally aren’t covered at all.

In many other countries, medical and dental care likewise are segregated systems. The difference is that prices for major procedures in the U.S. are so high they can be out of reach even for middle-class patients. Some people resort to so-called dental tourism, seeking care in countries like Mexico and Spain. Others obtain reduced-cost care in the U.S. from dental schools or line up for free care at occasional pop-up clinics.

Underlying this “insurance” system in the U.S. is a broader, unstated premise that dental treatment is somehow optional, even a luxury. From a coverage standpoint, it’s as though the mouth is walled off from the rest of the body.

My humbling situation is not about failing to brush or floss, not about cosmetics. My two lower front teeth collapsed just before my 40th birthday. It turned out that, despite regular dental care, I had developed an advanced case of periodontitis — a chronic inflammatory condition in which pockets of bacteria become infected and gradually destroy gum and bone tissue. Almost half of Americans 30 and older suffer from mild to severe forms of it.

My diagnosis was followed by extractions, titanium implants in my jaw, installation of porcelain teeth on the implants, bone grafts, a series of gum surgeries — and that was just the beginning. I’ve since had five more implants, more gum and bone grafts and many, many new crowns installed.

At least I’ve been able to get care. The situation is much worse for people with lower incomes and no family support. Although Medicaid, the state-federal insurer for poor and disabled people, covers children’s dental services, states decide themselves on whether to offer benefits for adults. And many dentists won’t accept patients on Medicaid, child or adult, because they consider the reimbursement rates too low.

The program typically pays as little as half of what they get from patients with private insurance. For example, as Kaiser Health News reported in 2016, Medicaid in Colorado pays $87 for a filling on a back tooth and $435 for a crown, compared with the $150 and $800 that private patients typically pay.

“It’s really a labor of love to do it,” said Dana Lubet, a recently retired dentist in Madison, Wis., who estimated Medicaid paid only a third of his costs. Accepting too many, he said, “could easily kill your practice.”

A few years ago, while in his mid-50s, Nick DiGeronimo, a facility maintenance worker at a New Jersey sports center, obtained private insurance coverage through the Affordable Care Act, hoping to get treatment for progressive tooth decay.

He needed two implants but, to his dismay, the plan did not cover them. To pay the $10,500 bill, he had to take out loans. “Dental insurance is basically useless,” said DiGeronimo. “It’s a sham, a waste of money, and another case of the haves versus the have-nots.”

As for older Americans, many lose employer-based dental coverage when they retire even as they suffer from increasing dental problems. Among those 65 and older, 70 percent have some form of periodontal disease, according to the Centers for Disease Control and Prevention. Yet basic Medicare plans do not include dental coverage, although options exist for seniors to purchase it.

Overall, in 2015, almost 35 percent of American adults of working age did not have dental insurance. By contrast, only about 12 percent of American adults under 65 did not have medical insurance in 2016. That lack of coverage and treatment can diminish economic and social opportunities — for instance, it can be costly at work or in a job interview not to smile because of unsightly or missing teeth.

Eventually, poor prevention and treatment can become a medical problem — leading to serious, and occasionally deadly, health consequences. In an infamous 2007 case — described by Mary Otto in her book “Teeth: The Story of Beauty, Inequality and the Struggle for Oral Health in America” — Deamonte Driver, a 12-year-old boy in Maryland, died after a tooth infection spread to his brain. The family’s Medicaid coverage had lapsed.

Research has demonstrated links between periodontal infections and chronic conditions like diabetes and cardiovascular disease. Studies have found associations between periodontitis and adverse pregnancy outcomes, such as premature labor and low birth weight. Tooth problems also hinder chewing and eating, affecting nutritional status.

The split between the medical and dental professions, however, has deep roots in history and tradition. For centuries, extracting teeth fell to tradesfolk like barbers and blacksmiths — doctors didn’t concern themselves with such bloody surgeries.

In the U.S., the long-standing rift between doctors and dentists was institutionalized in 1840, when the University of Maryland refused to add training in dentistry and oral surgery to its medical school curriculum — leading to the creation of the world’s first dental school.

Dentists have in some ways benefited from the separation — largely escaping the corporate consolidation of American medicine, with many making good livings in smaller practices. Patients often willingly pay out-of-pocket, at least to a point.

Some people deliberately forgo dental coverage, considering it less urgent than having insurance against medical catastrophes. “You might not get a job as hostess at the restaurant, but by the same token people that have a lot of missing teeth live to tell the tales,” Lubet said.

With fluoridation and advances in treatment, many Americans have come to take the health of their teeth for granted and shifted their attention to more cosmetic concerns. And the dental field has profited from the business.

In my experience, which includes extensive travel in other countries, Americans often seem disoriented or even horrified when confronted with imperfect dentition. During my period of intense dental care here, I hated wearing temporaries and often braved the public with missing front teeth. I found myself routinely reassuring people that, yes, I knew about the gap, and yes, I was having it dealt with.

Meanwhile, the bold line between what is covered or what is not often strikes patients as nonsensical.

Last fall, Lewis Nightingale, 68, a retired art director in San Francisco, needed surgery to deal with a benign tumor in the bone near his upper right teeth. The oral surgeon and the ear, nose and throat doctor consulted and agreed the former was best suited to handle the operation, although either one was qualified to do it.

Nightingale’s Medicare plan would have covered a procedure performed by the ear, nose and throat doctor, he said. But it did not cover the surgery in this case because it was done by an oral surgeon — a dental specialist. Nightingale had no dental insurance, so he was stuck with the $3,000 bill.

If only his tumor had placed itself just a few inches away, he thought.

“I said, what if I had nose cancer, or throat cancer?” Nightingale said. “To separate out dental problems from anything else seems arbitrary. I have great medical insurance, so why isn’t my medical insurance covering it?”

This story was produced by Kaiser Health News, which publishes California Healthline, a service of the California Health Care Foundation.

May, 2018|Oral Cancer News|

The Sate of Liquid Biopsy

Author:Pam Harrison
Date: March 5, 2018
Source: Medscape.com

So called “liquid biopsies” — which can detect circulating tumor DNA (ctDNA) in blood samples — are not yet ready for prime time in the diagnosis or management of early-stage or advanced solid tumors, a new expert review concludes.

These assays are also not useful, outside of clinical trials, for monitoring patients for minimal residual disease following definitive treatment of cancer, nor for cancer screening, the expert review concludes.

The review was prepared jointly by the American Society of Clinical Oncology (ASCO) and the College of American Pathologists (CAP) and was published online March 5 in the Journal of Clinical Oncology.

“This is an area of great interest to both pathologists and oncologists, [and] it’s also an area where we see a lot of commercial advertisement and a lot of enthusiasm from the public,” Jason Merker, MD, PhD, cochair of the expert panel, who was representing the CAP, said in a statement.

“We thought it was a good time to look at the literature and take an evidence-based approach to various uses for ctDNA assays,” he added.

“Like all new things in medicine, the use of ctDNA assays in routine cancer care requires evidence of clinical utility. At present, there is insufficient evidence of clinical validity and utility for the majority of ctDNA assays in advanced cancer, including those that interrogate a panel of genes,” said Daniel F. Hayes, MD, coauthor of the review, who was representing ASCO.

“What is promising is that this area of research is rapidly evolving, so there should be enough evidence soon to formulate evidence-based guidance for a variety of clinical scenarios,” Hayes suggested.

Review Based on Literature Review

For the review, panel members identified 77 relevant articles in the literature. They limited their analysis to variants in ctDNA for solid tumors and to sequence or copy number variants in DNA.

 

They assessed overall evidence of the ability of a test to reliably detect the variant or variants of interest (analytic validity); whether a test accurately detects the presence or absence of a pathologic state or predicts outcomes for patients (clinical validity); and whether the use of the test improves patient outcomes compared with not using it (clinical utility).

The authors focused largely on the use of ctDNA assays in the setting of metastatic cancer, because that is the area for which there is most evidence. Much less research supports the use of liquid biopsy in other settings.

Advanced Cancer

“Fundamentally, there are two paradigms to demonstrate clinical utility and the adoption of ctDNA as a clinically useful test,” the panel members write.

The most reliable strategy is to conduct a prospective clinical trial designed to evaluate how well the test performs as a stand-alone diagnostic test. However, no such trial has yet been carried out, they write.

The second approach is to assess whether the ctDNA test in question delivers the same information that physicians would seek through tissue genomic evaluation.

“[D]emonstrating that a ctDNA assay has high agreement with tumor tissue genotyping may provide sufficient evidence of utility for ctDNA assays in driving patient treatment decisions,” the panel members explain.

They go on to document how far short ctDNA assays fall with respect to meeting this high level of agreement.

First, only one polymerase chain reactin–based ctDNA test has been approved by the US Food and Drug Administration and the European Medicines Agency. That test is the COBAS assay for the detection of EGFR genetic variants in non–small cell lung cancer (NSCLC).

Another assay is available in Europe for the detection of the KRAS mutation in colorectal cancer (CRC).

“These assays have demonstrated clinical validity but the clinical utility in this setting is based on retrospective analyses,” the panel members point out.

Even in light of these approvals, the panel members note that physicians should continue to rely on tissue sample analysis if nothing is detected on ctDNA testing.

They also point out that ctDNA levels may drop while a tumor is still responding to treatment, and as a result, the sensitivity of the test may be compromised.

As for tumor types other than NSCLC and CRC, there is limited evidence to support the clinical validity of ctDNA analysis, the panel members conclude.

The clinical utility of assays developed for the detection of other potentially targetable variants, such as BRAF in melanoma, is not yet established, they add.

Further confounding the diagnostic potential of ctDNA testing is the fact that advanced cancers may be “genetically heterogeneous.”

Although ctDNA tests may be able to pick up subclonal variants in cancer, these variants may not predict how well patients will respond to treatments that theoretically target the variant.

“[S]ubclonality may undermine the clinical utility of ctDNA assays,” the panel members state.

 

Monitoring Response to Therapy

Ideally, liquid biopsies could help physicians monitor patients’ response to treatment, as some tumor-associated proteins now enable them to do.

This, too, remains a challenge, because quantifying changes in ctDNA over time is not as simple as determining whether or not a variant is present. Nor has the best unit by which to measure DNA burden been established.

“Correlations between changes in ctDNA levels and tumor responses or outcomes have been demonstrated in small proof-of-principle studies in a variety of cancer types,” the panel members acknowledge.

“However, currently there is a lack of rigorous evidence on clinical validity, let alone clinical utility, because few large, prospective validation studies have been performed on ctDNA-based monitoring,” they conclude.

 

Use to Monitor Residual Disease

Researchers expressed hope that after curative treatment of a solid tumor, ctDNA assays could be used to monitor patients for minimal residual disease, much as is done in hematogic malignancies using assays to detect leukemic cells in blood following completion of chemotherapy.

However, there is not enough evidence to support the ability of ctDNA tests to detect low levels of minimal residual disease in a manner similar to assays used in the management of diseases such as leukemia, the panel members conclude.

Moreover, “[t]he false-negative rate of ctDNA analysis in…patients who relapse without ctDNA being detected and the false-positive rate [in] patients who do not relapse despite the ctDNA assay being positive have not been established sufficiently for any assay,” they caution.

There is also no evidence that treatment based on detection of ctDNA improves patient outcomes, a major metric of clinical validity.

Screening for Cancer

In an ideal world, ctDNA tests could be used in the early detection of cancer in patients who have no signs of disease.

However, the feasibility of using ctDNA tests to screen asymptomatic individuals has not been demonstrated.

“[D]iagnosing the presence of cancer in a patient without cancer, and determining tissue of origin, have not been established,” the authors point out.

There is also a risk that such tests might be positive for cancers in cases in which none exists and thus lead to overdiagnosis. Currently, overdiagnosis is a major problem with, for example, mammography in breast cancer and prostate-specific antigen screening for prostate cancer, the panel members observe.

Dr Merker has served as a consultant to or in an advisory role for Bio-Rad Laboratories, Rainbow Genomics, and Genoux and has received patents or royalties or has other intellectual property in the measurement and monitoring of cell clonality. Dr Hayes owns stock or has other ownership interests in OncImmune and InBiomotion and has served as a consultant or as an advisor to Cepheid. He has also received research funding, mostly for his institution, from AstraZeneca, Puma Biotechnology, Pfizer, Eli Lilly, Merrimack Pharmaceuticals, Parexel, and Menarini Silicon Biosystems (aka Veridex/Johnson & Johnson). He also holds a number of patents and receives royalties for some of them.

 

 

March, 2018|Oral Cancer News|

Australia may become the first country to eliminate one form of cancer

Author: Brad Jones
Date: March 8, 2018
Source: flipboard.com

The International Papillomavirus Society has announced that Australia could become the first country to eliminate cervical cancer entirely.

According to a new study, Australia’s efforts to distribute a human papillomavirus (HPV) vaccine for free in schools have been a resounding success. The sexually transmitted infection causes 99.9 percent of cases of cervical cancer.

In 2007, the Australian federal government began offering the vaccine to girls aged 12-13, and in 2013 it was made available to boys, too. Girls and boys outside of that age bracket but under nineteen are also entitled to two free doses of the vaccine.

Between 2005 and 2015, the percentage of Australian women aged between 18 and 24 who had HPV dropped from 22.7 percent to just 1.1 percent. Immunization rates have increased further since 2015, contributing to what’s being described as a “herd protection” effect.

Coupled with a more advanced screening test that was introduced by the Australian government in December 2017, there are hopes that no new cases of cervical cancer will be reported within ten or twenty years.

THE WORLD ISN’T CATCHING UP

In the US, the HPV vaccine is not free. It can cost as much as $450 for the full regimen, according to the Association of Reproductive Health Professionals, although financial assistance is often available. In 2016, 78.6% of 15-year-old Australian girls, and 72.9% of 15-year-old Australian boys were vaccinated – but only 50% of American girls between 13 and 17, and 38% of American boys between 13 and 17 had received the vaccination, as per data published by the Henry J. Kaiser Family Foundation.

The situation is much worse in the developing world, where papillomavirus incidence rate remains high. “Two-thirds of the world’s population of women don’t get access to what Australian women do,” said Joe Tooma, the chief executive of the Australian Cervical Cancer Foundation. “Unless we do something, it will still be one of the major cancer killers in developing countries.”

Administering the HPV vaccine in schools has also proven to be effective in a trial that took place in Bhutan. Offering this kind of free access to the vaccine in other developing countries may seem like an expensive measure, but as the Australian example shows, it could ease the burden of cervical cancer down the line.

 

March, 2018|Oral Cancer News|

Immunotherapy: beyond melanoma and lung cancer treatment

Author: David Crow
Source: www.ft.com
Date: March 4, 2018
In the late 1800s, William Coley, a surgeon in New York, developed what scientists now think was the first cancer immunotherapy.

Coley noticed one of his patients, Fred Stein, had started recovering from cancer after catching a serious infection. The observation made him wonder whether the bacteria had somehow stimulated the patient’s immune system and recruited the body’s natural “resisting powers” in the fight against Mr. Stein’s tumours.

The surgeon began treating inoperable cancer patients with bacterial injections — known as “Coley’s toxins” — and recorded some success, but his poorly documented findings were dismissed by contemporaries who favoured radiation and chemotherapy.

Mr. Coley died in 1936 and his theories were all but forgotten: it would take almost 80 years for oncologists to take cancer immunotherapy seriously.

Today, immunotherapies are among the world’s best selling drugs and they have dramatically improved the survival prospects for some of the sickest patients, especially those with melanoma and lung cancer.

“Immunotherapy is here to stay,” says Jill O’Donnell-Tormey, chief executive of the Cancer Research Institute. “It’s not just a blip, it’s not overhyped — I think it is going to become the standard of care for many cancer types.”

The most common immunotherapy drugs are known as checkpoint inhibitors, which work by removing brakes in the immune system so the body can attack cancer.

Their discovery was made possible by the research of James Allison, now a professor at the MD Anderson Cancer Center in Texas, who spent the 1990s and early 2000s working on immunotherapy even as many other scientists dismissed it as an intriguing but futile sideshow.

60 percentage of advanced melanoma patients who survive three years when they take a combination of two checkpoint inhibitors Checkpoint inhibitors have proven remarkably effective in people with advanced melanoma, a disease once known as the “cancer that gave cancer a bad name” because it had such a terrible prognosis, with most patients dying within three to 18 months.

Today, almost 60 per cent of advanced melanoma patients survive three years if they take a combination of two checkpoint inhibitors, both made by Bristol-Myers Squibb, the US pharmaceutical group that bought Yervoy, the drug based on Dr Allison’s findings, in 2009.

A rival drug made by Merck, known as Keytruda, can significantly boost survival in lung cancer patients when added to a type of chemotherapy, according to early findings from a trial that is due to be published shortly. Other companies, including Roche and AstraZeneca, make competing versions.

It was not until 2013 that checkpoint inhibitors gained widespread acclaim among oncologists, but the drugs were soon being hailed as the biggest breakthrough in cancer treatment since the advent of chemotherapy.

The hype served to cloud some uneasy truths.

When checkpoint inhibitors work, they are remarkably effective, helping patients live for months or years longer than expected with less severe side-effects than other drugs. However, with the exception of the remarkable impact in melanoma and, to a lesser extent, lung cancer, most patients do not respond.

Although immunotherapies have now been approved in a long list of cancers from bladder and gastric to liver, the response rates in these illnesses is lower, with as many as 4 out of 5 patients deriving no benefit at all.

When the second generation of checkpoints, known as PDL1 inhibitors, were approved in 2014, researchers and pharma executives confidently predicted they would quickly push response rates higher by combining them with newer experimental immunotherapies.

So far no one has come up with the magic combination, despite running hundreds of trials.

Giovanni Caforio, chief executive of Bristol-Myers Squibb, hails “unprecedented progress” with immunotherapies, but concedes the next step, which he describes as finding “intelligent combinations”, has not moved as quickly.

“I think that it is not growing at the same speed, but I wouldn’t call it stalling,” he says. “I think it’s moving at a speed that is probably more typical of the speed of [traditional] cancer research.”

Sean Bohen, chief medical officer of AstraZeneca, says the quick advent of checkpoint inhibitors was all the more remarkable because immunotherapy “had been a disappointment for decades”. Yet he cautions progress might become slower because the “science is going to harder places”.

That is not necessarily a bad thing, says Dr. Bohen, because it encourages companies and researchers to work in a more methodical way rather than making speculative guesses: “I believe it’s a healthier way to do drug development”.

The challenge now is finding new drugs that can be added to checkpoints and boost the immune response to cancer without putting patients at risk or causing intolerable side effects.

One hope is a so-called IDO inhibitor, which suppresses an enzyme that tumours use to hide from the immune system. Both Merck and Bristol-Myers are testing their checkpoints in combination with this type of medicine in a partnership with Incyte, a US biotech group that is developing the most advanced IDO inhibitor. The first trials are due to complete in May.

Regardless of whether drugmakers and scientists find the right combination any time soon, the remarkable progress in recent years means the field is unlikely to languish as it did after Mr. Coley’s early discoveries.

 

March, 2018|Oral Cancer News|

Hall-Of-Fame Bills Quarterback Jim Kelly Says Oral Cancer Is Back

Author: Elana Glowatz
Date: March 1, 2018
Source: Newsweek.com
Hall-of-Fame quarterback Jim Kelly, who led the Buffalo Bills to four Super Bowls, announced March 1 that he is fighting oral cancer for the third time.

“As our family has faced many trials and triumphs throughout the years, you have blessed us with your prayers. We are asking for those prayers once again,” Kelly said in a statement. “The oral cancer we hoped would be gone forever has returned.”

Oral cancer falls within the realm of head and neck cancers and can include malignancies on the lips, the tongue, the back of the mouth or throat, the tonsils and the tissue around the jaw, among other locations. According to the Oral Cancer Foundation, signs of cancer in those areas could include trouble swallowing, chewing or speaking, numbness or an earache.

The foundation estimates that almost 10,000 people die from oral cancers every year.

Kelly played 11 seasons in the NFL, all with Buffalo, and is most well-known for leading the team to four consecutive conference championships between 1991 and 1994, although the Bills subsequently lost the Super Bowl each time.

The Bills have since retired Kelly’s number 12 jersey and he was inducted into the Pro Football Hall of Fame.

The quarterback was first diagnosed with the cancer in 2013 and had part of his upper jaw removed, according to Sports Illustrated. He received radiation and chemotherapy the following year when more cancer was found.

“Jim is a tough and courageous man and we know he will fight this battle with strength and determination,” the Buffalo Bills organization said in a statement, responding to Kelly’s announcement. “The Buffalo Bills will support the Kelly family during this trying time and we ask our fans to pray for the family as Jim begins the treatment process and the road to recovery.”

Photo Credit: JIM COMMENTUCCI/ALLSPORT/GETTY IMAGES

March, 2018|Oral Cancer News|

In Memoriam: Jimmie C. Holland, MD

The Oral Cancer Foundation is deeply saddened by the passing of OCF Science Advisory Board member, Dr. Jimmie C. Holland. When our organization was in it’s infancy, Dr. Holland was an early supporter of OCF.  She was one of the first in the profession to focus attention on the mental well being of cancer patients. With OCF being a foundation that is heavily geared to funding the advancement of research, and being very hard science and research oriented,  her compassion for the mental health of cancer patients was a key component in humanizing our efforts, and ensuring that we stayed people centric.  We are tremendously grateful for her advanced work in Psycho-oncology, the good it has done for so many in the oral cancer community, and the guidance she offered us. She will be missed by many.

Author: William Breitbart
Source: https://blog.oup.com
Date: Feb. 23, 2018

Jimmie C. Holland, MD, internationally recognized as the founder of the field of Psycho-oncology, died suddenly on 24 December 2017 at the age of 89. Dr. Holland, who was affectionately known by her first name, “Jimmie,” had a profound global influence on the fields of Psycho-oncology, Psychosomatic Medicine, and Oncology.

Dr. Holland was the Attending Psychiatrist and Wayne E. Chapman Chair at Memorial Sloan-Kettering Cancer Center (MSK) and Professor of Psychiatry, Weill Medical College of Cornell University in New York. In 1977, she was appointed Chief of the Psychiatry Service in the Department of Neurology at MSK. The Psychiatry Service at MSK was the first such clinical, research, and training service established in any cancer center in the world. In 1996, Dr. Holland was named the inaugural Chairwoman of the Department of Psychiatry and Behavioral Sciences at MSK Cancer Center, also the first such department created in any cancer center in the world. Over 25 years ago, Dr. Holland founded and co-edited the international Psycho-Oncology journal.

Dr. Holland edited the first major textbooks of Psycho-oncology, and in 1989 edited the Handbook of Psychooncology: Psychological care of the patient with cancer. This landmark textbook was notable for several reasons; it established a “new” field, a subspecialty of both Psychosomatics and oncology. I remember being a young faculty member in Dr. Holland’s service and the very real sense that we were creating something that had not existed before. I remember her asking me to write multiple chapters, including several in which I had very little expertise. I expressed my concern, “I’m not an expert on the psychiatric complications of head and neck cancer!” She calmly reassured me, “Well, Bill, no one is. So when you finish researching and writing the chapter I suppose then you’ll be the world’s expert!”

Psycho-oncology was born and named with the publication of this textbook and with Dr. Holland’s founding of the International Psycho-oncology Society (IPOS) in 1984, then the American Psychosocial Oncology Society in 1986. Subsequently, Dr. Holland edited, with a group of co-editors, what became known as the “Bible” of Psycho-oncology; Psycho-oncology was published in 1998, and represented the most comprehensive, multidisciplinary, and international encyclopedia of a field entering its adolescence. 2010 saw the publication of the second edition followed by the third edition in 2015. Every card-carrying “psycho-oncologist” (in 57 countries with national psycho-oncology societies) had to have the latest edition in their library to demonstrate their link to Jimmie Holland. Dr. Holland also co-wrote two well received books for the public: The Human Side of Cancer and Lighter as We Go: Virtues, Character Strengths, and Aging, the latter reflecting her interests in Geriatric Oncology as she approached her 90th birthday.

Dr. Holland was born in the small farming community of Nevada, Texas in 1928. She credits the local family physician in that community for her interest in medicine and caring for those who were suffering. She was one of only three women in her class at Baylor College of Medicine. In 1956, Dr. Holland married the renowned oncology pioneer James Holland, MD, who was then Chief of Medical Oncology at Roswell Park in Buffalo, NY. She would chide James, complaining that cancer patients were asked every conceivable question about their physical functioning but never, “How do you feel emotionally?” Dr. Holland pioneered the inclusion of psychological and emotional well-being patient-reported outcomes in quality of life measures and as a component of clinical outcomes in clinical trials.

Dr. Holland has received too many awards to list, however some notable ones include: The Medal of Honor for Clinical Research from the American Cancer Society, The Marie Curie Award from the Government of France, and the Margaret L. Kripke Legend Award for contributions to the advancement of women in cancer medicine and cancer science from the MD Anderson Cancer Center. She served as President of the Academy of Psychosomatic Medicine (APM) in 1996 and was the recipient of the APM’s Hackett Lifetime Achievement Award in 1994. She was also the inaugural recipient of the Arthur Sutherland Award for Lifetime Achievement from IPOS.

Over a 40-year career at MSK Cancer Center, Dr. Holland created and nurtured the field of Psycho-oncology, established its clinical practice, advanced its clinical research agenda, and through her pioneering efforts, launched the careers of the leaders of a national and worldwide field who mourn her passing and continue to work in what has become a shared mission to emphasize the care in cancer care.

After stepping down as Chairman of the MSK Department of Psychiatry and Behavioral Sciences in 2003, she kept working full time, seeing patients, conducting research, training and supervising fellows, and traveling the world lecturing and teaching. She also helped bring Psycho-oncology to Africa through her work with the African Organization for Cancer Research & Training in Cancer (AORTIC).

Born in a humble farming community with a one room school house, Dr. Holland created a life that led her to New York and the capitals of the world, honored by so many organizations and societies. She was teaching and seeing patients up until two days before her death. I think we’ll all remember her for various reasons. I certainly have many memories from a 34 year career working beside her. But on that list was her generosity and loving attitude towards her family, her patients, her colleagues, trainees, and everyone who crossed her path. Those who worked alongside her in medicine have made her mission our mission. We will continue this mission’s work, always remembering and honoring Dr. Jimmie Holland. Her death is a profound loss for all of Psychiatry, Psychosomatic Medicine, Psycho-oncology, and Oncology. We’ve lost a pioneer, a remarkable woman, a once-in-a-generation influencer.

Suicide Among Cancer Survivors — Highest Risk in HNC

Author: Roxanne Nelson, RN, BSN
Source: MedScape.com
Date: Feb. 20, 2018

ORLANDO, Florida — Head and neck cancer (HNC) accounts for only about 4% of new cancer cases in the United States, but the risk for suicide among survivors is significantly higher than for survivors of all other cancer types, with the exception of pancreatic cancer.

“The risk of suicide is significantly elevated across cancer sites, and the risk is especially high among HNC and pancreatic cancer survivors,” said Nosayaba Osazuwa-Peters, BDS, MPH, CHES, instructor, Department of Otolaryngology-Head and Neck Surgery, Saint Louis University School of Medicine, Missouri.

“Cancer survivors are candidates for suicide-related psychosocial surveillance,” he added.

Cancer is the number 2 cause of death in the United States and accounts for 1 of every 4 deaths. Suicide is the tenth cause of death, independent of cancer. “If you add cancer to it, you get the perfect storm,” he said.

“Survivorship does come at a cost, and this is one of the more unfortunate costs of cancer survivorship,” Osazuwa-Peters told delegates here at the Cancer Survivorship Symposium (CSS) Advancing Care and Research.

Currently, there are more than 16 million survivors in the United States. The good news is that more people are surviving cancer, and there is now more focus on competing causes of death and comorbidities, he explained. There is also more focus on the increased risk for acute and late toxicities, which needs to be addressed as the rate of survival increases.

Osazuwa-Peters pointed out that there are “a lot of unmet psychosocial needs and struggles with functionality in this population. The overall risk of suicide among cancer survivors is 50% higher than in the general population.”

Findings from a recent study presented in 2017 at the European Psychiatric Association Congress found that a diagnosis of cancer significantly increases an individual’s risk of dying by suicide by 55% as compared to those without cancer.

“Throughout the lifetime of a survivor, the risk of suicide consistently remains higher,” Osazuwa-Peters pointed out.

Suicide Risk Significantly Higher in HNC

In this study, Osazuwa-Peters and colleagues sought to estimate the incidence of HNC-associated suicide in comparison with other common cancers and to quantify the suicide rate among HNC survivors compared with survivors of cancers other than HNC.

They used data from the Surveillance, Epidemiology and End Results (SEER) database from 2000-2014 to identify all cancer deaths that were confirmed as suicide. The death rates from suicide were estimated for the 21 most common cancers, including HNC.

SEER data revealed that there were 4513 suicides among 4,235,657 cancer survivors during that time frame. This extrapolates to an incidence rate of 23.6 suicides per 100,000 person-years.

For cancers in all other sites combined, the suicide rate was 45% lower than for HNC for both males (mortality rate ratios [MRRs] = 0.55; 95% confidence interval [CI], 0.48 – 0.64) and females (MRR = 0.55; 95% CI, 0.37 – 0.81).

Pancreatic cancer was the only cancer type in which the suicide rate was higher than for HNC (86.4 suicides per 100,000 person-years for pancreatic cancer vs 63.4 suicides per 100,000 person-years for HNC). When stratified by sex, this finding held true only for males; the suicide MRR was significantly higher for male pancreatic cancer survivors compared to that of HNC survivors (MRR = 1.54; 95% CI, 1.23 – 1.90). For females, the suicide MMR was highest with HNC compared with all other cancer types.

“A lot of conversation revolves around depression and fear, but depression does not equate to suicide, and data show that even patients who screen okay for depression still commit suicide,” said Osazuwa-Peters. “There are other factors, such as pain and fear, that may heighten the risk of suicide.”

It is important “that suicide is tackled as a problem” when guidelines are developed by the National Comprehensive Cancer Network and other major players, he said.

“Misery Index”

In a discussion of the paper, Christopher J. Recklitis, PhD, MPH, director of research at the Perini Family Survivors’ Center, Dana-Farber Cancer Institute, Boston, Massachusetts, noted that the suicide risk among cancer survivors has been studied for a while, and it has previously been suggested that HNC survivors are particularly at risk.

 

“This study is important because it focused on head and neck cancers, which isn’t often seen, and we can say that these data are largely confirmatory showing the elevated risk,” he said. “My take on this is that it highlights the need for better integration of mental health care into medical survivorship care.”

Not only does the risk for suicide need to be considered, but in general, the psychosocial needs of this population need to be considered more broadly, because suicide is something of a “misery index,” he commented.

“The number of people who are unfortunately ending their lives through suicide suggests that there is large group of people who are quite miserable and thinking about suicide and suffering in a way that needs attention,” he said.

But the study opens the door to several questions, he noted, namely, what is it about HNC that explains this excess risk?

“HNC survivors face poor prognosis, pain, disfigurement, and functional impairments, but that can be said of other cancer survivors,” he pointed out. He added that this group also has a higher risk for substance abuse and depression, but it is not known whether that risk contributes to risk for suicide.

“We need to understand these risks better so we can identify patients at risk and provide effective interventions, and also support the medical providers caring for this high-risk group,” Recklitis added. “We also need to move beyond registry data and study the risk over the course of survivorship, as it can change over time.”

Dr Osazuwa-Peters and Dr Recklitis have disclosed no relevant financial relationships.

Cancer Survivorship Symposium (CSS) Advancing Care and Research. Abstract 146, presented February 17, 2018.

 

 

February, 2018|Oral Cancer News|

Bareback Rider Cody Kiser Uses Tucson Rodeo Role to Rail Against Oral Cancer

Author: Norma Gonzalez
Source: Arizona Daily Star
Date: Feb. 23, 2018

Prior to Friday’s first event, Cody Kiser stretched and danced around the dressing room behind the chutes. Kiser was nothing but smiles as he loosened up for bareback riding at the 93rd annual La Fiesta de los Vaqueros.

While in high school in 2006, Kiser suffered an injury competing in bull riding. The bull stepped on his face, breaking all the bones in its left side. Kiser’s jaw was broken in two places and had to be wired shut. Through plastic surgery, Kiser had his face put back together.

Now, Kiser’s smile is more than just a gruesome injury story. The 27-year-old from Carson City became a spokesperson and role model with the Oral Cancer Foundation in 2014, and is the first spokesman to be affiliated with the rodeo.

“My side of it isn’t giving out a lot of facts,” he said. “Everyone knows smoking and chewing is bad. If you do it long enough, it’ll kill you.”

Kiser has never smoked or chewed. He simply doesn’t like it.

“I was never part of that,” Kiser said. “I just like to lead a healthy lifestyle and it just worked out so perfect to get involved with the foundation.”

So now, the bareback rider lends his voice to the foundation and helps in the prevention of tobacco use. According to oralcancer.org, as many as 15 percent of high school boys use smokeless tobacco in the United States. The nicotine content in a can of dip equals approximately 80 cigarettes, the website says.

The foundation’s slogan “Be smart — don’t start” could be seen embroidered down Kiser’s right sleeve.

“My part is the anti-tobacco, chewing or smoking, for the kids,” he said. “So I go around and represent the Oral Cancer Foundation and try to spread the word to these youngsters coming out to the rodeo that you don’t need to smoke or chew to be cool or to be a cowboy.”

At rodeos, Kiser hangs out with children and will have autograph sessions at times. Even if he finds kids hanging out nearby, he’ll reach out to the children.

Kiser said he knows plenty of cowboys who started using tobacco at a young age, so talking to children is important.

“It’s not so much smoking, but everyone’s chewing. It’s so prevalent (in the rodeo community),” Kiser said. “You talk to guys and they say they started chewing at 13 because their dad would do it.”

Kiser’s rodeo career has taken him all over the United States. He worked as Bradley Cooper’s stunt double in “American Sniper.” When Kiser stops to think about everything he’s been able to do at such a young age, he says he knows he’s been able to live an amazing life.

“So when I talk to younger people, I tell them not to smoke or chew, but I also tell them they need to travel — even if it’s just in the United States,” Kiser said. “I’m just the luckiest guy to be able to do all that, and rodeo has been the gateway to that.”

La Fiesta de los Vaqueros

  • Meili Chuinard Hepner, a 12-year-old student at Miles-Exploratory Learning Center, was honored after the bareback riding event. Meili, who came out to the Tucson Rodeo through the Children’s Western Wish Foundation, was named an honorary princess and was presented with a sash, buckle and cowboy hat signed by contestants. Meili, who was accompanied by her mother, Lisa, and siblings Noah and Amira, has neurofibromatosis (NF2), which causes tumors to grow on nerve endings. Lisa Chuinard said Meili was already suffering from hearing loss when she was adopted from China, but wasn’t diagnosed with NF2 until 2016. The 12-year-old said she was happy to be able to come out to the rodeo.
  • Evan Jayne made his seventh appearance at the Tucson Rodeo when he competed in bareback riding on Friday. Jayne was inspired by Louise Serpa’s book of rodeo photographs as a kid and eventually moved to the United States from France to pursue rodeo. The 35-year-old met Serpa 10 years ago and was photographed by the Tucson icon.

Jayne finished Friday’s run with a 73.00 score.

  • Riker Carter was the first bull rider to compete Friday, and the only one to have a qualifying run. Carter was awarded an 86.50.
  • The Tucson Rodeo announced a crowd of 9,000.

 

 

 

February, 2018|Oral Cancer News|