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Why drinking wine causes very dry mouth, and how eating cheese helps prevent it

Source: www.medicaldaily.com
Author: Lizette Borreli

The real reason why wine and cheese are often paired together has to do with creating a more balanced mouth feel to prevent dry mouth.

Photo courtesy of Pexels, Public Domain

At a happy hour, a dinner event, or a winery, we’re likely to see wine and cheese together on the menu. This classic food pairing makes it less likely for us to get dry mouth when we drink wine, and science has found out why. The food combination pair of astringent wine with fatty cheese, opposing foods of sensory perception, help create a more balanced mouth feel.

In the video, “Why Does Wine Make Your Mouth Feel Dry?” MinuteEarth explains the temporarily leather-like feel in our mouth is linked to the tannins in wine. The over consumption of tannins, like having a few glasses of wine, causes the slippery proteins in our saliva, tongues and cheeks to stick together, which produces a rough feeling on the tongue. Luckily, the bonds between the tannins and proteins are temporary, meaning once the mouth creates new saliva, it will dilute the tannins and carry them away.

Instead of waiting for new saliva to develop, there are proteins in fatty foods that will bond with the tannins, rather than our mouth. In a 2012 study, published in the journal Cell, researchers suggest drinking wine and eating cheese together work as the mild astringent cuts fat. Astringents tend to have a strong effect each time the mouth is exposed to them, implying they react more strongly with the lubricating proteins in the mouth upon each exposure.

A separate study published in the Journal of Food Science found when four different types of cheeses were paired with four different wines, the cheese influenced the dominant taste of each wine. For example, when participants paired a dry white Sancerre with Epoisses cheese, they were more likely to detect citrus notes. Meanwhile, when a spicy red Bourgogne was paired with Roquefort, the astringency decreased because the the fat in the cheese coated the mouth, therefore, reducing the tannin-induced drying.

These findings simply suggest why wine and cheese pairings have come to exist. An excess of tannins leads to dry mouth, but pairing astringent foods with fatty foods, like cheese, can help offset this feeling. Our mouth will feel smooth and leather-free.

Moreover, this sensory method can help us better understand why our perception of food changes when it is paired with something else. Perhaps this is why sandwiches are paired with pickles; why green tea goes with sushi; and why oil goes with vinegar. These famous food pairings could be a direct result of cultures finding the most balanced pairings based on what the foods are made of.

Until then, we will gladly pair our wine and cheese together, in the name of food science.

Novel vaccine therapy can generate immune responses in patients with HPV-related head and neck cancer

Source: www.news-medical.net
Author: staff

A novel vaccine therapy can generate immune responses in patients with head and neck squamous cell carcinoma (HNSCCa), according to researchers at the Abramson Cancer Center of the University of Pennsylvania. The treatment specifically targets human papillomavirus (HPV), which is frequently associated with HNSCCa, to trigger the immune response. Researchers will present the results of their pilot study during the 2017 American Society of Clinical Oncology Annual Meeting in Chicago (Abstract #6073).

HNSCCa is a cancer that develops in the mucous membranes of the mouth, and throat. While smoking and tobacco use are known causes, the number of cases related to HPV infection – a sexually transmitted infection that is so common, the Centers for Disease Control says almost all sexually active adults will contract it at some point in their lifetimes – is on the rise. The CDC now estimates 70 percent of all throat cancers in the United States are HPV-related. Sixty percent are caused by the subtype known as HPV 16/18.

“This is the subtype we target with this new therapy, and we’re the only site in the country to demonstrate immune activation with this DNA based immunotherapeutic vaccine for HPV 16/18 associated head and neck cancer,” said the study’s lead author Charu Aggarwal, MD, MPH, an assistant professor of Hematology Oncology in the Perelman School of Medicine at the University of Pennsylvania.

The vaccine is delivered as an injection of antigens – which leads the immune system to start producing antibodies and activate immune cells. At the time of injection, physicians use a special device to deliver a pulse of electricity to the area, which stimulates the muscles and speeds the intake of the antigens. Aggarwal noted that this study represents a multidisciplinary approach involving the lab and the clinic.

“This is truly bench-to-bedside and shows the value of translational medicine within an academic medical center,” Aggarwal said.

Penn researchers treated 22 patients with the vaccine. All of the patients had already received therapy that was intended to be curative – either surgery or chemotherapy and radiation. When doctors followed up an average of 16 months later, 18 of those patients showed elevated T cell activity that was specific to HPV 16/18. All of the patients in the study are still alive, and none reported any serious side effects.

“The data show the therapy is targeted and specific, but also safe and well-tolerated,” Aggarwal said.

Because of the positive activity, Aggarwal says the next step is to try this therapy in patients with metastatic disease. A multi-site trial will open soon that combines the vaccine with PD-L1 inhibitors, which target a protein that weakens the body’s immune response by suppressing T-cell production.

More patients presenting with HPV-associated oral cancers in Lubbock, TX

Source: lubbockonline.com
Author: Ellysa Harris

Detecting oral cancers in patients in their 50s and 60s has never been uncommon. But local dentists and doctors say finding it in younger patient populations has become a new norm.

Oral cancers driven by Human Papillomavirus are now the fastest growing oral and oropharyngeal cancers, according to the Oral Cancer Foundation website. And local health officials say they’ve seen a few more cases than usual.

Dr. Joehassin Cordero, FACS, professor, chairman and program director ofTexas Tech’s Health Sciences Center Department of Otolaryngology-Head & Neck Surgery, said less people are smoking and that has contributed to the decrease in the number of cases of oral cancers in the past two decades.

“In that same period, we have seen an increase in the HPV oropharyngeal cancer,” he said. “And oropharyngeal cancer — what it means it’s affecting the base of your tongue and tonsils.”

Dr. Brian Herring, a Lubbock dentist, chalks the increase up to increased awareness.

“I’m assuming probably for years and years and years it has affected the mouth but we didn’t know that,” he said. “As we get better at cellular diagnostics and molecular diagnostics, things like that, we’re finding that there is a large portion of cancers that do have an HPV component.”

What’s more alarming, said Dr. Ryan Higley, oral surgeon with West Texas Oral Facial Surgery, is it’s being diagnosed in younger people.

Higley said oral cancers are generally diagnosed between the ages of 55 and 65, mostly in women.

“With HPV-associated cancers, we see those four to 10 years before that,” he said. “It’s a younger patient population.”

Cordero said the oral cancers are often caused by exposure to HPV from years before.It starts with exposure to the HPV infection. One in four people in the United States are currently infected, according to the Centers for Disease Control and Prevention website.

“It’s truly considered a sexually transmitted disease,” Cordero said. “It has to do with not so much kissing, but oral sex.”

It’s passed on when somebody with an active lesion engages in sexual activities with another person, he said.

Nine out of 10 infections will disappear on their own, according to the CDC, but infections that linger for longer than about two years can lead to cancer.

“That doesn’t mean they’ll have cancer next week,” Cordero said.

Researchers are still trying to figure out why and how long after HPV exposure it takes for cancer to develop, he said.

“We don’t know the true mechanism because most of these people were not exposed a year ago,” he said. “They were not exposed six months ago. They were exposed a long time before that.”

When it does present, he said, there generally aren’t any noticeable symptoms.Because of that, it’s often diagnosed in later stages, Herring said.

“What we’re finding is because the demographic is changing, they’re not getting diagnosed as early because they’re not expecting to have this problem,” he said.

Screenings for oral HPV exist.

“The gold standard examination is your typical dental exam,” Herring said. If your dentist detects something unusual that might need further examination, he or she will make a referral to an oral surgeon.

Higley said oral HPV cancer presents as a lesion that looks like a kanker that won’t heal.

“However, cancerous lesions can have multiple presentations so that’s not exclusive,” he said. “So oftentimes, we’ll have a patient present with a hard nodule underneath their jaw line or in their neck. Sometimes they’ll just have red or white lesions within the mouth, hoarseness in their voice or difficulty swallowing. All those are things that need to be checked.”

The cancer seems to be more treatable, he said, but it’s hard to pinpoint why.

“We really don’t know if they’re more responsive to treatment because we’re treating a little bit younger patient population who is overall more healthy or if it’s inherant in the tumor itself,” Higley said.

Cordero said he hopes the HPV vaccine, which is recommended for both girls and boys 11 or 12 years old and people up to 26 years old, provides a measure of protection against the infection.

“We’re hoping in the next 10 to 20 years that head and neck cancer caused by HPV will be completely gone,” he said.

Symptoms of throat cancer depend on which throat structures are affected

Source: tribunecontentagency.com
Author: Eric Moore, M.D.

Dear Mayo Clinic: Are there early signs of throat cancer, or is it typically not found until its late stages? How is it treated?

Answer: The throat includes several important structures that are relied on every minute of the day and night to breathe, swallow and speak. Unfortunately, cancer can involve any, and sometimes all, of these structures. The symptoms of cancer, how early these symptoms are recognized and how the cancer is treated depend on which structures are involved.

All of the passageway between your tongue and your esophagus can be considered the throat. It includes three main areas. The first is the base of your tongue and tonsils. These, along with the soft palate and upper side walls of the pharynx, are called the oropharynx. Second is the voice box, or larynx. It consists of the epiglottis — a cartilage flap that helps to close your windpipe, or trachea, when you swallow — and the vocal cords. Third is the hypopharynx. That includes the bottom sidewalls and the back of the throat before the opening of the esophagus.

Tumors that occur in these three areas have different symptoms, behave differently and often are treated differently. That’s why the areas of the throat are subdivided into separate sections by the head and neck surgeons who diagnose and treat them.

For example, in the oropharynx, most tumors are squamous cell carcinoma. Most are caused by HPV, although smoking and alcohol can play a role in causing some of these tumors. Cancer that occurs in this area, particularly when caused by HPV, grows slowly usually over a number of months. It often does not cause pain, interfere with swallowing or speaking, or have many other symptoms.

Most people discover cancer in the oropharynx when they notice a mass in their neck that’s a result of the cancer spreading to a lymph node. Eighty percent of people with cancer that affects the tonsils and base of tongue are not diagnosed until the cancer moves into the lymph nodes.

This type of cancer responds well to therapy, however, and is highly treatable even in an advanced stage. At Mayo Clinic, most tonsil and base of tongue cancers are treated by removing the cancer and affected lymph nodes with robotic surgery, followed by radiation therapy. This treatment attains excellent outcomes without sacrificing a person’s ability to swallow.

When cancer affects the voice box, it often affects speech. People usually notice hoarseness in their voice soon after the cancer starts. Because of that, many cases of this cancer are detected at an early stage. People with hoarseness that lasts for six weeks should get an exam by an otolaryngologist who specializes in head and neck cancer treatment, as early treatment of voice box cancer is much more effective than treatment in the later stages.

Early voice box cancer is treated with surgery — often laser surgery — or radiation therapy. Both are highly effective. If left untreated, voice box cancer can grow and destroy more of the larynx. At that point, treatment usually includes major surgery, along with radiation and chemotherapy — often at great cost to speech and swallowing function.

Finally, cancer of the hypopharynx usually involves symptoms such as pain when swallowing and difficulty swallowing solid food. It is most common in people with a long history of tobacco smoking and daily alcohol consumption. This cancer almost always presents in an advanced stage. Treatment is usually a combination of surgery, chemotherapy and radiation therapy.

If you are concerned about the possibility of any of these cancers, or if you notice symptoms that affect your speech or swallowing, make an appointment for an evaluation. The earlier cancer is diagnosed, the better the chances for successful treatment. — Eric Moore, M.D., Otorhinolaryngology, Mayo Clinic, Rochester, Minn.

Note: For information, visit www.mayoclinic.org

First long-term study on HPV claims the vaccine is 100% effective at protecting men from cancer caused by the STI

Source: www.dailymail.co.uk
Author: Cheyenne Roundtree

The first long-term study conducted into the HPV vaccine confirm it is almost 100 percent effective at protecting men from developing oral cancer.

The treatment was approved to the market in 2006 to prevent women from getting cervical cancer but experts haven’t been able to fully examine its effect over time. Now, the results are in from a three-year study on the effects – the longest investigation ever on HPV.

It confirmed that there was no trace of cancer-linked strains of HPV among men who received the vaccine – whereas two percent of untreated men had a potentially cancerous strain.

Another study, also released today, found the jab makes it next to impossible for vaccinated children to develop genital warts from the STI in their late teens and 20s.

Despite a multitude of interest and research, these are the first substantial studies to confirm the vaccine’s ability to protect people from the STI and diseases that can stem from it.

Human papillomavirus (HPV) is the most common sexually-transmitted disease in the US, with approximately 80 million people currently infected.

Although most infections disappear on their own, without even displaying symptoms, some strains can lead to genital warts and even cancers, including prostate, throat, head and neck, rectum and cervical cancer. Approximately 28,000 cases of cancer caused by HPV are diagnosed annually – most of which would have preventable with the vaccine, the CDC says.

The vaccine was first introduced with the main goal to prevent cervical cancer in women, but only about half of those eligible are getting the shots.

The study on HPV vaccines leading to oral cancer in men was led by Dr. Maura Gillison of the University of Texas MD Anderson Cancer Center. It was the first research done on whether the vaccine might prevent oral HPV infections in young men, and the results suggest it can.

The data were compiled from 2,627 men and women ages 18 to 33 years in a national health study from 2011 to 2014. The results in men were striking – no infections in the vaccinated group versus 2.13 percent of the others.

The two-dose vaccine study on genital warts was conducted by medical experts at the Boston University School of Medicine and examined the number of shots given to patients. They concluded that girls given two or three jabs prevented better against genital warts compared to those given one or no jabs.

There were similar results in the two and three jab test subjects, which experts concluding two counts of the vaccine were enough.

Rebecca Perkins, an obstetrician and the lead author of the Boston study, said: ‘This study validates the new recommendations and allows us to confidently move forward with the two dose schedule for the prevention of genital warts.’

Health Beat: Hunting head and neck cancer cells

Source: www.wfmz.com
Author: Melanie Falcon

Leonard Monteith led a healthy lifestyle. That’s why sudden problems with his mouth caught his attention.

“I noticed that when I would stick my tongue out, it would deviate to one side, and I thought that’s not right,” said Monteith, 66.

Doctors found an inch-wide tumor at the base of Monteith’s tongue. He was diagnosed with HPV positive cancer.

“The traditional treatment for head and neck cancer is really toxic and exhaustive and leads to side-effects that are very significant,” said Dr. Nabil Saba, a medical oncologist at Emory University Winship Cancer Institute in Atlanta.

After treatment, Monteith’s cancer went away for six months, but then it came back in his lungs.

Saba is a nationally-known expert in the treatment of head and neck cancers. He thought Monteith would be a good candidate for a new therapy.

“Immunotherapy is really, I think, a complete game changer,” said Saba.

Saba said two separate immunotherapy drugs are showing real promise. A drug called Nivolumab blocks the cancer receptors, allowing the body’s immune system to fight the cancer. Another drug, Pembrolizumab, also works in a similar way.

Because the trials are ongoing, Saba can’t say which specific drug Monteith was on.

“He had very good response to the treatment, to the point where we could not see any more lung lesions on the scan,” Saba said.

Monteith has been improving for three years, but he knows his condition could change without warning.

“I just live my life as I think I would have anyway,” said Monteith.

Doctors say the survival rates for patients who continued on Nivolumab were twice of those who did not take the immunotherapy drug. Twenty percent of the patients on the drug had their tumors shrink.

Research Summary: Hunting head and neck cancer cells (pdf format)

Changing definition of margin status for oral cancer

Source: www.medpagetoday.com
Author: staff

Data cast doubt on 5-mm standard, use of frozen sections

A commonly used metric for defining a close surgical margin for resected oral-cavity tumors failed to identify adequately the patients at increased risk of recurrence, a retrospective review of 432 cases showed.

The analysis showed an inverse relationship with increasing distance between invasive tumor and inked main specimen margin on the main specimen, but results of a receiver operating characteristic curve analysis identified a cutoff of < 1 mm as most appropriate for classifying patients as having a high risk of local recurrence, as opposed to the more commonly used cutoff of 5 mm.

The analysis also showed that resection of tissue beyond 1 mm on intraoperative frozen section did not improve local disease control, as reported online in JAMA Otolaryngology-Head and Neck Cancer.

“The commonly used cutoff of 5 mm for a close margin lacks an evidential basis in predicting local recurrence,” Steven M. Sperry, MD, of the University of Iowa in Iowa City, and colleagues concluded. “Invasive tumor within 1 mm of the permanent specimen margin is associated with a significantly higher local recurrence risk, though there is no significant difference for greater distances.

“This study suggests that a cutoff of less than 1 mm identifies patients at increased local recurrence risk who may benefit from additional treatment. Analysis of the tumor specimen, rather than the tumor bed, is necessary for this determination.”

The results add to a growing volume of evidence that margins <5 mm can still be curative, said Michael Burkey, MD, of the Cleveland Clinic, who was not involved in the study. The data also add to evidence that the margins calculated from the main specimen are more predictive than frozen-section margins that many head and neck surgeons have used for years.

“This doesn’t change the fact that clearly getting all the tumor out and clearing margins microscopically are still critical to curative surgery,” Burkey told MedPage Today. “The study provided good data to show that when they got positive margins, even if they subsequently treated with radiation therapy, that led to no improvement in local recurrence.”

“A second key point is that the way we determine the adequacy of surgery is changing,” he added. “We used to say 5 mm, and now it’s probably 1 to 2 mm. More and more we’re finding that the best way to look at margins is off the main specimen, not by taking frozen sections from the tumor bed.”

Despite widespread use in surgical management of head and neck cancers, interpretation of margin status and associated prognostic implications remain imprecise. A survey of head and neck surgeons showed that 83% of respondents considered carcinoma in situ as a positive margin and 17% included dysplasia in the definition. Additionally, 69% of the surgeons used a cutoff of <5 mm between invasive tumor and resection margin to a close margin, consistent with multiple reports in the literature. However, other literature suggested a smaller-distance cutoff is adequate, Sperry’s group noted.

To continue an investigation of the clinical significance and impact of surgical margins in oral-cavity cancer, the authors retrospectively reviewed results in 432 consecutive patients with primary oral-cavity squamous cell carcinoma treated at the University of Iowa from 2005 to 2014. Patients with recurrent disease were excluded from the analysis. The primary outcome was local recurrence as determined by minimum distance in millimeters between invasive tumor and inked main specimen margin.

The patients had a median age of 62, and men accounted for 58% of the study population. T-stage distribution consisted of T1 disease in 45% of patients, T2 in 21%, and T3/4 in 34%. Subsite location was tongue in 45%, alveolus in 21%, floor of the mouth in 18%, and other in 15%.

Rates of local recurrence by margin status were:
44% for microscopic positive margins
28% for margins <1 mm
17% for 1-mm margins
13% for 2-mm and 3-mm margins
14% for 4-mm margins
11% for ≥5-mm margins

“These data demonstrated an exponential inverse relationship between distance and local recurrence, with no appreciable difference in local recurrence for distances greater than 1 mm,” the authors reported.

Local recurrence also was determined on the basis of intraoperative frozen section assessment from tumor bed sampling. The analysis showed similar recurrence rates for close-margin distances between patients with involved and negative frozen sections. Among patients with a positive main specimen margin, those with an involved frozen margin had the highest local recurrence rate at 54%, as compared with 36% for patients with a negative frozen margin.

The authors analyzed the results on the basis of whether additional tissue was resected to achieve a negative margin after initial frozen section indicated cancer. The analysis incorporated collapsed margins of ≥5 mm, 1 to 5 mm, <1 mm, and positive. Success was defined as a final margin uninvolved with either invasive carcinoma or carcinoma in situ after further resection. For patients with a positive main specimen margin, successful additional resection did not improve local control.

“For patients with final margin distances grater than 0 millimeter, the local recurrence rate appeared to be the same whether a successful additional resection of the margin was performed or note,” the authors reported.

Finally, Sperry’s group analyzed local recurrence according to whether patients received adjuvant radiation therapy. For patients with a positive main specimen margin, radiotherapy did not improve local control, and the recurrence rate was the same for the other main-specimen margin categories, regardless of whether radiation therapy was administered.
Study limitations included a relatively small group of surgeons performing the majority of surgical procedures, and the inability to compare results based on different methods of intraoperative margin evaluation, such as tumor bed versus main specimen sampling, the authors noted.

Reviewed by:
Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

Primary Source:
JAMA Otolaryngology-Head and Neck Surgery

Source Reference: Tasche KK, et al “Definition of ‘close margin’ in oral cancer surgery and association of margin distance with local recurrence rate” JAMA Otolaryngol Head Neck Surg 2017; DOI:10.1001/jamaoto.2017.0548.

Swallowing exercises can improve quality of life for head and neck cancer patients

Source: www.targetedonc.com
Author: Gina Columbus

While patients with head and neck cancer are likely to experience difficulty swallowing after undergoing intesity-modulated radiation therapy (IMRT), Lynn Acton, MS, CCC (SLP) says the use of swallowing exercises can drastically improve muscle movement for these patients both during and after radiation therapy (RT).

In a study conducted by researchers at Dana-Farber Cancer Institute and Brigham Women’s Hospital, patients with head and neck cancer who underwent RT in a 2-year period were evaluated for swallowing difficulty with a video swallow to score stricture and aspiration. Of the 96 patients evaluated who received IMRT once daily, 32% had some aspiration after therapy, while 37% had evidence of stricture following RT.

Studies are currently ongoing to explore the utility of swallowing modalities for these patients. For example, an interventional, randomized, multicenter phase III trial is comparing early-active swallowing therapy versus nonspecific swallowing management (NCT02892487). Researchers are conducting the study to determine that early-active swallowing therapy can improve the quality of life of patients undergoing RT for head and neck cancer.

Additionally, a behavioral questionnaire is evaluating adherence to preventative swallowing exercises and the reasons why patients choose not to follow them (NCT03010150). Patients will complete the questionnaire at baseline and again at 6 months following RT that will discuss adherence to swallowing exercises.

Acton, a lecturer in surgery (otolaryngology) and speech pathologist at Yale School of Medicine, discussed the significance of swallowing modalities for patients with head and neck cancer during and after RT in an interview with Targeted Oncology.

Targeted Oncology: What is the benefit of doing these swallowing exercises for this patient population?

Acton: I spoke about prophylactic exercises for swallowing for patients with head and neck cancer who are undergoing RT. We have found that if we keep the muscles mobile during the treatment, there is less fibrosis of the muscles. If the patients don’t have fibrosis, they are able to move better and have better swallowing function. During the treatment, patients will have some pain. We try to manage that and do things like a mouthwash to numb the area before they do these exercises.

It is more important to keep the muscles mobile because, when a joint like your jaw becomes immobile, the cartilage becomes thinner and the joints becomes inflamed and painful. If we keep the muscles moving, then the function is much greater. We like to [continue] to do the exercises after treatment, because RT can continue to contract the muscles over time. Therefore, patients do the exercises several times during the day and after treatment, too.

Targeted Oncology: Have there been any advancements in this field that have increased the quality of life for these patients even further?

Acton: It is basically a lifelong thing at this point. For young patients, they say they feel relief after doing the exercises. Some of them [are simple] neck exercises, [such as] neck rolls. I do try to tag it in with something that they are already doing during the day. On their smartphone, I’ll put an [alarm] that reminds them to do their exercises on the way to work, or maybe [while] they are reading a newspaper. I [put the written exercises] in the memos section [of their phone] to explain the exercises. Doing those things makes it a positive result. For the patients who do the exercises, we notice that they’re able to maintain their oral opening. Normally, you should be able to put 3 fingers in your mouth.

When I started, I was seeing patients after RT because we didn’t know it was important to keep these muscles mobile [during treatment]. They would be at a 1-finger opening and then we would have to work to stretch the muscles. I’ve also talked to patients after completing their [swallowing exercises] and they no longer have food sticking in their throat. They do work.

Targeted Oncology: What impact does prophylactic swallowing exercises have on patients?

Acton: Well, not everybody is compliant, so we tell them what the negative effects are of not doing the exercises. Some patients have to get a feeding tube because they are not maintaining hydration.

If you do the exercises, you can maintain good swallowing function and [function of the] muscles not only for swallowing. [They also help for] speech; some of the patients will have radiation and have very hoarse voices. I will have to counsel them on how to talk without straining. Their vocal chords become swollen during RT. We teach them how to talk gently so they don’t do further damage to the chords.

Targeted Oncology: How should specialists handle adherence to these exercises?

Acton: It is most important for patients to do the exercises when they least feel like doing them. We want you to take the mouthwash, do the exercises, and if I see the patients I explain to them that this is a very intensive treatment. This [radiation] treatment works, but if you don’t do the things I am going to ask you to do, you are going to have disability after the treatment is done and we want to prevent that.

You have to see the patient frequently. [Seeing] them during RT and after the treatment would be ideal, because patients get a lot of encouragement. I will explain to them that I have seen [other] patients and evaluated their swallowing, and [if it is] perfect and it is because they did the exercises. I also let them know that before we do the exercises, patients will have to increase the oral opening.

Targeted Oncology: Are there any other types of exercises in addition to prophylactic swallowing that are worth mentioning?

Acton: We start with the mouth opening. Today, we are seeing a different population of people versus in the late 80s—it was a lot of type A-personality men and they sometimes found that [these exercises] were hard and [thought that] it was going to be better. It was the complete opposite.

We watch them do the exercises to move the muscles in the neck. Even just a simple, hard swallow can be done every time they eat or drink something, gargling, extreme-yawn positions, and moving the back of the tongue.

The head and neck area is a very narrow area, so I do tailor the exercises to the patient and [explain to them] what they might expect. What can you do if you feel the food sticking in your throat? You can swallow hard; you can swallow twice. I do explain to them the specific things they should do if these things happen. Generally, for anyone who is having RT [in this area] you want them to be able to move their neck and swallow—the RT the beams hit various points.

Targeted Oncology: What are the main points you hope the community oncologists took away from your lecture and what does the future hold?

Acton: In the future, I hope that patients will be able to see these professionals more frequently. It is just important that we see these patients and that they are treated. These exercises are very easy to do; [patients should] not be afraid of doing them.

Reference:
Caglar HB, Tishler RB, Othus M, et al. Dose to larynx predicts for swallowing complications after intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72(4):1110-1118. doi:10.1016/j.ijrobp.2008.02.048.

European Commission approves Bristol-Myers Squibb’s Opdivo (nivolumab) for squamous cell cancer of the head and neck in adults progressing on or after platinum-based therapy

Source: pipelinereview.com
Author: Bristol-Myers Squibb

Bristol-Myers Squibb Company today announced that the European Commission (EC) has approved Opdivo (nivolumab) as monotherapy for the treatment of squamous cell cancer of the head and neck (SCCHN) in adults progressing on or after platinum-based therapy. Opdivo is the first and only Immuno-Oncology (I-O) treatment that demonstrated in a Phase 3 trial a significant improvement in overall survival (OS) for these patients.

“Adult patients with squamous cell cancer of the head and neck that progresses on or after platinum-based therapy are fighting a debilitating and hard-to-treat disease that is associated with a very poor prognosis,” said Kevin Harrington, M.D., Ph.D., professor in Biological Cancer Therapies at The Institute of Cancer Research, London, and a consultant clinical oncologist at The Royal Marsden NHS Foundation Trust in London. “As an oncologist who helps patients deal with this terrible disease, I hope that nivolumab will now be made available as widely as possible, offering this group of patients a new treatment option that can potentially improve their overall survival.”

The approval was based on results from CheckMate -141, a global Phase 3, open-label, randomized trial, first published in The New England Journal of Medicine last October, which evaluated Opdivo versus investigator’s choice of therapy in patients aged 18 years and above with recurrent or metastatic, platinum-refractory SCCHN who had tumor progression during or within six months of receiving platinum-based therapy administered in the adjuvant, neo-adjuvant, primary or metastatic setting. Investigator’s choice of therapy included methotrexate, docetaxel, or cetuximab. The primary endpoint was OS. The trial’s secondary endpoints included progression-free survival (PFS) and objective response rate (ORR).

“The European Commission’s approval of Opdivo marks not only the first new treatment option in 10 years for patients with advanced cancers of the head and neck, but also the first Immuno-Oncology treatment for SCCHN,” said Murdo Gordon, executive vice president and chief commercial officer, Bristol-Myers Squibb. “Bristol-Myers Squibb remains committed to redefining survival for patients with cancer, and now that Opdivo is approved in Europe, we will work collaboratively with EU health authorities to ensure it is available for these patients as quickly as possible.”

In the interim analysis of the pivotal trial, Opdivo demonstrated statistically significant improvement in OS with a 30% reduction in the risk of death (HR=0.70 [95% CI: 0.53-0.92; p=0.0101]), and a median OS of 7.5 months (95% CI: 5.5-9.1) for Opdivo compared with 5.1 months (95% CI: 4.0-6.0) for the investigator’s choice arm. There were no statistically significant differences between the two arms for PFS (HR=0.89; 95% CI: 0.70, 1.13) or ORR (13.3% [95% CI: 9.3, 18.3] vs 5.8% [95% CI: 2.4, 11.6] for Opdivo and investigator’s choice, respectively. The EC approval was based on updated study results, which will be presented at the 53rd Annual Meeting of the American Society of Clinical Oncology (ASCO).

Patient reported outcomes (PROs) were evaluated using the following European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Assessment: EORTC QLQ-C30, EORTC QLQ-H&N35, and 3-level EQ-5D instruments. Patients treated with Opdivo exhibited stable PROs, while those assigned to investigator’s choice therapy exhibited significant declines in functioning (e.g., physical, role, social) and health status as well as increased symptomatology (e.g., fatigue, dyspnoea, appetite loss, pain and sensory problems).

The safety profile of Opdivo in CheckMate -141 was consistent with prior studies in patients with melanoma and non-small cell lung cancer. Serious adverse reactions occurred in 49% of patients receiving Opdivo. The most frequent serious adverse reactions reported in at least 2% of patients receiving Opdivo were pneumonia, dyspnea, aspiration pneumonia, respiratory failure, respiratory tract infection, and sepsis.

About Head & Neck Cancer
Cancers that are known as head and neck cancers usually begin in the squamous cells that line the moist mucosal surfaces inside the head and neck, such as inside the mouth, the nose and the throat. Head and neck cancer is the seventh most common cancer globally, with an estimated 400,000 to 600,000 new cases per year and 223,000 to 300,000 deaths per year. The five-year survival rate is reported as less than 4% for metastatic Stage IV disease. Squamous cell cancer of the head and neck (SCCHN) accounts for approximately 90% of all head and neck cancers with global incidence expected to increase by 17% between 2012 and 2022. Risk factors for SCCHN include tobacco and alcohol consumption. Human Papilloma Virus (HPV) infection is also a risk factor leading to rapid increase in oropharyngeal SCCHN in Europe and North America.

About Opdivo
Opdivo is a programmed death-1 (PD-1) immune checkpoint inhibitor that is designed to uniquely harness the body’s own immune system to help restore anti-tumor immune response. By harnessing the body’s own immune system to fight cancer, Opdivo has become an important treatment option across multiple cancers.

Opdivo’s leading global development program is based on Bristol-Myers Squibb’s scientific expertise in the field of Immuno-Oncology and includes a broad range of clinical trials across all phases, including Phase 3, in a variety of tumor types. To date, the Opdivo clinical development program has enrolled more than 25,000 patients. The Opdivo trials have contributed to gaining a deeper understanding of the potential role of biomarkers in patient care, particularly regarding how patients may benefit from Opdivo across the continuum of PD-L1 expression. In July 2014, Opdivo was the first PD-1 immune checkpoint inhibitor to receive regulatory approval anywhere in the world. Opdivo is currently approved in more than 60 countries, including the United States, the European Union and Japan. In October 2015, the company’s Opdivo and Yervoy combination regimen was the first Immuno-Oncology combination to receive regulatory approval for the treatment of metastatic melanoma and is currently approved in more than 50 countries, including the United States and the European Union.

U. S. FDA approved indications for Opdivo
Opdivo® (nivolumab) as a single agent is indicated for the treatment of patients with BRAF V600 mutation-positive unresectable or metastatic melanoma. This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Opdivo® (nivolumab) as a single agent is indicated for the treatment of patients with BRAF V600 wild-type unresectable or metastatic melanoma.

Opdivo® (nivolumab), in combination with YERVOY® (ipilimumab), is indicated for the treatment of patients with unresectable or metastatic melanoma. This indication is approved under accelerated approval based on progression-free survival. Continued approval for this indication may be contingent upon verification and description of clinical benefit in the confirmatory trials.

Opdivo® (nivolumab) is indicated for the treatment of patients with metastatic non-small cell lung cancer (NSCLC) with progression on or after platinum-based chemotherapy. Patients with EGFR or ALK genomic tumor aberrations should have disease progression on FDA-approved therapy for these aberrations prior to receiving OPDIVO.

Opdivo® (nivolumab) is indicated for the treatment of patients with advanced renal cell carcinoma (RCC) who have received prior anti-angiogenic therapy.

Opdivo® (nivolumab) is indicated for the treatment of patients with classical Hodgkin lymphoma (cHL) that has relapsed or progressed after autologous hematopoietic stem cell transplantation (HSCT) and post-transplantation brentuximab vedotin. This indication is approved under accelerated approval based on overall response rate. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

Opdivo® (nivolumab) is indicated for the treatment of patients with recurrent or metastatic squamous cell carcinoma of the head and neck (SCCHN) with disease progression on or after platinum-based therapy.

Opdivo® (nivolumab) is indicated for the treatment of patients with locally advanced or metastatic urothelial carcinoma who have disease progression during or following platinum-containing chemotherapy or have disease progression within 12 months of neoadjuvant or adjuvant treatment with platinum-containing chemotherapy. This indication is approved under accelerated approval based on tumor response rate and duration of response. Continued approval for this indication may be contingent upon verification and description of clinical benefit in confirmatory trials.

April, 2017|Oral Cancer News|

HPV vaccine; cancer prevention

Source: www.nujournal.com
Author: staff

Human papillomavirus (HPV) is a sexually transmitted infection, of several strains, most associated with cervical cancers. The virus is so common that nearly all males and females have been infected at some time in their life. One in four is currently infected in the nation.

Signs and symptoms of HPV are variable. Most will recover from the virus within two years without ever knowing they were infected, making HPV easy to spread. Occasionally, the virus lasts much longer in the body which can cause cells to change and lead to cancer. Fortunately, we have a vaccine to prevent cancer caused by HPV.

The Food and Drug Administration (FDA) has approved three vaccines for HPV; Cervarix, Gardasil, and Gardasil 9. These vaccines are tested and proven to be safe and effective.

Prevention is important with HPV. The vaccine should be administered before exposure to the virus for stronger protection against cervical, vaginal, vulvar, penile, and some mouth or throat cancers. (Gardasil and Gardasil 9 also prevent genital warts and anal cancer.) The best age to obtain maximum potential of the vaccine is at 11 or 12 years old. At this age, the body’s immune system is the most receptive to the vaccination’s virus-like particles and the body produces higher amounts of antibodies in defense, protecting the adolescent for his or her future. Both girls and boys should get the HPV vaccine. For ages 9-14, two doses – six to twelve months apart, are recommended. For 15-26 year olds, three doses are recommended. Side effects may include brief soreness, or redness or swelling at the injection site.

The HPV vaccine does prevent cancer, limiting biopsies and invasive procedures thus cutting potential health care costs. Most private insurance companies cover preventive vaccinations, it is best to call your carrier for more information. The HPV vaccine is covered by Minnesota Health Plans. Uninsured individuals may be eligible to get the vaccine at their local public health office.

Schedule your adolescent’s annual health exam today and ask which HPV vaccine is best for the child in your life.

“Every year in the United States, HPV causes 30,700 cancers in men and women. HPV vaccination can prevent most of the cancers (about 28,000) from occurring.” (CDC, December, 2016)

Learn more at www.cdc.gov/hpv or www.cancer.gov

April, 2017|Oral Cancer News|