HPV vaccine important preventive tool for survivors of childhood cancer

Fri, Jul 1, 2016

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Source: www.curetoday.com
Author: Ellie Leick

As childhood cancer survivors are at an increased risk of developing second cancers later in life, James Klosky recommends that this population receive the human papillomavirus (HPV) series of vaccines.

A survey of 679 survivors one to five years out of treatment was conducted to evaluate how many received the vaccine compared with their healthy peers. A great disparity was discovered, as survivors — all of whom were between age 13 and 26 — were less likely to receive the vaccine. Researchers also investigated the reasons why many survivors did not receive it.

Klosky, an associate member and director of psychological services in cancer survivorship at St. Jude Children’s Research Hospital, presented the findings from this research at the 2016 Annual Meeting of the American Society of Clinical Oncology (ASCO), a gathering of 30,000 oncology professionals in Chicago. CURE spoke with Klosky at the meeting to discuss the key takeaways and the importance of the HPV vaccine to survivors of childhood cancer.

Can you give an overview of the study and its purpose?
The HPV vaccine is the first vaccine that’s designed to prevent cancers. We are particularly interested in the application of this vaccine amongst survivors of childhood cancers, who are at increased risk for HPV-related cancers in young adulthood relative to their healthy peers.

On average, the onset of these cancers occur seven years earlier in survivors of childhood cancers compared to their healthy peers. Additionally, survivors of childhood cancer have an increased risk of acquiring a second cancer. Therefore, the application of this vaccine is very important. We at St. Jude Children’s Research Hospital do everything we can to protect our survivors from second cancers, and the HPV vaccine is one mechanism we are able to utilize.

Why are second cancers more likely in survivors of childhood cancer?
As a general population, 80 percent of people who are sexually active will be exposed to HPV in their lifetime. For those of us who have a strong immune system, the virus will typically clear out of our systems in approximately two years. Often, there will not be any symptoms. However, for survivors of childhood cancers and other groups that have immune deficiencies, it appears they might be more likely for complications associated with HPV upon infection.

What did this study specifically find? What are the key takeaways?
This study compared survivors of childhood cancer with their peers in the U.S. We analyzed the rates of initiation of the HPV vaccine amongst survivors and then of the U.S. population, focusing on two different groups: those who are 13 to 17 years of age and those who are 18 to 26 years of age.

Within the 18 to 26 age group, the rates of the HPV vaccine initiation were essentially equivalent; 26 percent of survivors had initiated the vaccine whereas 24 percent in the general population had initiated it.

However, there were differences in the 13 to 17 age groups. Among survivors of childhood cancers, only 22 percent had initiated the vaccine compared with 42 percent of the general population.

It is important to note that the HPV vaccine is designed to be administered prior to sexual activity. It is important to get vaccinated as a young teenager because the HPV vaccine is protective, not therapeutic. Therefore, once a patient is exposed to the virus, there is not much we can do about it.

Among survivors of childhood cancers, were there predictors of not initiating the vaccine?
We found the most robust predictor was among survivors who stated their doctors had not recommended the vaccine. And essentially, one of the main messages here is that we really need our physicians to be recommending the vaccine because that should translate into a higher initiation rate.

Another strong influence against receiving the vaccine was hearing about it from a friend. Adolescents often talk about the negative aspects of the vaccine, such as the pain involved when receiving the vaccine and the fact that three vaccines are necessary to complete the protection. Hearing this does not encourage other adolescents to initiate the vaccine.

We also found those who are male and those who had never been sexually active are also more likely not to initiate the vaccine. That’s a bit concerning because although HPV is typically implicated in terms of cervical cancers and a lot of the gynecological-associated cancers, men can also have oropharyngeal cancers, anal cancers, penile cancers and other types of cancers within HPV ideology. Additionally, males are often the carriers.

Finally, those who do not feel receiving the vaccine makes you a responsible or good person are less likely to receive it.

What are the next steps for this project?
Overall, the lack of physician recommendation was most strongly associated with not initiating. Our next step in the research is to create intervention programs to get physicians to make clear recommendations with conviction and confidence to survivors of childhood cancer. This will hopefully translate into more survivors getting protected.

Is there ever a reason to refrain from receiving the HPV vaccine?
The indication of the vaccine is very broad. For survivors of childhood cancer who have had a particularly complex treatment history and are continuing to have severe late effects of childhood cancer, a conversation needs to happen between their oncologist, the family and the patient.

In terms of vaccine programs, they are designed as more of a public health tool; the vaccines should be safe for everyone. If there are any concerns about the vaccine, we want you to talk to your doctor.

Regardless of the direction of the effect, increasing these types of communications will hopefully translate to the best health care for our patients.

What are your hopes for this project?
If we are able to demonstrate the immunogenicity, safety and tolerability of the HPV vaccine among survivors of childhood cancer, we’ll have a platform for a vaccine program within this high-risk group. Protecting survivors from second cancers in any way we can is the ultimate goal. There’s not much I can do about patients’ genetics or other fixed factors, but getting the vaccine is something, behaviorally, I can influence. If I, my group or the consumers of this research have influenced conversations that translate into initiating and completing the three-vaccine series, then this research has been successful.

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New study analyzes physical therapy for head and neck cancer survivors

Sun, Jun 26, 2016

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Source: www.curetoday.com
Author: Andrew J. Roth

The aftermath of treatment for head and neck cancer can be particularly difficult, according to Ann Marie Flores. Flores, assistant professor, Department of Physical Therapy, Movement & Rehabilitation Science, Bouvé College of Health Sciences, Northeastern University, conducted a pre-pilot study looking at early physical therapy education for this patient population.

CURE interviewed Flores about her poster, which she presented at the 8th Biennial Cancer Survivorship Research Conference in Washington, DC.

Could you first give some background about this study? How did it come to be?
It was a spinoff of some studies that I began in breast cancer. I conducted a literature review of rehab needs of breast cancer survivors about 10 years ago and found that there was very little out there. Then, when I started a rehab oncology program at a previous institution, the patient population that were referred to the program tended to not be breast cancer patients, because they physically and functionally tend to do well in aggregate. Most of my patients referred were those with head and neck cancer. I went through the same process to look through literature critically to figure out what exists in terms of physical therapy and rehabilitation-based approaches. I’ve updated this over a long period of time and this poster is a systematic review of the quality of evidence. I combined this literature and data review with talking to a focus group of cancer survivors.

What did you find?
I asked the focus group if they needed more information and the answer was “Yes!” over and over again. The majority of comments I heard were exactly about physical therapy, self-care and efficacy—things we specialize in. They were also adamant about oral health and dental care, understanding salivary function, tongue motion, muscles and more. We also heard a lot about emotional and social support. So many of these survivors said they felt they were losing their mind because no one around them understood what they were going through after treatment.

It was very interesting to see the concordance of the systematic review results with our focus groups.

What is it about this population that you think creates such a need for information?
Head and neck cancer survivors make up about 4 percent of all cancer survivors. What many of these patients have are multimodality therapies, highly disfiguring surgeries, surgeries that contribute to high rates of disability. Many patients also get chemotherapy and radiation. These survivors can have impairments that can compromise key functions of life—breathing, eating and speaking.

Can these patients get the services they need? Where?
They should be able to, yes. I am a long-standing member of the American Physical Therapy Association and we have a task force that specializes in head and neck studies. We’ve published four studies looking at measuring physical therapy–related impairments that we can rehabilitate, such as shoulder dysfunction, trismus and lymphedema. With trismus, patients can’t open their mouths. Many patients with head and neck cancer have either had muscle tissue removed or have highly scarred jaw muscles. And with lymphedema, you can get that in any part of your body, including the head and neck. Many patients will have lymph fluid collect in the under part of their neck.

For a patient who has finished treatment and facing some of these issues, where should he/she go for support?
As a patient, I’d tell my doctor that I need a referral to a physical therapist. In fact, the next steps following on our research will be to pilot test our patient education materials to determine their clinical feasibility, acceptability, and impact on PT outcomes. We want to ensure that these materials are patient-centered and relevant across the survivorship trajectory.

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HPV vaccination could be offered to schoolboys to decrease risk of cancer

Sun, Jun 26, 2016

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Source: www.mirror.co.uk
Author: Andrew Gregory

A vaccination could soon be offered to every schoolboy to help tackle the rising rate of some cancers in men, a Government minister revealed on Thursday. Health chiefs are poised to drop their opposition to extending the jab to protect against the human papilloma virus (HPV), which is already given to all Year 8 girls. The likely move follows growing alarm over cancers of the mouth, throat, neck and head, as well as penile and anal cancer, amid growing evidence that they are caused by HPV.

The NHS (National Health Service) spends more than £300m a year treating head and neck cancers, while giving the vaccine to all boys would cost just £22m, supporters say.

Health Minister Jane Ellison has revealed that the independent Joint Committee on Vaccination and Immunization (JCVI) is investigating the change, with its verdict due early next year. Mrs Ellison – who has previously described giving the HPV jab to girls only as “a little odd” – said: “I understand the wish for it to be available to all adolescents regardless of gender.

“The JCVI is reconsidering its initial advice on this and modeling is under way to inform its consideration. We will look at that as a priority when we get it.

“I recognize the frustration that people have expressed and I have talked personally to Public Health England officials who are involved in the modelling work.”

The minister said money was already available to extend the vaccination program if the JCVI said yes, adding: “The Government have always acted on its recommendations.” The looming move comes after a Commons debate heard that men are six times more likely than women to have an oral HPV infection – yet they are not vaccinated.

Conservative MP Sir Paul Beresford , a part-time dentist himself, said up to 70% of throat cancers are caused by HPV, adding: “The statistics make for hideous reading.”

HPV is also linked to around 80% of anal cancer in men, almost half of penile cancers and is responsible for nine out of 10 cases of genital warts. A national vaccination program HPV was introduced for 12 and 13-year-old girls as long ago as 2008, to prevent cervical cancer.

But experts agree the program does not create sufficient “herd immunity”, prompting a recent decision to begin a trial to give the jab to some gay men. Around 40,000 men who have sex with men (MSM) will be vaccinated, targeting under-45s who attend sexual advice clinics.

A campaign group called HPV Action has called for all boys to be vaccinated as soon as possible – warning 367,000 are at risk of developing a preventable disease in later life, for every year of delay.

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Rodeo rider partners with nonprofit group to fight smokeless tobacco use

Wed, Jun 22, 2016

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Source: www.fox13now.com
Author: Rebecca Cade
 

SALT LAKE CITY — Oral cancer is becoming an epidemic in the U.S., and has been in the news in the last year with the loss of major league baseball hall-of-famer, Tony Gwynn, who died at 54 from smokeless tobacco use.

Rodeo has a historic tie to smokeless tobaccos, and Oral Cancer Foundation, has teamed up with Bareback Rider Cody Kiser to draw awareness to, and prevent, this growing epidemic where it thrives – the rodeo circuit.

Smokeless/spit tobacco is one of the historic causes of deadly oral cancers, and is more addictive than other forms of tobacco use.

The nonprofit is seeking to spread awareness of oral cancer and the dangers of starting terrible tobacco habits. While others are focused on getting users to quit, The Oral Cancer Foundation is reaching out to young people to not pick up the habit that they may see one of their rodeo “heroes” engage in.

Their message is simple, “Be Smart. Don’t Start.”

With the strong addictive powers of smokeless tobacco, the foundation and Kiser aim to engage fans early.

At the rodeos, Kiser will be solely wearing OCF logos and wording, while handing out buttons, wristbands and bandanas with the campaign messaging on them. The bareback rider hopes this will make him an alternative positive role-model for the adolescent age group whose minds are so easily molded.

“It’s something I’ve always been passionate about, so when I got into the partnership with OCF, it was no big deal to be able to say ‘I don’t smoke or chew, never have, and it’s easy not to,'” Kiser said.

Kiser added it all starts with kids.

“Most of these guys I ride with started smoking and chewing in sixth or seventh grade,” he said. “So, if we can get to those kids now, and tell them ‘you don’t have to do this to be cool or be a cowboy’ and show them what you can do without it.”

More information on the campaign can be found at www.oralcancer.org

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

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Reno Rodeo: Cody Kiser ‘The luckiest guy in the world’

Mon, Jun 20, 2016

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Source: www.rgj.com
Author: Jordan Wines

Cody-Kiser

2016 Reno Rodeo competitor Cody Kiser has been competing in rodeos from the time he could walk.

He began his career riding sheep and roping dummy heads on hay bales. As he grew, so did his competitive spirit. Kiser began riding bulls, but suffered an injury early in his career.

“I had a bull step on my face, and I broke all the bones in the left side of my face,” Kiser said. “I broke my jaw in two places and had my jaw wired shut. I had to get plastic surgery on my face to get it put back together.”

After recovering, Kiser began riding bucking horses, bareback specifically. He continued to compete while attending college at the University of Nevada, Reno, where he completed his degree in civil engineering. Splitting time between school and his life on the rodeo circuit presented its own set of challenges.

“I did college rodeo for about two years, and I loved it. It just became way too much doing rodeo and school. I would put all my effort into schoolwork during the semester, and then would try to hit a couple of rodeos during school. During summer, I wouldn’t take any classes, and I would hit the rodeo as hard as I could, which was still difficult because I had internships and jobs over the summer.”

Riding bareback is more than just an event for Kiser, as his father also rode bareback competitively, and Kiser still uses some of the same equipment his father used.

“When I first started, I started using all of his stuff from when he rode, which was pretty wild, and I actually still wear his spurs. I believe a friend of his made them for him, and I still ride with those spurs, and that is really cool.”

Speaking with Kiser, you can see the people in his life are a big part of the reason he loves doing rodeo. After competing in one form or another for almost 25 years, Kiser said that his favorite rodeo memory was from Friday night, when he had, in his own words, a terrible ride.

“I rode terribly, but I had almost 150 people here to cheer me on.” Kiser said. He had extended family and friends, people that he works out with at his gym in Carson, and all of the people that his mom brought with her. “I’m not happy about how I rode, but I’m going to make up for that (Saturday).”

Being a part of the rodeo opened up a lot of opportunities for Kiser, as he now serves as a spokesmen for the Oral Cancer Foundation,

During all of his events, Kiser wears an embroidered shirt with the OCF logo on it. He became involved with the charity in college, when a girl from an engineering class knew that he competed in rodeo events, and asked him if he smoked or chewed. Things progressed quickly from there, with Kiser now serving as a spokesmen for the OCF, the first spokesmen to be affiliated with rodeo.

“It started as this very small thing, sort of sit back and see how it goes,” he said. “It sort of blew up, and has been doing really well. I get to interact with kids and people, and get the word out about the foundation and things, and now people are starting to recognize the oral cancer foundation patch and things when I go to rodeos.”

Kiser and the OCF are promoting a message of prevention, focusing on educating younger spectators of the sport. “What I do for them is go around to the rodeos, and just  try to do outreach to the kids, between 8 and 9 years old, maybe a little younger, all the way up to 18, high school and college age. Just trying to get out there and let them know that you don’t have to smoke or chew to be a cowboy, or be cool. I am out there to be a role model and to show them what you can do when you don’t smoke or chew.”

Participating in the rodeo also landed Kiser on a Hollywood film set, as Kiser worked as a stunt double for Bradley Cooper during the rodeo scenes in Clint Eastwood’s “American Sniper.” Kiser is extremely humble about the experience, but is open to appearing in more films in the future.

“I got to go and do this stunt for Clint Eastwood, and Bradley Cooper, I got to meet both of them and do this thing with them, and they were both the nicest guys, they walked up to me and shook my hand and introduced themselves as if I didn’t know who they were, and they were awesome guys and awesome people to work with. It was only a one day deal, and I wish I could have done more. I haven’t done anything recently like that, and I am really looking forward to maybe doing some more.”

As of Saturday, Kiser is fifth in the bareback standings. While his chances of making it to next week’s championships are slim, he isn’t going to let that stop him from going into the arena and having a blast.

“Tonight, I’m just having fun, and letting it all hang out. I’m going to go to town, have fun. I know what the horse is like, and I know what I am capable of.”

No matter the outcome of the event, Kiser is thankful for the experiences he has had while competing in this sport, and knows that rodeo has completely changed the course of his life. “Rodeo has made me who I am today, Family, community, discipline, hard work, all of those things come out of rodeo. And I can relate to so many life experiences and things to rodeo that I have been through and it is just unreal.”

If you are interested in helping the Oral Cancer Foundation, you can find Kiser on social media, or visit http://www.oralcancer.org/.

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

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Number of circulating tumor cells up after surgery in SCCHN

Sat, Jun 18, 2016

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Source: www.doctorslounge.com
Author: staff

Most patients with squamous cell carcinoma of the head and neck (SCCHN) have an increase in the number of circulating tumor cells (CTCs) after surgical resection, according to a study published online June 5 in Head & Neck.

Kris R. Jatana, M.D., from the Nationwide Children’s Hospital in Columbus, Ohio, and colleagues identified cytokeratin-positive CTCs using a negative depletion technique. They compared the numbers of CTCs immediately before and after surgical resection using blood samples from 38 patients with SCCHN.

The researchers found that 79 percent of patients had CTCs before and after surgery. Overall, 7.89 percent of patients had no CTCs before surgery but did have CTCs after surgery. After surgery there was an increased number of CTCs/mL in 60.5 percent of patients, with a 6.63-fold mean increase (P = 0.02).

“The timing of blood sample collection for such solid cancers that undergo surgical intervention, such as SCCHN, can potentially impact the number of CTCs identified,” the authors write. “Although a prognostic blood test for CTCs could have important treatment and surveillance implications, the viability and clinical significance of potentially surgically released CTCs in SCCHN is still not known.”

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Aspen Dental Practices Donate More Than $20,000 To The Oral Cancer Foundation For Oral Cancer Awareness Month

Thu, Jun 16, 2016

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Source: www.pharmiweb.com.org
Author: Aspen Dental
 

SYRACUSE, N.Y., May 31, 2016 /PRNewswire/ — Aspen Dental–branded practices will donate $22,375 to The Oral Cancer Foundation (OCF) as part of a program that contributed $5 for each ViziLite® oral cancer screening conducted during April for Oral Cancer Awareness Month. In total, more than 4,000 patients were screened across more than 550 practices in 33 states.

Since 2010, Aspen Dental-branded practices have donated more than $105,000 to OCF.

“Approximately 48,250 people in the U.S. will be diagnosed with an oral or oropharyngeal cancer this year; and of those only about 57% will be alive in five years,” said Natalie Riggs, Director of Special Projects for The Oral Cancer Foundation. In 2016 we estimate that 9500 individuals will lose their lives to oral cancers and we are grateful for the support from Aspen Dental practices in helping us raise awareness and aiding in our efforts to fight this disease.”

Oral cancer is frequently preceded by visible pre-malignant lesions and can be diagnosed at a much earlier stage (I or II) with ViziLite® Plus, a specially designed light technology.  When caught early and treated, the survival rate is 80 to 90 percent.

“We’re working to educate our patients about the risk factors, warning signs and symptoms associated with oral cancer so that we can help them catch the disease before it progresses,” said Dr. Murali Lakireddy, a general dentist who owns Aspen Dental offices in Ohio. “Many of our patients do not think about oral cancer when they go to the dentist, but in fact, oral cancer screenings are just as much a part of your routine dental visit as a deep clean from the hygienist.”

To learn more about oral cancer screenings, visit the OFC website at http://www.oralcancerfoundation.org/dental/how_do_you_know.html.

About Aspen Dental Practices
Dentists and staff at Aspen Dental practices believe everyone has the right to quality, affordable oral health care. As one of the largest and fastest-growing networks of independent dental care providers in the U.S., local Aspen Dental practices – more than 550 of them across 33 states – offer patients a safe, welcoming and judgment-free environment to address their dental challenges. Every Aspen Dental-branded practice offers a full range of dental and denture services – including comprehensive exams, cleanings, extractions, fillings, periodontal treatment, whitening, oral surgery, crown and bridge work – allowing patients to have the peace of mind that they are taken care of and protected, so they can focus on getting the healthy mouth they deserve. In 2015, Aspen Dental-branded practices recorded more than 3.7 million patient visits and welcomed nearly 785,000 new patients.

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Nivolumab Demonstrated Survival Benefit, Good Tolerance in Refractory HNSCC

Tue, Jun 7, 2016

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Source: www.asco.org
Author: Tim Donald, ELS
 

In the phase III comparative CheckMate 141 trial, nivolumab demonstrated a “significant improval in survival” in patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), compared with therapy of the investigator’s choice, according to Robert L. Ferris, MD, PhD, FACS, of the University of Pittsburgh Cancer Institute (Abstract 6009). There were fewer treatment-related adverse events with the PD-1 inhibitor than with investigator’s choice therapy, Dr. Ferris said, and nivolumab stabilized patient-reported quality-of-life outcome measures, whereas the investigator’s choice therapy led to meaningful declines in function and worsening of symptoms.

AM16.6009-Ferris2Dr. Robert L. Ferris

“Nivolumab is a new standard-of-care option for patients with refractory or metastatic HNSCC after platinum-based therapy,” Dr. Ferris said.

Dr. Ferris presented the trial results at the “Harnessing the Immune System in Head and Neck Cancer: Evolving Standards in Metastatic Disease” Clinical Science Symposium on June 6. He noted that in this trial of patients whose disease had progressed after platinum-based therapy, nivolumab doubled the 1-year overall survival (OS) rate, with 36.0% OS for the immunotherapeutic drug compared with 16.6% for the investigator’s choice therapy. These top-line results were presented at the 2016 American Association of Cancer Research meeting1; Dr. Ferris presented data the additional endpoints of quality of life, correlative biomarkers, and safety.

There is an extremely poor prognosis for patients with platinum-refractory recurrent or metastatic HNSCC, with median OS of 6 months or fewer. Previous research, by Dr. Ferris and others, has shown that HNSCC can express T-cell suppressive ligands, such as PD-L1, thereby evading host immune response. PD-L1 is frequently expressed on HNSCC cells, both HPV-positive and -negative.

The phase III CheckMate 141 study enrolled patients with HNSCC aged 18 and older with ECOG status 0 or 1, and with disease progression within 6 months after the most recent dose of platinum-based therapy. Patients were enrolled regardless of PD-L1 status and irrespective of number of previous lines of therapy. Immunohistochemistry testing for p16 was performed to determine HPV status. Patients were randomly assigned 2:1 to nivolumab (3 mg/kg intravenous [IV] every 2 weeks) or investigator’s choice of single-agent therapy with methotrexate (40 mg/m² IV weekly), docetaxel (30 mg/m² IV weekly), or cetuximab (400 mg/m² IV once, then 250 mg/m² weekly).

OS was compared between arms and by PD-L1 expression and HPV (p16) status. Nivolumab demonstrated a survival benefit in the overall study population, regardless of PD-L1 expression or p16 status, Dr. Ferris said. The magnitude of the OS benefit of nivolumab was greater in patients expressing PD-L1 at 1% or more (HR 0.55, 95% CI [0.36, 0.83]) compared with those expressing PD-L1 at less than 1% (HR 0.89, 95% CI [0.54, 1.45]). However, increasing levels of PD-L1 expression ( ≥ 5%, ≥ 10%) did not result in further OS benefit.

The OS benefit was greater with nivolumab than investigator’s choice therapy in both patients who were p16 positive (HR 0.56, 95% CI [0.32, 0.99]) and p16 negative (HR 0.73, 95% CI [0.42, 1.25]). When OS was analyzed for both PD-L1 expression and p16 status, the hazard ratios favored nivolumab for all subgroups.

Treatment-related adverse events of any grade were lower in the nivolumab arm (58.9%) than the investigator’s choice therapy arm (77.5%). Serious (grade 3 or 4) treatment-related adverse events were also lower in the nivolumab arm (13.1%) than in the investigator’s choice therapy arm (35.1%). Patient-reported outcome measures for quality of life were assessed based on two EORTC scales. Treatment with nivolumab stabilized the outcome measures of physical function, social function, absence of sensory problems, and absence of trouble with social contact, whereas the investigator’s choice therapy led to meaningful declines in function and worsening of symptoms.

AM16.6009-Uppaluri_0Dr. Ravindra Uppaluri

Discussant Ravindra Uppaluri, MD, PhD, of Washington University School of Medicine, said that the CheckMate 141 trial “continues to highlight the use of PD-L1 status as a stratifier.” The trial results “offer hope for patients with refractory or metastatic HNSCC,” he said. “Obviously better biomarkers are needed, and, ultimately, a composite immune profile may be required.”

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

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Heading back to the office following head and neck cancer

Sun, Jun 5, 2016

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Source: blogs.biomedcentral.com
Author: Daniel Caley

In Cancers of the Head & Neck launching today publishes the first study looking at disability and employment outcomes in patients with head and neck cancer related to the human papillomavirus (HPV). Dr Shrujal Baxi, Section Editor for survivorship and patient related outcomes and author of this study, explains more about their work in this Q&A:

The rates of patients diagnosed with HPV-related head and neck cancer is rising annually. By 2020, there will be more cases of HPV-related head and neck cancer than HPV-related cervical cancer in the United States. Numerous studies have shown that most patients with this diagnosis are likely to be cured of their disease, placing an increased emphasis on quality of life and non-cancer outcomes in this population of survivors. The majority of patients diagnosed with HPV-related head and neck cancer are working-age adults and employment is a serious issue both financially and psychologically.

How can treatment for head and neck cancer impact employment?
Treatment for head and neck cancer often involves a combination of chemotherapy and radiation given over a six to seven week period, often known as concurrent chemoradiation or combined modality chemoradiation. This process is considered toxic and can impact a patient’s ability to function normally including speaking, chewing, breathing and swallowing. Many patients require numerous supportive medications to get through treatment including narcotics for pain and anti-nausea medications. Patients can lose on average 10-15% of their weight within a few months and can suffer from severe fatigue and post-treatment depression.

Who was in your study?
We included 102 participants with HPV-related head and neck cancer treated with chemoradiation at our institution who were employed full-time for pay at the time of diagnosis.

How did the treatment impact employment?
97% of patients had to change their employment responsibilities in some way from reducing work, taking a break and then returning at a later date, or stopping altogether and not returning. There were 73 patients that stopped but eventually returned to work after treatment, and they required a median of 14.5 weeks to return. This is longer than the 12 weeks currently allowed according to the Family Medical Leave Act (FMLA).

Eight patients stopped working altogether and never went back. Eight patients stopped working during treatment and never returned to work. Aside from younger age predicting extra time off before returning to work, we did not find a patient, treatment or disease factor that accounted for needing extra time off.

What happened to these patients?
The majority of patients who returned to work continued. At nearly two years from completion of treatment, 85% of the original 102 patients were working for pay. Overall, survivors were doing very well in terms of quality of life with the majority not having any major limitations secondary to their treatment.

There were a group of survivors who were dissatisfied with their ability to work. Some were working but not satisfied with their abilities, while others were looking for work. Compared to those who were satisfied with their abilities, those that were unsatisfied were more likely to have more functional problems and more head and neck specific late toxicities from their treatment.

What does this mean for patients and providers?
I think that this study provides some guidance for patients and providers as they prepare for chemoradiation to treat HPV-related head and neck cancer. It is hopeful that most patients will return to work, but realistic expectations of ability to work will help in treatment planning. Employment is another reason why managing late toxicities remains an important aspect of optimal care for head and neck cancer survivors.

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Type 2 diabetes drug could be beneficial for head and neck cancer patients

Sun, Jun 5, 2016

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Source: www.eurekalert.org
Author: press release

Researchers at the University of Cincinnati (UC) College of Medicine have found that adding increasing doses of an approved Type 2 diabetes drug, metformin, to a chemotherapy and radiation treatment regimen in head and neck cancer patients is not well tolerated if escalated too quickly, but allowing slower escalation could be beneficial.

These findings are being presented via poster June 4 at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting: Collective Wisdom, being held June 3-7 in Chicago.

Trisha Wise-Draper, MD, PhD, assistant professor in the Division of Hematology Oncology at the UC College of Medicine, a member of both the Cincinnati Cancer Center and UC Cancer Institute and principal investigator on this study, says retrospective studies have shown improved outcomes in tumors treated with chemotherapy and radiation if they were also on metformin for diabetes.

“In head and neck squamous cell carcinoma, which develops in the mucous membranes of the mouth, nose and throat, diabetic patients taking a medication called metformin had better overall survival compared to those not on metformin when also treated with chemotherapy and radiation,” she says. “Additionally, pancreatic cancer patients treated with chemotherapy and metformin required higher doses of metformin–1,000 milligrams twice a day–to experience positive results.

“In basic science studies, metformin has been shown to stop mTOR, a molecular pathway present and active in this type of head and neck cancer, and pretreatment with metformin resulted in a decrease in the occurrence of oral cavity tumors in animal models. In this study, we wanted to see if the combination of escalating doses of metformin with the chemotherapy agent cisplatin and radiation for head and neck cancer tumors in non-diabetic patients would be effective.”

Wise-Draper says that metformin, which is an approved Type 2 diabetes medication, was provided by their investigational pharmacy. Metformin was administered orally in escalating doses for 7 to 14 days prior to starting the cisplatin and radiation and continued throughout standard treatment. Blood samples were collected before and after metformin treatment as well as during chemotherapy. Flow cytometry, a technique used to count cells, was used to detect the percent of circulating immune activated cells, and clinical laboratory tests including glucose, B12 and C-peptide (an amino acid that is important for controlling insulin) were performed.

“This is part of an ongoing clinical trial,” says Wise-Draper. “We found that eight patients with advanced head and neck cancer have been enrolled so far; we plan to have 30 total. Due to the relatively quick escalation of metformin, the patients’ tolerance was poor with higher doses of metformin when initiated 7 days prior to their chemotherapy and radiation therapy regimen.

“Therefore, the protocol was modified to allow slower escalation over 14 days. The most common toxicities observed included nausea (71 percent of patients) and vomiting (43 percent of patients), increase in creatinine (57 percent of patients), decreased white blood cell count (43 percent of patients) and pain when swallowing (43 percent of patients) with only nausea being directly attributed to metformin and the rest attributed to cisplatin and radiation.”

She adds that there wasn’t a substantial change in T cell or glucose levels with administration of metformin in the small sample of patients but that there were increased C-peptide levels in response to metformin administration.

“These results show that the combination of metformin and cisplatin and radiation was poorly tolerated when metformin was escalated quickly. However, there has been no significant increase in side effects thus far with the addition of metformin,” Wise-Draper says. “The trial is continuing with escalation of metformin over a longer period of time to provide more data; we will also try to increase our sample size.”

Note:
This research is being funded by the UC Cancer Institute. Wise-Draper cites no conflict of interest.

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