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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|

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|

New cancer test isn’t ready for prime time

Author: H Gilbert Welch
Date: February 14, 2018
Source: http://www.cnn.com/2018/02/13/opinions/liquid-biopsy-opinion-welch/index.html

(CNN)- A simple blood test to detect cancer early. How great is that?

There has been enthusiasm about the so-called “liquid biopsy” for years. In mid-January, however, doctors learned more — both about this vision and its problems.

A widely reported study in the journal Science described a liquid biopsy test — CancerSEEK — which combined measuring eight tumor biomarkers with testing for pieces of DNA with cancer associated mutations in 16 genes.

It’s not one test; it’s a battery of tests. And while collecting the blood may be simple, the subsequent analysis is extraordinarily complex.

The task at hand is particularly challenging. We all have pieces of DNA in our blood. Distinguishing the tumor DNA from the background DNA requires finding the mutations specifically associated with cancer.

Adding to the complexity, healthy individuals can have mutations. To avoid labeling innocuous mutations as cancerous requires a bunch of statistical fine-tuning.

In other words, there are a lot of steps in a liquid biopsy and much potential for things to go awry.

To their credit, the CancerSEEK investigators were very forthright that the study conditions were ideal for the test to accurately detect cancer. The liquid biopsy simply had to discriminate between patients with known cancer (the majority of whom had symptoms) and healthy individuals. And the statistical fine-tuning was tailored to the study participants — with the knowledge of who had, and who did not have, cancer.

Although the test was able to detect most of the late-stage cancers, it detected less than half of the stage 1 cancers.

But doctors don’t screen to find advanced cancer, we screen to find early cancer. And we don’t screen people with symptoms of cancer, we screen people who don’t have symptoms of cancer.

There’s no doubt that there would be more detection errors in the less controlled environment of the real world.

Just how often was made clear in a recent JAMA-Oncology study. Forty patients with metastatic prostate cancer received liquid biopsies to tailor therapy in real time to the genetics of their spreading tumors. That’s the vision for precision medicine.

But the investigators added a little twist. They wanted to know whether it mattered which lab the liquid biopsies were sent to. So they sent each patient’s blood for two different commercial liquid biopsies: Guardant360 and PlasmaSELECT. Both tests were designed to detect mutations in the same genes.

Yet in over half of the 40 patients, the tests gave different answers about which mutations were present. Different liquid biopsy tests give different answers in a majority of patients? That’s not precision, that’s awful.

Sure, the analyses of liquid biopsies will improve. But if this much confusion exists about what mutations are present in the blood of patients with metastatic cancer (who have a lot of tumor DNA), imagine the uncertainty that will exist for asymptomatic individuals not known to have cancer — the very people who would be screened.

And then there is the question of what to do with a positive result. This is very different than detecting a concerning lung nodule on a screening chest CT scan or a concerning breast mass on a screening mammogram. In these cases, it’s clear what to do to get a definitive answer: surgically biopsy the nodule or the mass. But with a liquid biopsy, the anatomic location of a cancer can be a mystery. It may not even be clear what organ the cancer is in.

Imagine what this might mean for a patient: A doctor says, “It looks like you have cancer, but we are not sure where.”

Even if there is certainty that the cancer is in, say, the liver, doctors may not know where in the organ. What to do then? Randomly biopsy different parts of the liver?

This is doubly concerning when screening average-risk individuals, because most positive results are expected to be false alarms. We typically learn that a screening test is falsely positive because a surgical biopsy is normal. But absent the knowledge of where to biopsy, how can we ever be sure a positive liquid biopsy is wrong?

Doctors won’t know where to look, but we will keep looking. Liquid biopsies are a recipe for more health anxiety, more procedures, more complications and more overdiagnoses. Not to mention, more out-of-pocket costs for our patients.

Of course, we should continue to study liquid biopsies. The detection of circulating tumor DNA may ultimately prove useful in selected settings, such as tailoring therapy for aggressive cancers that are rapidly mutating. But the real enthusiasm is for screening average-risk individuals.

One reason is obvious: there is a lot of money to be made. A Goldman Sachs video estimated the potential liquid biopsy market to be $14 billion annually, adding “and we’re just at the beginning.” That kind of money doesn’t come from testing the few patients with aggressive cancer, that comes from screening millions of people.

And there is a less obvious reason: it is easier for a new test to pass regulatory muster than it is for a new drug. While the FDA has a longstanding mandate to protect us from snake oil treatments, this often doesn’t extend to snake oil testing.

The enthusiasm for finding things that might benefit people in the future ignores the fact that doing so can cause people to have problems now. In short, a bad test can do as much damage as a bad drug. Worrisome liquid biopsies will start a cascade of subsequent, not-so-simple tests and procedures. People will be hurt in the process.

February, 2018|Oral Cancer News|

CDHA Urges Hygienists to Remind Patients of Oral Cancer Screening

Author: Canadian Dental Hygienists Association
Date: January 29, 2018
Source: https://www.oralhealthgroup.com

World Cancer Day (February 4) is a perfect time for dental hygienists across Canada to remind the public of the importance of regular oral cancer screenings, not only during dental appointments, but also now at home.

The Canadian Cancer Society projected in 2017 that 4,700 Canadians would be diagnosed with oral cavity cancer, and that 1,250 Canadians would die.  In hopes of improving the long-term outcomes for people diagnosed with oral cancer, the Canadian Dental Hygienists Association (CDHA) has partnered with the Oral Cancer Foundation and the American Dental Hygienists Association on a “Check Your Mouth™” initiative to help individuals identify the early signs and symptoms of oral cavity cancers.  “Dental hygienists recognize that early detection has great potential to reduce the oral cancer burden in Canada,” states Sophia Baltzis, CDHA president. “Between dental visits, which usually include an oral cancer screening, our clients can and should examine their mouths for suspicious tissue changes.”

The Check Your Mouth™ campaign features an interactive website (www.checkyourmouth.org) that offers easy-to-use tools and tips for a quick visual and tactile examination of the oral cavity.  Individuals can learn to self-discover the early symptoms of disease and then seek further evaluation from a dental professional if necessary.  “Dental hygienists are your partners in prevention,” adds Baltzis. “We encourage all Canadians to maintain a healthy lifestyle, practice good oral hygiene habits, and spot the early signs of oral cancer. The Check Your Mouth™ website is a valuable resource that everyone should explore.”  By raising public awareness of oral cancer and its early signs and symptoms, dental hygienists are helping to meet the global challenge of saving lives. Together, we can make a difference!

Serving the profession since 1963, CDHA is the collective national voice of more than 28,495 registered dental hygienists working in Canada, directly representing 19,000 individual members including dental hygienists and students. Dental hygiene is the 6th largest registered health profession in Canada with professionals working in a variety of settings, including independent dental hygiene practice, with people of all ages, addressing issues related to oral health. For more information on oral health,

January, 2018|Oral Cancer News|

Study Identifies Potential Cause of Hearing Loss from Cisplatin

Author: NCI Staff
Date: January 26, 2018
Source: National Cancer Institute (https://www.cancer.gov/news-events)

Results from a new study may explain why many patients treated with the chemotherapy drug cisplatin develop lasting hearing loss.

Researchers found that, in both mice and humans, cisplatin can be found in the cochlea—the part of the inner ear that enables hearing—months and even years after treatment. By contrast, the drug is eliminated from most organs in the body within days to weeks after being administered.

The study, led by researchers from the National Institute on Deafness and other Communication Disorders (NIDCD), part of the National Institutes of Health, was published November 21 in Nature Communications.

Cisplatin, a platinum-based chemotherapy drug, is commonly used for the treatment of many cancers, including bladder, ovarian, and testicular cancers. But cisplatin and other similar platinum-containing drugs can damage the cochlea, leaving 40%–80% of adults, and at least 50% of children, with significant permanent hearing loss, a condition that can greatly affect quality of life.

“This study starts to explain why patients who receive the drug sustain hearing loss,” said Percy Ivy, M.D., associate chief of NCI’s Investigational Drug Branch, who was not involved in the study. “This is very important, because as we come to understand how cisplatin-related hearing loss occurs, over time we may figure out a way to block it, or at least diminish its effects.”

A New Approach to Researching Cisplatin-Induced Hearing Loss

The new study differs from previous research because it is a comprehensive look at the pharmacokinetics, or concentration, of the drug in the inner ear, explained study investigator Andrew Breglio, of NIDCD.

The research team primarily used a technique called inductively coupled plasma mass spectrometry (ICP-MS) to quantify the amount of platinum left in inner ear tissue following cisplatin treatment in mice.

Lisa Cunningham, Ph.D., of NIDCD, who led the research team, noted that instead of using one high dose of cisplatin with mice as other studies have, they developed a treatment protocol like those used in everyday care, in which the drug is given in cycles.

Testing done following each cisplatin cycle showed increasingly progressive hearing loss in the mice. The researchers also measured platinum levels in various organs throughout the drug cycles and found that, whereas other organs eliminated the drug relatively quickly, the cochlea retained the cisplatin, showing no significant loss of platinum 60 days after the last administration of the drug.

The researchers also conducted postmortem analysis of inner ear tissue of human patients who had received cisplatin, and found that platinum was retained in cochleae at least 18 months after the last treatment. In addition, they found that in the cochlea of one pediatric patient (the only one available for study), significantly more platinum was retained than in adult patients, consistent with the fact that children’s ears are known to be more susceptible to cisplatin-induced hearing loss.

In both the mouse model and in studies of human tissue, the researchers determined that the platinum accumulates in a part of the cochlea called the stria vascularis, which, Breglio explained, regulates the makeup of the fluid that bathes the sensory hair cells in the ear “and is critical to their proper function.”

This lengthy retention in the cochlea could explain why this drug is damaging the inner ear, Breglio said. Furthermore, these findings, demonstrating the accumulation of the drug and identifying where it is retained, mean that future studies need to “look beyond hair cells” to explain cisplatin-induced hearing loss, the researchers wrote.

Findings That Could Lead to Hearing Loss Treatment and Prevention

The finding that cisplatin is retained in the cochlea indefinitely is important for patient care, Dr. Ivy said.

Hearing loss from cisplatin “is not a static injury, it doesn’t stay the same. It can progress over time and it can occur late,” she added. “That suggests that a long-term survivor needs ongoing monitoring of their hearing.”

She said it will be up to practitioners to continue this monitoring and to rapidly intervene with devices that assist in hearing, such as hearing aids.

Hearing loss can have a particularly negative impact on children, she said.

“If adults develop hearing loss, they’re more acutely aware of it, and are more likely to seek assistance, whereas younger children who develop hearing loss might not notice it as much or be unable to explain the problem,” she explained. “Since they can’t hear very well, they may have trouble paying attention and that could be misconceived as a learning disability or a behavior problem. And yet, if they get the appropriate intervention, they perform at the same level they did prior to receiving platinum.”

This is why researchers on Dr. Cunningham’s team are trying to find ways to block cisplatin from entering the inner ear. They are looking at the cellular mechanism by which cisplatin is taken up by the cells of the stria vascularis to find ways to block uptake, as well as identify drugs that might “target cisplatin itself, and bind it or sequester it” before it can get into the inner ear, Breglio said.

“[Cisplatin] is one of the most widely used anticancer drugs on the planet, and it’s saving a lot of lives,” Dr. Cunningham said. But the hearing loss is permanent. “So these patients are surviving and they have this hearing loss for the rest of their lives. What we’d like to be able to do is develop a therapy that will allow patients to take the life-saving drug, but preserve their hearing.”

 

January, 2018|Oral Cancer News|

Anti-smoking plan may kill cigarettes–and save Big Tobacco

Date: January 19, 2018
Author: Matthew Perrone
Source: www.apnews.com

WASHINGTON (AP) — Imagine if cigarettes were no longer addictive and smoking itself became almost obsolete; only a tiny segment of Americans still lit up. That’s the goal of an unprecedented anti-smoking plan being carefully fashioned by U.S. health officials.

But the proposal from the Food and Drug Administration could have another unexpected effect: opening the door for companies to sell a new generation of alternative tobacco products, allowing the industry to survive — even thrive — for generations to come.

The plan puts the FDA at the center of a long-standing debate over so-called “reduced-risk” products, such as e-cigarettes, and whether they should have a role in anti-smoking efforts, which have long focused exclusively on getting smokers to quit.

“This is the single most controversial — and frankly, divisive — issue I’ve seen in my 40 years studying tobacco control policy,” said Kenneth Warner, professor emeritus at University of Michigan’s school of public health.

The FDA plan is two-fold: drastically cut nicotine levels in cigarettes so that they are essentially non-addictive. For those who can’t or won’t quit, allow lower-risk products that deliver nicotine without the deadly effects of traditional cigarettes.

 

US health officials are pushing ahead with an unprecedented plan to make cigarettes less addictive and provide lower-risk alternative products to US smokers. (Jan. 19)

This month the government effort is poised to take off. The FDA is expected to soon begin what will likely be a years-long process to control nicotine in cigarettes. And next week, the agency will hold a public meeting on a closely watched cigarette alternative from Philip Morris International, which, if granted FDA clearance, could launch as early as February.

The product, called iQOS (pronounced EYE-kose), is a penlike device that heats Marlboro-branded tobacco but stops short of burning it, an approach that Philip Morris says reduces exposure to tar and other toxic byproducts of burning cigarettes. This is different from e-cigarettes, which don’t use tobacco at all but instead vaporize liquid usually containing nicotine.

For anti-smoking activists these new products may mean surrendering hopes of a knockout blow to the industry. They say there is no safe tobacco product and the focus should be on getting people to quit. But others are more open to the idea of alternatives to get people away from cigarettes, the deadliest form of tobacco.

Tobacco companies have made claims about “safer” cigarettes since the 1950s, all later proven false. In some cases the introduction of these products, such as filtered and “low tar” cigarettes, propped up cigarette sales and kept millions of Americans smoking. Although the adult smoking rate has fallen to an all-time low of 15 percent, smoking remains the nation’s leading preventable cause of death and illness, responsible for about one in five U.S. deaths.

Anti-smoking groups also point to Big Tobacco’s history of manipulating public opinion and government efforts against smoking: In 2006, a federal judge ruled that Big Tobacco had lied and deceived the American public about the effects of smoking for more than 50 years. The industry defeated a 2010 proposal by the FDA to add graphic warning labels to cigarette packs. And FDA scrutiny of menthol-flavored cigarettes — used disproportionately by young people and minorities — has been bogged down since 2011, due to legal challenges.

“We’re not talking about an industry that is legitimately interested in saving lives here,” said Erika Sward of the American Lung Association.

But some industry observers say this time will be different.

“The environment has changed, the technology has changed, the companies have changed — that is the reality,” said Scott Ballin, a health policy consultant who previously worked for the American Heart Association.

Under a 2009 law, the FDA gained authority to regulate certain parts of the tobacco industry, including nicotine in cigarettes, though it cannot remove the ingredient completely. The same law allows the agency to scientifically review and permit sales of new tobacco products, including e-cigarettes. Little has happened so far. Last year, the agency said it would delay the deadline for manufacturers to submit their vapor-emitting products for review until 2022.

The FDA says it wants to continue to help people quit by supporting a variety of approaches, including new quit-smoking aids and opening opportunities for a variety of companies, including drugmakers, to help attack the problem. As part of this, the FDA sees an important role for alternative products — but in a world where cigarettes contain such a small amount of nicotine that they become unappealing even to lifelong smokers.

“We still have to provide an opportunity for adults who want to get access to satisfying levels of nicotine,” but without the hazards of burning tobacco, said FDA Commissioner Dr. Scott Gottlieb. He estimates the FDA plan could eventually prevent 8 million smoking-related deaths.

“SMOKE-FREE FUTURE”

Philip Morris International and its U.S. partner Altria will try to navigate the first steps of the new regulatory path next week.

At a two-day meeting before the FDA, company scientists will try and convince government experts that iQOS is less-harmful than cigarettes. If successful, iQOS could be advertised by Altria to U.S. consumers as a “reduced-risk” tobacco product, the first ever sanctioned by the FDA.

Because iQOS works with real tobacco the company believes it will be more effective than e-cigarettes in getting smokers to switch.

Philip Morris already sells the product in about 30 countries, including Canada, Japan and the United Kingdom.

iQOS is part of an elaborate corporate makeover for Philip Morris, which last year rebranded its website with the slogan: “Designing a smoke-free future.” The cigarette giant says it has invested over $3 billion in iQOS and eventually plans to stop selling cigarettes worldwide — though it resists setting a deadline.

Philip Morris executives say they are offering millions of smokers a better, less-harmful product.

Matthew Myers of the Campaign for Tobacco-Free Kids still sees danger. He says FDA must strictly limit marketing of products like iQOS to adult smokers who are unable or unwilling to quit. Otherwise they may be used in combination with cigarettes or even picked up by nonsmokers or young people who might see the new devices as harmless enough to try.

“As a growing percentage of the world makes the decision that smoking is too dangerous and too risky, iQOS provides an alternative to quitting that keeps them in the market,” Myers says.

It’s unclear whether existing alternatives to cigarettes help smokers quit, a claim often made by e-cigarette supporters. Research from the Centers for Disease Control and Prevention suggests about 60 percent of adult e-cigarette users also smoke regular cigarettes.

THE CASE FOR LOWER NICOTINE

Experts who study nicotine addiction say the FDA plan is grounded in the latest science.

Several recent studies have shown that when smokers switch to very low-nicotine cigarettes they smoke less and are more likely to try quitting. But they also seek nicotine from other sources, underscoring the need for alternatives. Without new options, smokers would likely seek regular-strength cigarettes on the black market.

Crucial to the FDA proposal is a simple fact: nicotine is highly addictive, but not deadly. It’s the burning tobacco and other substances inhaled through smoking that cause cancer, heart disease and bronchitis.

“It’s hard to imagine that using nicotine and tobacco in a way that isn’t burned, in a non-combustible form, isn’t going to be much safer,” said Eric Donny, an addiction researcher at the University of Pittsburgh.

A study of 800 smokers by Donny and other researchers showed that when nicotine was limited to less than 1 milligram per gram of tobacco, users smoked fewer cigarettes. The study, funded by the FDA, was pivotal to showing that smokers won’t compensate by smoking more if nicotine intake is reduced enough. That was the case with “light” and “low-tar” cigarettes introduced in the 1960s and 1970s, when some smokers actually began smoking more cigarettes per day.

Still, many in the anti-smoking community say larger, longer studies are needed to predict how low-nicotine cigarettes would work in the real world.

LEGAL RISKS

Key to the FDA plan is the assumption that the two actions will happen at the same time: as regulators cut nicotine in conventional cigarettes, manufacturers will provide alternative products.

But that presumes that tobacco companies will willingly part with their flagship product, which remains enormously profitable.

Kenneth Warner, the public policy professor, said he would be “astonished” if industry cooperates on reducing nicotine levels.

“I don’t think they will. I think they will bring out all of their political guns against it and I’m quite certain they will sue to prevent it,” he said.

In that scenario, the FDA plan to make cigarettes less addictive could be stalled in court for years while companies begin launching FDA-sanctioned alternative products. Tobacco critics say that scenario would be the most profitable for industry.

“It’s like Coke, you can have regular Coke, Diet Coke, Coke Zero, we’ll sell you any Coke you like,” said Robin Koval, president of the Truth Initiative, which runs educational anti-tobacco campaigns.

But the FDA’s Gottlieb says the two parts of the plan must go together. “I’m not going to advance this in a piecemeal fashion,” he said.

When pressed about whether industry will sue FDA over mandatory nicotine reductions, tobacco executives for Altria and other companies instead emphasized the long, complicated nature of the regulatory process.

“I’m not going to speculate about what may happen at the end of a multiyear process,” said Jose Murillo, an Altria vice president. “It will be science and evidence-based and we will be engaged at every step of the way.”

 

January, 2018|Oral Cancer News|

HPV vaccine is safe, effective after 10 years: study

Author: AFP/RelaxNews
Date: November 30, 2017
Source: Globalnews.ca

New research looking into the long-term effects of the human papillomavirus (HPV) vaccine has found it to be both safe and effective in protecting against the most virulent strains of the virus.

Led by Dr. Daron G. Ferris, professor in the Department of Obstetrics and Gynecology at the Medical College of Georgia and at the Georgia Cancer Center at Augusta University, the study is the longest followup to date on the vaccine, looking at data from 1,661 male and female participants who were followed for just under 10 years.

Of these participants, around two-thirds received a three-dose regimen of the vaccine when they were ages nine to 15 and sexually inactive.

Initially about one-third received a placebo — not a vaccine — however, the placebo group also received the vaccine 30 months into the study, meaning that these individuals were followed a shorter period of time.

Ferris found that the vaccine was virtually 100 per cent effective in preventing the disease, although vaccinating earlier produced the most robust initial and long-term antibody response, the proteins found in the blood which help fight infection.

“We needed to answer questions like if we vaccinate earlier in life, will it last,” explained Ferris, “The answer is yes, this cancer prevention vaccine is working incredibly well 10 years later. A booster vaccine likely will not be needed by these young people. I think now we have come full circle.”

The new finding also supports previous research which suggests that a more widespread and earlier administration of the HPV vaccine, before teens and preteens are exposed to the infection, is the preferred option.

Although the disease can be cleared in around two-thirds of infected individuals, the virus can persist in the remaining one-third, potentially causing a wide range of further health problems.

The quadrivalent vaccine, which protects against HPV types 6, 11, 16 and 18, is designed to better arm the immune system to eliminate the virus.

According to the National Cancer Institute, HPV types 16 and 18 account for essentially all cervical cancer and for most other HPV-related cancers such as penile and anal cancers. Types 6 and 11 account for about 90 per cent of genital warts as well as non-cancerous tumour growths in the respiratory tract.

 

HPV is the most sexually transmitted infection in the U.S.A. Around 79 million Americans, most in their late teens and early 20s, are infected according to the Centers for Disease Control and Prevention (CDC). HPV is also the most common cause of cervical cancer.

The Food and Drug Administration approved the first quadrivalent vaccine, Gardasil, in June 2006, with the vaccine currently approved for patients ages nine to 26.

 

Although the CDC reports that around 43 per cent of U.S. teens are up to date on recommended doses of the HPV vaccine, Ferris added that, “Now we need to push for more young people to get vaccinated. We are doing miserably in the United States.”

The HPV researchers added that the vaccine can be given along with the meningococcal and tetanus, diphtheria and pertussis vaccines, to 11- and 12-year-olds.

The results can be found published online in the journal Pediatrics.

November, 2017|Oral Cancer News|

10 Facts Everyone Should Know About HPV

Author: Lindsay Holmes
Date: November 27, 2017
Source: Huffingtonpost.com

First thing: Don’t stress.

An HPV diagnosis from your doctor doesn’t have to be scary.

In the first season of HBO’s “Girls,” Lena Dunham’s character, Hannah, gets a startling wake-up call when she tests positive for the human papillomavirus. She gets upset and confronts her ex-boyfriend about it. Her best friend tells her “all adventurous women” have HPV, but she generally buys into the overblown idea that her life is over.
Diagnoses like HPV can be complicated, and also unfairly laden with stigma. Research shows that shame and fear surrounding sexual health issues can be a barrier to testing and management.
But it doesn’t have to be this way. Experts say that educating yourself can help take the scariness out of an HPV diagnosis and help you manage your health.

Below is a breakdown of the facts everyone ― yes, including men! ― should know about HPV:

  1. HPV IS INCREDIBLY COMMON.

Approximately 79 million Americans have HPV, according to the U.S. Centers for Disease Control and Prevention. Most of those infected are in their 20s.
“HPV is very common, and most people will be exposed to HPV at some time in their lives,” Dr. Grace Lau, an assistant professor in the Department of Obstetrics and Gynecology at NYU Langone Health, told HuffPost.

  1. HPV IS CONSIDERED A SEXUALLY TRANSMITTED INFECTION.

It’s the most common one, according to the CDC. It’s typically spread through vaginal or anal sex, and it can be passed on even if your partner isn’t showing any symptoms.

“It requires intimate skin to skin contact for transmission,” Lau said. “Condom usage decreases the risk of transmission, but doesn’t completely take away that risk.”

  1. MANY DOCTORS MAY NOT EVEN TEST FOR IT.

Physicians may not screen for HPV during routine Pap smears or other health testing because of how common it is, according to the American Cancer Society. They may wait until you show signs of an infection (like genital warts), or they may test for it if you’re a woman whose Pap smear comes back abnormal.

  1. MEN CAN GET HPV AND PASS IT TO THEIR PARTNERS.

If you think the virus is a women’s health issue, think again: Research published in 2014 found that 69 percent of men studied had HPV.

  1. BUT THERE ISN’T A REAL WAY TO TEST MEN.

Currently, there’s no real recommended HPV test for men, according to the CDC. Most tests are done on women through routine screenings for cervical cancer.

“Women should have regular visits with their gynecologist and get regularly screened with pap smears,” Lau said.

  1. IT MIGHT INCREASE YOUR RISK FOR CANCER OR OTHER HEALTH ISSUES.

HPV is most commonly associated with a risk for certain cancers, including cervical cancer or oral cancers. Some forms of the virus can also cause genital warts. However, as the CDC points out, there’s no need to panic, either:
Cancer often takes years, even decades, to develop after a person gets HPV. The types of HPV that can cause genital warts are not the same as the types of HPV that can cause cancers.
Regular check-ins with your doctor can help monitor your health so you stay on top of any potential issues, Lau said.

  1. HPV DOESN’T NECESSARILY STAY WITH YOU FOREVER.

“Patients commonly assume that HPV is a lifelong infection that will stay with them always,” Lau said. “But most HPV infections in most people can be cleared by the immune system within one to two years.”

That doesn’t necessarily give you a free pass to ignore it, though. Lau stresses that it’s important to monitor your heath with your physician.

“If you have been diagnosed, it’s important to follow up with your doctor to make sure it clears,” she said.

  1. THERE ARE HUNDREDS OF STRAINS OF THE VIRUS.

There are high-risk strains and low-risk strains of HPV. Two high-risk types, HPV 16 and 18, are most commonly associated with precancerous or cancerous cell growth.

“HPV is not just one virus, but a group of over 200 related viruses. Each virus is labeled with a number to distinguish it from the others, and different viruses can target different areas of the body and can cause different possible diseases in humans,” Lau said. “Some cause skin problems like warts and others can lead to cancers.”

The HPV vaccine targets those high-risk strains, along with the strains that cause 90 percent of genital warts.

  1. THE VACCINE CAN PROTECT YOU.

Lau says everyone who plans on being sexually active should be vaccinated. Doctors typically instruct preteens get the vaccine, but if that doesn’t happen, it’s OK: Lau says the vaccine can be recommended for women up through age 26 and men up through age 21.

“The HPV vaccine is indicated for people who haven’t had sex yet, because it protects them against the viruses they haven’t been exposed to yet. However, the vaccine may still be helpful in people who have been sexually active,” she added.

  1. IT’S NOTHING TO FEEL ASHAMED ABOUT.

Bottom line: There’s no reason to buy into any stigma surrounding HPV ― or any sexual health issue, for that matter. The best thing you can do is stay proactive and smart about your well-being.

“HPV is something to be aware of and to be informed about,” Lau said. That’s it.

November, 2017|Oral Cancer News|