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Why oral cancer threatens men

Source: www.scientificamerican.com
Author: Claudia Wallis, Scientific American November 2018 Issue

Back in 2006, when the vaccine for human papillomavirus (HPV) was introduced, I rushed to get my teenage daughters immunized. Here, amazingly, was a vaccine that could actually prevent cancer. By blocking HPV infection, it protects girls from the leading cause of cervical malignancies. I didn’t give much thought to my son, and neither did the medical establishment. It wasn’t until 2011 that health authorities recommended the vaccine for boys.

In hindsight, that delay was a mistake, though perfectly understandable: the vaccine was developed with cervical cancer in mind and initially tested only in girls. Today, however, we see a rising tide of cancers in the back of the throat caused by HPV, especially in men, who are three to five times more vulnerable than women. This surge of oropharyngeal cancers, occurring in many developed nations, took doctors by surprise. Oral cancers were expected to decline as a result of the drop in smoking that began in the 1960s.

Smoking-related oropharyngeal cancers are, in fact, down. But making up the difference, particularly in men, are those related to HPV, which have more than doubled over the past two decades. With cervical cancer waning (thanks to screening and prevention), this oral disease is now the leading HPV-related cancer in the U.S. Nearly 19,000 cases were reported in 2015, according to a recent report by the Centers for Disease Control and Prevention. Roughly nine out of 10 involve a nasty strain called HPV-16.

Researchers link the rise of these cancers to changing sexual practices, perhaps dating back to the 1970s. “People have more partners than they had in the past, and they initiate oral sex at an earlier age than previous generations did,” says Gypsyamber D’Souza, associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. Greater exposure to oral sex means that the nearly ubiquitous virus gets transferred from the genitals to the mouth.

Studies suggest that most women develop protective antibodies to HPV after having a few sexual partners, but for men, it may take more than 10 partners. A likely reason for the difference, says oncologist Maura Gillison of the University of Texas MD Anderson Cancer Center, is that “in women, the infection is vaginal-mucosal; in men, it’s entirely on the skin,” where it is much less likely to trigger an antibody response. Males can get an active infection again and again, and it lingers longer than in women, making them the “Typhoid Marys of HPV,” as Gillison puts it. The path from infection to cancer may take decades and is not well understood.

Fortunately, the HPV vaccine should prevent these oral cancers, just as it protects against cervical cancer (as well as virus-related cancers of the vulva, labia, penis and anus). After lagging for years, U.S. rates of vaccination of boys are catching up with that of girls. New CDC data show that in 2017, 68.6 percent of girls and 62.6 percent of boys, ages 13 to 17, had received at least one dose of the vaccine—up from 65.1 and 56 percent, respectively, in 2016. If the trend continues, HPV-related cancers will ultimately become a scourge of the past in the U.S.

The tough question is what to do in the meantime for the large number of people, especially at-risk men, who have never been immunized. The CDC recommends the vaccine for children as young as nine and up to age 21 for boys and 26 for girls. Merck, which makes the only HPV vaccine now used in the U.S., is seeking approval to make it available up to age 45, but the $130-a-dose vaccine is less cost-effective in older populations. “It’s best given before people are sexually active,” explains Lauri Markowitz, team lead and associate director of science for HPV at the CDC. “The vaccine is not therapeutic; it’s prophylactic.” A vaccine advisory committee meeting this fall will weigh whether to revise current recommendations. One possibility, she says, is raising the upper age for boys to 26, matching that for girls.

D’Souza, Gillison and others are investigating ways to identify and screen people who may be at an especially high risk for oral HPV cancers—a significant challenge. There is no Pap-smear equivalent for this devastating disease, no reliable way to spot precancerous or early-stage lesions. And research by and her colleague Carole Fakhry shows that even if you focus on a high-risk group such as men in their 50s—8 percent of whom are infected with one of the noxious HPV strains—only 0.7 percent will go on to develop the cancer. There’s little point in terrifying people about the small odds of a bad cancer, D’Souza says, so “we’re working on understanding which tests would be useful.”

October, 2018|Oral Cancer News|

As HPV-related cancer rates climb, experts scrutinize barriers to HPV vaccination

Source: www.cancertherapyadvisor.com
Author: Bryant Furlow

Oropharyngeal squamous cell carcinomas (SCCs) are now the most commonly diagnosed human papillomavirus (HPV)-associated cancers in the United States, with 15,479 men and 3438 women diagnosed in 2015, according to an analysis by the Centers for Disease Control and Prevention (CDC).1

Between 1999 and 2015, cervical cancer and vaginal squamous cell carcinoma (SCC) rates declined, by 1.6% and 0.6% per year, respectively. But rates for vulvar SCC increased by 1.3% annually during the same period. Anal SCC rates also climbed by approximately 2% a year among men and 3% among women.1

Rates of oropharyngeal SCC — cancers of the throat and tongue — climbed as well, particularly among men (2.7% a year vs 0.8% in women).

All told, more than 43,000 Americans were newly diagnosed with HPV-related cancers in 2015, the analysis showed, up from 30,115 in 1999.1 Most people diagnosed with HPV-associated malignancies are older than 49 years.1 Most women diagnosed with cervical cancer are older than 30 years.1

“We don’t actually know what caused the increase in HPV infections but we know now that we have a safe and effective vaccine that can prevent infections,” said Lois Ramondetta, MD, professor of gynecologic oncology and reproductive medicine at the University of Texas MD Anderson Cancer Center, Houston.

“We’re seeing people who were infected decades ago developing these cancers,” Dr Ramondetta said. “We’ll see rates continue to rise over the coming years because the vaccine wasn’t available before 2006.”

HPV vaccination rates are improving, Dr Ramondetta noted.

Overall, approximately half of adolescents in the United States have completed the HPV vaccine dose-series — well shy of the 2020 herd immunity goal of 80%.

“That’s the overall up-to-date vaccination rates for adolescents aged 13 to 17,” Dr Ramondetta explained. “That’s definitely not where we want it to go but it is 5% higher than last year. If you look at the one-completed-dose vaccine initiation rate, that’s 65.5%.”

HPV vaccination rates are improving more rapidly among boys than girls.

“For some reason, safety is not as big a concern for boys and their parents,” Dr Ramondetta said. “It shouldn’t be a concern at all. This vaccine has been studied more than just about any other vaccine. But if you ask parents why girls are not vaccinating, safety seems to be a concern for some.”

There appears to be less stigma among parents about sons becoming sexually active than there is about the sexual activity of daughters, said Debbie Saslow, PhD, senior director of HPV-related and women’s cancers at the American Cancer Society in Atlanta, Georgia.

Vaccination rates vary geographically, both between countries and within the US. Only a handful of states require that public school students receive the HPV vaccine. Vast expanses of the rural US have few or no pediatricians and limited access to the vaccine.

Australia introduced HPV vaccines at the same time as the US, nearly a decade ago, but Australia achieved 80% vaccination rates in just a year, Dr Saslow said. That was largely because the Australian government paid for the vaccines and they were administered in schools. As a result, this year, Australia changed cervical cancer screening recommendations to reflect the reduced risk: at age 25, women start undergoing HPV testing (rather than pap tests) every 5 years.

That will eventually happen in the US as well, Dr Saslow predicted.

“It’s going to happen but the question is when,” she said. “What will happen is we’ll start screening later, at age 25 and maybe eventually 30, and screening will get away from Pap testing, because Pap tests are not as effective in vaccinated people: they’ll detect a bunch of cervical changes unrelated to cancer. It will all be false positives. We’ll need to go to strictly HPV-based testing” or potentially some new type of screening test, according to Dr Saslow.

In the US, there appear to be socioeconomic or class barriers at play regarding HPV vaccination. Completion rates tend to be higher among more affluent groups, meaning that those who get the first vaccine are more likely to complete the series.

But there’s also a “reverse disparity” in initiating HPV vaccination at all Dr Saslow noted. “Poor and minority kids have higher rates of [the] first dose. Providers might be doing their own risk-based recommendations to parents, which they should not be doing, saying these kids are at higher risk.”

In high-socioeconomic-status urban and suburban communities, vaccine hesitance and prevalent “anti-vax” conspiracy theories may be barriers to vaccination. In rural areas, religious conservativism about sex and sexually transmitted disease — as well as the political climate — are likely factors, Dr Ramondetta added. Rates of HPV vaccination are worse than those for, say, polio or measles, suggesting that hesitance is related to the sexual nature of HPV transmission.

“There’s still a stigma about HPV infection, which is crazy, since most people are exposed,” said Dr Ramondetta. “Normalizing HPV is important — it’s just an aspect of the human condition, like flu.”

“There is ample evidence of the efficacy, safety and durability of this vaccine,” Dr Ramondetta said. “We need to find new ways to educate the public. We can talk to one another all we want in journals but meanwhile, social media is filled with [misinformation] … We need to take a larger role in social media, flooding it with accurate information.”

“Most parents just need reassurance,” she added. “Their motivation is to keep their kids safe.”

Doctors should recommend HPV vaccination every time they see adolescent patients and their parents, Dr Saslow emphasized. And, oncologists need to reach out to family physicians and pediatricians, she said.

References
1. Van Dyne EA, Henley SJ, Saraiya M, Thomas CC, Markowitz LE, Benard VB. Trends in human papillomavirus-associated cancers — United States, 1999-2015. MMWR Morb Mortal Wkly Rep. 2018;67(33);918–924.

October, 2018|Oral Cancer News|

Adam Kay picks the best books about living with cancer

Source: www.theguardian.com
Author: Adam Kay

As Orson Welles so cheerily put it, we are born alone, we live alone and we die alone. But none of us has to struggle through cancer alone, thanks to a vast pool of literature, non-fiction and poetry that tackles the subject.

In C: Because Cowards Get Cancer Too, columnist and self-confessed hypochondriac John Diamond writes with almost unbearable honesty about his fears as he is diagnosed with throat cancer. As he puts it, this is his “attempt to write the book I was looking for the night I got the bad news”, and it explains “what it’s like to be a person with cancer, to deal with the pain and the fear and the anger”. While his feelings vacillate between hope and despair, his dark humour sings through. Taking the reader on a gripping and emotional journey, this account captures the unpalatable but essential truth that not all those living with cancer are “bravely battling” – some are just plain scared. Diamond is one of a handful of writers who can make me snort out loud in public through the magic of their words, and is much missed.

The true story beautifully told by Rebecca Skloot in The Immortal Life of Henrietta Lacks is astonishing. Henrietta was a penniless black tobacco farmer who died in 1951, but whose cervical cells changed the shape of medicine. Taken without permission, cells from her tumour have since been multiplied and shared around the world to advance our understanding of cancer. Skloot’s book was inspired by a science lesson in which her teacher told the class that if they went to almost any cell culture lab in the world and opened its freezers, they might find billions of Henrietta’s cells in small vials on ice. The biography examines how those cells enabled scientists to make advances in fields ranging from cancer and gene mapping to IVF. Skloot confronts issues of racism, poverty, consent and the anguish of Henrietta’s family.

Clive James wrote in this paper about living with late-stage cancer in his weekly column, Reports of My Death. One of his latest (and, he assumed, last) books of poetry, Sentenced to Life, and its surprise sequel, Injury Time, are filled with verses that address the feeling of wanting to live life to its fullest while waiting for death to knock. “Now, not just old, but ill, with much amiss / I see things with a whole new emphasis,” he reflects. In these volumes, he describes his sense of loss, and guilt at leaving behind the people he loves, and draws on his trademark humour.

There are many cancer blogs out there, but to my mind one of the best was The C Word, subsequently turned into a book and a TV series starring Sheridan Smith. Lisa Lynch has a gloriously witty turn of phrase in dealing with the emotional ups and downs of living with breast cancer – or, as she put it, The Bullshit. Made all the more poignant as she died after the book was published, it is no-nonsense, funny, moving and entirely devoid of self-pity.

If we trust the Pulitzer prize panel about this kind of thing, and I suspect we should, then read The Emperor of All Maladies by oncologist Siddhartha Mukherjee. It is an in-depth, but clear and at times poetic depiction of the “lethal, shape-shifting entity” – its past, present and putative future.

October, 2018|Oral Cancer News|

Oral treatment may not be far off for head and neck cancer patients

Source: app.secure.griffith.edu.au
Author: staff, Griffith University

A highly promising approach to treating HPV-driven head and neck cancer is on the way, and it could be in the shape of a simple oral medication. This is according to new breakthrough research led by Griffith University, which has conducted trials showing that the drug, Alisertib, tested in trials to treat other cancers such as lung and kidney, can also successfully destroy the cancer cells associated with head and neck cancer.

Human Papilloma Virus (HPV) is the main culprit in head, neck and oral cancers. The virus is thought to be the most common sexually transmitted infection (STI) in the world, and most people are infected with HPV at some time in their lives.

The latest trials – which have taken place over the past three years at Griffith’s Gold Coast campus – have shown a particular enzyme inhibitor in the drug, has the ability to prevent proliferation of HPV cancer cells in advanced head and neck cancers.

A 100 per cent success rate
Led by Professor Nigel McMillan, program director from Griffith’s Menzies Health Institute Queensland, the trials have shown a 100 per cent success rate in the drug eradicating the cancerous tumours in animals.

“Head and neck cancers can unfortunately be very difficult to treat, just by the very nature of where they are located in and around the throat, tongue and mouth,” says Professor McMillan.

“This part of the body contains some delicate areas such as the vocal chords and areas relating to speech, taste, smell, saliva etc, therefore there can be some significant side effects with the current treatment options.

“Quality of life is a major consideration in this patient group and therefore a simple oral treatment regimen will have massive benefit over other treatments in terms of reducing some quite drastic side effects.”

In Australia, there are over 5000 new cases of head and neck cancer each year. First line treatments include radiation and surgery (increasingly of the robotic type), followed by chemotherapy, however survival rates of around 70 per cent have remained unchanged for the past 35 years.

Half of all head and neck cancers are known to be caused by the HPV virus, with four times as many men (784) as women (250) estimated to have already died from the disease in Australia during 2018.

In the United States, there are now more cases of head and neck cancer than there are cervical cancer, a disease which is now set to become much more rare in Australia due to the introduction a decade ago of the world-leading national (HPV) vaccination program for schoolchildren.

Professor McMillan says the next step in the research is for the drug to be extended to human trials at the Gold Coast with patients for whom other treatments have so far proved unsuccessful.

October, 2018|Oral Cancer News|

New risk factor for mouth cancer uncovered

Source: www.medicalnewstoday.com
Author: Tim Newman, fact checked by Paula Field

In some regions, mouth cancer incidence has risen. A recent study investigates a new risk factor for mouth cancer. In certain parts of the world, over the past couple of decades, mouth cancer rates have soared. For instance, in the United Kingdom, rates of mouth cancer have increased by 68 percent. They rose from eight cases per 100,0000 in 1992–1995 to 13 cases per 100,000 in 2012–2014.

In the United States, mouth cancer and mortality rates have declined overall. However, when examined at a state level, the data reveal a more complex picture. For instance, mouth cancer deaths have risen significantly in Nevada, North Carolina, Iowa, Ohio, Maine, Idaho, North Dakota, and Wyoming.

Some known risk factors for mouth cancer include smoking tobacco, drinking alcohol, human papillomavirus (HPV), and chewing betel quid, which is a mix of natural ingredients wrapped in a betel leaf that is popular in some parts of Southeast Asia.

In India, mouth cancers are the most common cause of cancer-related deaths in men aged 30–69 years old. Scientists think that chewing betel quid could be responsible for many of these deaths.

New risk factor for mouth cancer
Although scientists have confirmed some risk factors, there is still much to learn about how and why mouth cancer affects certain individuals and not others. Recently, scientists set out to investigate another potential risk factor: air pollution.

The researchers, funded by the Ministry of Science and Technology in Taiwan, published their findings this week in the Journal of Investigative Medicine.

In particular, the team focused on the impact of fine particulate matter, also known as PM2.5. These are particles of liquid or solid matter that measure 2.5 micrometers in diameter or under. Scientists already knew that PM2.5 has a negative impact on cardiovascular and respiratory health, but they wanted to find out whether exposure to higher levels of PM2.5 might also increase mouth cancer risk.

To investigate, they collated information from 482,659 men aged 40 years old or above. All participants had attended health services and given information about smoking and chewing betel quid.

The scientists next gathered data from 66 air quality-monitoring stations across Taiwan. By referring to the participants’ health records, the scientists could estimate each person’s exposure to PM2.5.

Risk increased by 43 percent
The researchers collected the data in 2012–2013. During this time, 1,617 men developed mouth cancer. As expected, both tobacco smoking and chewing betel quid increased mouth cancer risk. After taking a range of influencing factors into account, the scientists demonstrated that exposure to PM2.5 also increased mouth cancer risk.

The scientists compared PM2.5 levels of below 26.74 micrograms per cubic meter (ug/m3) with those above 40.37 ug/m3. They associated the higher levels of PM2.5 with a 43 percent increase in the risk of developing mouth cancer. According to the authors:

“This study, with a large sample size, is the first to associate mouth cancer with PM2.5. […] These findings add to the growing evidence on the adverse effects of PM2.5 on human health.”

Alongside PM2.5’s relationship with mouth cancer, the authors identified a correlation between higher levels of ozone and an increased risk of developing the disease.

The next challenge will be to understand how particulate matter might cause mouth cancer. Although this will require more detailed studies, some theorize that carcinogenic compounds found in PM2.5, including polycyclic aromatic hydrocarbons and heavy metals, might be part of the answer.

Because these particles have such a small diameter, the body absorbs them relatively easily, potentially causing damage as they travel through the body.

However, the authors also remind us to be cautious — this is an observational study, so it cannot definitively prove that pollution causes mouth cancer. Also, it is not clear exactly how much PM2.5 enters the mouth.

This interaction needs further investigation, but the large size of the current study makes their conclusions worthy of follow-up.

October, 2018|Oral Cancer News|

HPV vaccine expanded for people ages 27 to 45

Source: www.nytimes.com
Authors: Denise Grady and Jan Hoffman

About 14 million women and men become infected with the human papillomavirus each year in the United States, according to the Centers for Disease Control and Prevention. CreditCreditKeith Bedford/The Boston Globe, via Getty Images

The HPV vaccine, which prevents cervical cancer and other malignancies, is now approved for men and women from 27 to 45-years-old, the Food and Drug Administration said on Friday.

The vaccine is Gardasil 9, made by Merck, and had been previously approved for minors and people up to age 26.

It works against the human papillomavirus, HPV, which can also cause genital warts and cancers of the vulva, anus, penis and parts of the throat. The virus has many strains. It is sexually transmitted, and most adults encounter at least one strain at some point in their lives. The vaccine protects against nine strains, including those most likely to cause cancers and genital warts.

“Today’s approval represents an important opportunity to help prevent HPV-related diseases and cancers in a broader age range,” Dr. Peter Marks, director of the F.D.A.’s Center for Biologics Evaluation and Research, said in a statement.

The approval was based on a study in women ages 27 to 45, showing that an earlier version of the vaccine was highly effective in preventing persistent HPV infection, genital warts, vulvar and vaginal precancers, cervical precancers and cervical cancers related to the virus types covered by the vaccine.

The vaccine’s effectiveness in men ages 27 to 45 is inferred from the data in women, from its efficacy in younger men and from evidence that it created immunity in a study of men 27 to 45-years-old.

The most common side effects of the vaccine include soreness at the injection site, swelling, redness and headaches.

If a person has already been exposed to a particular strain of HPV, the vaccine will not work against that strain. For that reason, vaccination has been strongly recommended for young people before they become sexually active.

But even someone who has already been exposed to a few strains — but not to all nine in the vaccine — can still gain protection against the strains they have not encountered.

“This is great,” Dr. Lois M. Ramondetta, a professor of gynecologic oncology at MD Anderson Cancer Center in Houston, said in an interview. “It’s a prevention vaccine. The best time to get it is before you turn 13 and have any intimate activity at all. But, that said, it protects against nine types of HPV, so if you have one of the types, you still can be protected from other HPV types.”

She added: “There is a whole generation of people we were missing who didn’t know about it. Doctors weren’t good at talking about it.”

She and Dr. William Schaffner, an infectious disease expert at Vanderbilt University, said people over 26 began asking doctors about the vaccine. Some were leaving marriages or monogamous relationships, expected to begin dating and realized they might be exposed to the virus.

“They want to feel protected to some extent,” Dr. Ramondetta said. “Now they have the opportunity.”

Younger people need two shots, but the older ones will need three, spaced a few months apart.

Dr. Ramondetta noted that tumors affecting part of the throat — called oropharyngeal cancers — caused by HPV are rising, particularly in men. The vaccine is believed to help prevent them.

Dr. Schaffner said a panel that advises the Centers for Disease Control and Prevention has already been discussing the data on using the vaccine in older people, and is expected to make a recommendation about it. The recommendation could be universal, meaning that everyone in that age range should receive it, or it could be “permissive,” meaning that the decision is up to doctors and patients.

Once that group, the Advisory Committee on Immunization Practices, recommends a vaccine, insurers generally cover it.

October, 2018|Oral Cancer News|

HPV16 vaccine yields added benefit in recurrent throat cancer

Source: www.medpagetoday.com
Author: Ian Ingram, Deputy Managing Editor, MedPage Today

Adding a tumor-specific vaccine to PD-1 checkpoint inhibition was safe and effective in HPV16-positive patients with recurrent or metastatic oropharyngeal cancer, a small phase II trial found.

Among 24 patients treated with nivolumab (Opdivo) and the ISA101 long peptide vaccine, 22 of whom had oropharyngeal cancer, 33% responded and median overall survival was 17.5 months, Cornelis Melief, PhD, of ISA Pharmaceuticals in the Netherlands, reported here at the 4th annual Cancer Immunotherapy Conference.

All eight of the responders had oropharyngeal cancer (36%), with two complete and six partial responses. The median duration of response among these patients was 10.3 months, and responses were seen in both platin- and cetuximab-refractory patients, and those refractory to both.

Melief noted that one of the partial responders had total clearance of the primary tumor, but a solitary lung metastasis remained, but was stable at 2.5 years.

Rate of overall survival at 6 and 12 months was 75% and 70%, respectively. The combination was well tolerated and safe, said Melief, with no increase in the rate of serious adverse events. A randomized trial is planned to confirm the findings.

“The results of our trial are among the first clinical data to support the general concept of combining cancer vaccination with immune checkpoint blockade to enhance efficacy of vaccine-activated T cells in the immunosuppressive tumor environment,” Melief’s group wrote in JAMA Oncology, where the findings were also published.

The findings compare favorably to outcomes in a larger group of p16-positive patients in CheckMate 141, which tested nivolumab in recurrent or metastatic, chemotherapy-refractory squamous cell head and neck cancer, and led to FDA approval in that setting.

Overall response among the 63 p16-positive patients in that trial was 15.9%, and median overall survival was 9.1 months.

Median progression-free survival (PFS) in the current study was just 2.7 months, similar to that in CheckMate 141: 2.0 months in nivolumab-treated patients, which was no different from the PFS with standard therapy at 2.3 months (HR 0.89, 95% CI 0.70-1.13, P=0.32).

“These findings are nearly double the response rate and median overall survival reported in the CheckMate 141, KEYNOTE-012, and KEYNOTE-055 trials,” said Theodoros Teknos, MD, of Seidman Cancer Center in Cleveland, calling the study an important incremental discovery in the burgeoning field of immunotherapy for head and neck cancer.

In KEYNOTE-012, the rate of overall response rate was 12% in a similar patient group (survival was not reported). In KEYNOTE-055, the rates were 20% and 8 months, respectively.

“Based on the findings reported in this study, additional investigation in the form of a larger randomized clinical trial evaluating the contribution of HPV16 vaccination to PD-L1 inhibition is warranted,” he told MedPage Today. “Nested in this trial, it would be advisable to perform robust analysis of immunologic subsets and cytokine profiling to identify biomarkers of response to this treatment approach.”

Teknos, who was not involved in the study, noted that the subgroup analysis again calls into question the use of PD-L1 as a biomarker. While 43% of the PD-L1 ≥1% group were responders, 18% of the PD-L1 < 1% group were as well.

Melief also presented data on the ISA101 vaccine in 62 late-stage HPV-positive cervical cancer patients treated with the ISA101 vaccine in combination with chemotherapy and highlighted the survival difference among those with a vaccine-induced T-cell response. Median overall survival was 22.7 months in those that had an HPV-specific response above the median versus 12.9 months for those with a response below the median (HR 0.286, 95% CI 0.149-0.551, P=0.0066).

He noted that this was not due just to immunocompetence differences between patients, as the effect was found to be independent of patients’ immune status.

The current study enrolled 24 patients from 2015 to 2016 — 20 men and four women. Outside of the oropharyngeal cancer patients, there was one patient with anal and cervical cancers each. Patients received three 100 μg doses of the subcutaneous ISA101 vaccine (days 1, 22, and 50). Starting on day 8, intravenous nivolumab was given every 2 weeks for a year or until disease progression or unacceptable toxicity.

Toxicities were of the expected variety: fever and injection site reactions with ISA101, and diarrhea, fatigue, and hepatoxicity with nivolumab. Two patients had grade 3 and 4 adverse events that led to discontinuation of nivolumab (an asymptomatic transaminase level elevation and a lipase elevation, respectively).

October, 2018|Oral Cancer News|

Oral sex and ‘deep kissing’ linked to increase in HPV-positive head and neck cancer

Source: www.sbs.com.au
Author: Amelia Dunn

Jake Simpson was 22 when he started to get painful toothaches. Trips back and forth to the dentist couldn’t seem to fix the growing lump at the back of his mouth It came as a total surprise to Jake, his partner Carly, and their newborn son Noah, when oncologists in Brisbane told him he had stage four head and neck cancer, and would need to start treatment immediately.

“We didn’t know what any of it meant. He was so young and healthy, we couldn’t believe it,” Carly said.

Despite rigorous treatment and surgery that removed more than two-thirds of his tongue, Jake’s cancer was too aggressive and spread to his lungs. He died within eight months of his diagnosis.

These cancers, known as oropharyngeal cancers in the back of the tongue and tonsils, are on the rise in young men, and are caused by the sexually transmitted disease HPV – human papillomavirus. While doctors believe it is most commonly passed on through oral sex, some argue it’s now as easy as ‘deep kissing’.

“Jake wasn’t tested for HPV because it was too aggressive from the day one, but that age bracket that he fell in, more than likely, the cause was HPV,” Carly said.

HPV has been dubbed the ‘common cold’ of STDs. Over 80 per cent of Australian adults will get HPV at one point in their lives, and most will clear it without even knowing.

But two particular strains, P16 and P18 are closely linked with cancer, not just in the cervix like widely known, but increasingly in the head and neck.

Two strains of HPV, P16 and P18 are closely linked with cancer, not just in the cervix like widely known, but increasingly in the head and neck.
Source: The Feed

Researchers across the US, UK and Australia say changing sexual practices over the last 50 years, and an increase in sexual partners has prompted the rising incidence rate of this cancer.

Oncologist Brett Hughes has witnessed the significant shift in the patient demographic, who says nearly 80 per cent of his patients now have HPV positive cancers.

“We now see an age group of people who generally live very healthy lifestyles; that don’t necessarily have to have drunk or smoke and the other risk factors that we’d normally associate with cancers in the mouth or throat.”

The cancer is also eight times more likely to present in men. Dr Hughes said oropharyngeal cancers are now the most common HPV related cancer in Australia, trumping cervical cancer, and are continuing to rise.

“It’s predicted for Australia and it may even be as late as in the 2030s that we might see the peak incidence which is a little bit scary considering how common this cancer is becoming.”

While this cancer is increasing, many take comfort in Australia’s strong vaccination program to fight HPV related cancers.

The Gardasil vaccine, developed by Australian of the year Professor Ian Frazer, was first administered to Australian girls in 2007, and then to boys in 2013 after it became clear HPV was affecting them as well. But Professor Frazer said people need to be given the vaccine before they’re sexually active.

“All the vaccines that we currently use are vaccines to prevent infection. A vaccine to cure an infection is a different beast all together,” he said.

Without a therapeutic vaccine, sexually active adults who missed out on the vaccine at school are still at risk of contracting persisting HPV, with Prof Frazer insisting “the big challenge now is to get something for oropharyngeal cancer.”

Right now, there is no vaccine for adults and no way of testing or preventing HPV positive oropharyngeal cancers. But there are people out there trying to change that.

After Jake Simpson passed away in 2016, he donated $20,000 for research into early intervention for these cancers.

His family chose a saliva research program currently underway at the Institute of Health and Biomedical Innovation in Brisbane lead by Professor Chamindie Punyadeera. The lab work is aimed at creating a simple and easy test everyone can do to monitor their HPV status at the dentist or GP.

“What we want to do is early intervention and detection,” she said.

“If you detect early, 80 per cent of patients survive. If you detect late, 20 per cent of them survive.”

But as the technology is still five years away from public use, and a therapeutic vaccine is perhaps even further away, Carly and Professor Punyadeera agree young people just need to be aware that this cancer exists, and is on the rise.

“Young boys think it’s a women’s cancer type. It’s not at all,” Prof Punyadeera said.

“It’s really sad and we all need to be aware of HPV associated head and neck cancers.”

October, 2018|Oral Cancer News|

Youth vaping has soared in 2018, new data show

Source: www.wsj.com
Authors: Betsy McKay and Jennifer Maloney

Number of high schoolers who used e-cigarettes in the past 30 days has risen some 75% in 2018

Teen use of e-cigarettes has soared this year, according to new research conducted in 2018 that suggest fast-changing youth habits will pose a challenge for public-health officials, schools and parents.

The number of high-school students who used e-cigarettes in the past 30 days has risen roughly 75% since last year, according to a person who has seen new preliminary federal data.

That would equate to about three million, or about 20% of high-school students, up from 1.73 million, or 11.7% of high-school students in the most recently published federal numbers from 2017.

Nearly a third of 13-to-18-year-olds who responded to a separate survey conducted by The Wall Street Journal with research firm Mercury Analytics said they currently vape.

The new numbers offer a rare look at evolving teen vaping habits. Sales of e-cigarettes are expected nearly to double this year over 2017, and researchers have wondered how much of that increase is because of teen use. But there can be a long lag time between the collection of data and public reports.

Most of the teens who vape said they are doing it for reasons other than to quit smoking, according to the Journal’s survey conducted in 49 states in May. More than half said they do it because they like the flavors that e-cigarette liquids come in and they think vaping is fun. More than two-thirds said they believe vaping can be part of a “healthy life.”

U.S. Food and Drug Commissioner Scott Gottlieb said last week that teen use “has reached an epidemic proportion.” He announced new measures to curb teen vaping and warned he is considering banning flavored products.

The preliminary federal numbers from 2018 are from the government’s latest National Youth Tobacco Survey, according to the person familiar with the data. The survey was conducted in the spring.

The number of high-school users of combustible, or traditional, cigarettes increased slightly from the 2017 survey, this person said.

Monitoring the Future, a long-running youth survey conducted by the University of Michigan, found in 2017 that 16.6% of 12th-graders and 13.1% of 10th-graders had vaped nicotine, marijuana or flavoring in the previous 30 days. Richard Miech, the survey’s principal investigator, said he believes there has been a “considerable jump” in adolescent vaping this year.

This year’s sales growth has been driven largely by the Juul, a slim device that resembles a flash drive and has become a status symbol among teens, who often vape sweet-flavored liquids like mango. Juul has a 72.8% dollar share of the estimated $2.5 billion market in channels measured by market-research firm Nielsen, according to a Wells Fargo analysis.

Health officials are concerned that the high levels of nicotine in some liquids can alter the chemistry of developing brains, making them more sensitive to addiction.

Juul Labs Inc. says its device is intended to help adult smokers quit. “We cannot be more emphatic on this point: No minor or non-nicotine user should ever try JUUL,” a spokeswoman said. “Our packaging includes a prominent nicotine label and clearly states for adult smokers.”

Parents and educators say they are trying to do more to combat vaping with children back to school. “There is a lot more that needs to be done because at this point there are so many thousands of kids who are addicted to nicotine,” said Meredith Berkman, a founder of Parents Against Vaping E-Cigarettes, which advocates for action to restrict e-cigarette access.

Trinity School in New York City, for example, plans this year to incorporate more material on e-cigarettes into its health-education program for students, said John Allman, head of school. “Parents are letting us know about this,” he said of teen use.

The Journal survey was conducted online with 1,722 participants initially, and most of the survey questions focused on 1,007 participants who said they either vape, used to vape, or know someone who vapes. Nearly three-quarters of the 1,007 participants were 17 or 18 years old; 62% were white, 21% were African-American and 18% were Hispanic. Rates of e-cigarette use are higher in older than younger teens.

A total of 501 participants said they vape: 153 regularly, and 348 occasionally. Their most common reasons for vaping were for the flavors, and because they think it’s cool. “I just enjoy the flavor and blowing really big clouds,” one participant wrote.

“It made me feel good the first time I tried it, and I got hooked,” wrote another.

When asked what they were inhaling, 71% said flavors, and 61% said nicotine.

More than two-thirds of the current vapers said they believe vaping can be part of a healthy life, though they believe there are some risks. More than half said their views of vaping had been influenced by posts on social media, an issue that has public-health experts concerned.

The percentage of respondents who said they vape is unusually high, and should be interpreted with caution, said David Abrams, a professor in the College of Global Public Health at New York University. “We can’t make too much of it,” he said, because the survey was conducted online, and the questions weren’t all asked the way they are asked on large academic or government surveys.

Measures taken by the FDA, Juul, schools and parents to limit underage access to vaping devices since this spring may also be having an effect, some experts say. “It’s possible that prevalence and use may decline over time,” said Jidong Huang, an associate professor of health management and policy at Georgia State University who studies e-cigarette use.

September, 2018|Oral Cancer News|

RJR Slapped with $6.5M verdict over musician’s mouth cancer

Source: blog.cvn.com
Author: Arlin Crisco

R.J. Reynolds was hit with a $6.5 million verdict Tuesday for the part jurors found the company played in the mouth cancer a Florida musician developed after years of smoking. Harewood v. R.J. Reynolds, 2007-CA-46331.

The award followed the Florida 11th Circuit Court jury’s conclusion that nicotine addiction and cigarettes caused the oral cancer doctors diagnosed Glenn Simmons with in 1995. Simmons, a bassist in bands throughout much of his life, began smoking as a teenager and smoked about a pack a day for decades. He died in 2003, at age 48, from complications related to cancer-related radiation therapy. Monday’s verdict found Reynolds liable on fraud and conspiracy claims related to a sweeping scheme to hide the dangers of cigarettes. However, while jurors awarded Simmons’ daughter, Hanifah Harewood $6.5 million in compensatory damages, they rejected a claim for punitives in the case.

The case is one of thousands of Florida’s Engle progeny lawsuits against the nation’s tobacco companies. They stem from a 2006 Florida Supreme Court decision decertifying Engle v. Liggett Group Inc., a class-action tobacco suit originally filed in 1994. Although the state’s supreme court ruled that Engle progeny cases must be tried individually, it found plaintiffs could rely on certain jury findings in the original case, including the determination that tobacco companies had placed a dangerous, addictive product on the market and had conspired to hide the dangers of smoking through much of the 20th century.

In order to be entitled to those findings, however, each Engle progeny plaintiff must prove the smoker at the heart of their case suffered from nicotine addiction that legally caused a specific smoking-related disease.

Key to the seven-day Simmons trial was the link between his smoking and his mouth cancer. During Monday’s closings, Reynolds’ attorney, King & Spalding’s Randall Bassett, argued the cancer’s location and Simmons’ relatively young age at diagnosis were inconsistent with smoking-related oral cancer. Bassett noted that defense expert Dr. Samir El-Mofty, an oral pathologist from Washington University, concluded Simmons’ cancer stemmed from an infection related to a tooth extraction. “Not a cancer caused by smoking, but a cancer caused by a virus that sometime along the way Mr. Simmons had been exposed to,” Bassett said.

But Harewood’s attorney, Koch, Parafinczuk, Wolf & Susen’s Austin Carr reminded jurors that Simmons’ treating physician, Dr. Francisco Civantos, a South Florida otolaryngologist, believed cigarettes caused Simmons’ cancer. “Dr. Civantos is the more credible, experienced, the more competent physician and surgeon,” Carr said during Monday’s closings. “He is the doctor that you should believe over [the defense] witness.”

September, 2018|Oral Cancer News|