Call for NZ Government to fund HPV vaccine for boys

Mon, Mar 21, 2016

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Source: www.nzherald.co.nz
Author: Martin Johnston

Throat-cancer patient Grant Munro paid for his son to be vaccinated against the sexually-transmitted HPV virus because the Government has refused.

A 58-year-old scientific expert on viruses, he is backing a campaign by doctors calling for the extension of state funding of the controversial HPV vaccine to boys. Dr Munro, whose cancer was linked to HPV infection, says it is a form of discrimination against males that the Government will only pay for girls to have the vaccine.

State medicines agency Pharmac said it had decided not to fund the Gardasil vaccine for boys at present, but it is an option for the future. Its advisory committee assigned a low priority to funding it for all males aged 11-19 and high priority for males 9-26 “who self-identify as having sex with other males”.

In Australia, the vaccine is government-funded for boys and girls. Gardasil can protect against four strains of HPV – human papilloma virus – that can cause pre-cancerous lesions in the genital tract and mouth, and genital warts. It has been offered to New Zealand girls partly to help reduce cervical cancer.

Rates of throat-related cancers have risen sharply since the 1980s and HPV, from oral sex, is thought to be the cause. The actor Michael Douglas was treated for tongue cancer caused by HPV and has spoken of the link between HPV and performing oral sex.

After Dr Munro was treated for a tonsil tumour that contained evidence of HPV, he paid $450 for his 14-year-old son to receive the three injections of vaccine.

In 2013, Dr Munro had delayed seeking medical help for throat problems he put down to hayfever – “a sort of sore throat, sometimes a little difficulty swallowing, sometimes a little blood in the saliva, snoring. I now also remember having ferocious night sweats.”

His GP sent him to a throat surgeon who, within days, removed his left tonsil. Chemotherapy and radiotherapy followed. He thought he was in remission from cancer, until last week when a PET scan showed up a “highly suspicious” lymph node in his neck. Now he has been referred to a cancer specialist to discuss his options.

Dr Munro is a patient-representative of the HPV project, a group of specialists and patients, which promotes vaccination against the virus, and he will speak at its Auckland University event this week.

Surgeons report seeing many more cases of cancer of the tonsils, the base of the tongue, the back of the throat and the soft palate – together called oropharyngeal cancers.

From around 1990 to 2010, the per-capita rate of these cancers in New Zealand men more than doubled, to more than 4 per 100,000. The female rate rose significantly too, but is much lower than for men, at around 1 per 100,000 each year.

“Men are more exposed to the virus,” said Auckland ear, nose and throat surgeon Dr John Chaplin, “because the route of exposure is understood to be oral sex and that the concentration of virus in the female genital tract is much higher than in the male tract”.

“Previously all these tumours related to smoking and alcohol exposure and the rates of those are going down.”

Patients with HPV-linked throat tumours have better survival prospects, at around a 90 per cent chance of still being alive without any progression of the disease two years after diagnosis, but the side effects of treatment can be severe.

Waikato ENT doctors Theresa Muwanga-Magoye and Julian White have said that in the US, the male oropharyngeal cancer rate exceeds the cervical cancer rate, and that reasons for this may include HPV vaccination of girls, cervical screening of women, smoking, alcohol and other lifestyle factors.

Dr White said that because the rate of male oropharyngeal cancer in New Zealand had risen significantly closer to the cervical cancer rate, “it should be seen as just as important as cervical cancer when discussing HPV-related cancers and their prevention and treatment”.

Gayle Dickson, of the Gardasil Awareness NZ group, has started an online petition calling for the suspension of Gardasil vaccination until various overseas actions, including legal cases against the vaccine supplier, “have been completely carefully analysed”. The petition has more than 1500 supporters.

Internationally and in New Zealand, deaths and serious illnesses have been blamed on the vaccine.

However, the NZ Health Ministry says the vaccine has a “good safety profile”.

More than 200,000 New Zealand females have received the vaccine since 2008. By last June, 568 cases of adverse reactions had been reported following vaccination, including 41 considered serious.

The ministry, citing overseas authorities and New Zealand’s Medicines Adverse Reactions Committee, says they have found “no association between HPV immunisations and a range of health conditions including chronic fatigue syndrome, auto-immune conditions, multiple sclerosis, complex regional pain syndrome, postural orthostatic tachycardia syndrome and sudden death”.

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Costco Wholesale to stop selling tobacco products at hundreds of locations

Mon, Mar 21, 2016

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Source: www.medicaldaily.com
Author: Jaleesa Baulkman

Sorry smokers, but you’ll have to go someplace other than Costco to get your cigarettes.

The New York Daily News reported the retailer has spent the past few years quietly phasing tobacco products out of nearly 300 stores; there are 488 in total. Tobacco smoke has been linked to adverse health effects, such as lung and oral cancer, though that’s not why Costco did it. Instead, the company said the decision was more about business than public health.

“Tobacco is a very low margin business, tends to have higher theft and is labor intensive in some cases (due to local municipality regulations) — further, we felt we could better use the space to merchandise other items,” a spokesman from Costco told The Street.

According to The Street, Costco officials first hinted at the ban during a call with analysts, where they said tobacco sales had fallen to a “low double digit.” The company hasn’t made an official announcement because “[press releases] are a waste of money.”

The retail giant’s move is another blow to the tobacco industry, which has seen a significant drop in the percentage of Americans who smoke in the past 50 years. In 2014, the smoking rate hit an all-time low of 17.8 percent, and the rate is still dropping, The Huffington Post reported. Not to mention other retailers have quit selling these kinds of products, too.

In 1996, Target was the first large retail store to stop selling cigarettes, citing costs related to efforts to keep cigarettes out of the hands of minors, The New York Times reported. In 2014, CVS also stopped selling cigarettes in its 7,600 of its pharmacies nationwide. However, unlike Costco and Target, CVS said its decision was an effort to “help people on their path to better health.”

“CVS Caremark is continually looking for ways to promote health and reduce the burden of disease,” CVS Caremark Chief Medical Officer Dr. Troyen A. Brennan previously said in a statement. “Stopping the sale of cigarettes and tobacco will make a significant difference in reducing the chronic illnesses associated with tobacco use.”

Cigarette use is responsible for the deaths of more than 480,000 people each year, according to the Centers for Disease Control and Prevention. Despite the many studies and graphic anti-smoking ads shedding light on the cancers and diseases associated with the habit, more than 20 percent of men and more than 15 percent of women in the United States still light up.

CVS’ ban did lead to a 1 percent decrease in cigarette sales, so who’s to say Costco’s elimination won’t have a similar effect?

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The Oral Cancer Foundation’s Founder, Brian R. Hill, honored by the Global Oral Cancer Forum – International oral cancer community honor his accomplishments in the field.

Fri, Mar 11, 2016

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Source: www.prnewswire.com
Author: The Oral Cancer Foundation
 

Bryan R. Hill receiving the award at the Global Oral Cancer Forum. (PRNewsFoto/Oral Cancer Foundation)

NEWPORT BEACH, Calif., March 10, 2016 /PRNewswire-USNewswire/ — At the recent Global Oral Cancer Forum (GOCF), Brian R. Hill, Executive Director and Founder of the Oral Cancer Foundation (OCF), was honored for his work as an advocate and innovative thinker in the oral cancer arena. The GOCF organizers and community awarded Hill the 2016 Global Oral Cancer Forum Commitment, Courage and Innovation Leadership Award for his dedication and contributions to the field of oral cancer over the last 18 years. Upon accepting the award, Hill received a standing ovation from those in attendance, which included global oral cancer thought leaders, researchers, treatment physicians, other non-profit organizations and representatives from various government agencies, including the National Institutes of Health / National Cancer Institute, and the World Health Organization (WHO).

When asked about being honored Hill said, “In the beginning and for many years I was alone at OCF and it was just the seed of an idea. Those grassroots efforts matured into a robust network of important relationships with a common goal. Today OCF is so much more than just me and my singular efforts. Through the benevolence of the many OCF supporters, particularly in the RDH, dental/medical professional communities and survivor groups, OCF has grown into a powerful national force for proactive change of the late discovery paradigm, access to quality information, disease and patient advocacy, funding of research, and patient support.” Hill acknowledges that he had the mentorship of some of the brightest minds of the non-profit world to build his understanding of appropriate governorship of an entity such as OCF, as well as support from core researchers and treatment professionals in the oral cancer arena. “To paraphrase someone far more famous, if I was able to see farther than others had going before me, it was because I stood on the shoulders of many highly accomplished others who helped me achieve my goals,” says Hill.

Hill, a stage four oral cancer survivor, became a student of the disease after his own diagnosis left him looking for answers. Since founding OCF and overseeing the path and initiatives of the foundation for more than a decade and a half, Hill often finds the advocacy role suits him well. He has championed anti-tobacco legislation within the political system, and is an advocate at various government entities such as the CDC regarding vaccination of boys against the virus known to be the primary cause of most oropharyngeal cancers.  He also sits on two National Institutes of Health (NIH) oversight committees—one at the National Cancer Institute (NCI), which oversees clinical trials in immunotherapies in head and neck cancers, the other at the National Institute of Dental and Craniofacial Research (NIDCR) reviewing trials looking at long-term outcomes and complications of treatment in head and neck cancers. In addition, Hill still one-on-one counsels patients, participates in OCF’s online Patient Support Forum, and is often the voice for a community that has lost its own, through many diverse media interviews and lectures.

While OCF has received many awards for its advocacy work and contributions to the battle against oral cancer, including recognition from the NIH/NIDCR, WHO, Great Non-Profits, various universities and professional medical and dental societies, and even Internet guru Mashable.com for innovations in applying technology to serve its health oriented goals, receiving recognition from this forums organizers and some of the  leading authorities on oral cancer in the international community is particularly meaningful. Those in attendance are recognized as experts in the field and understand the challenges and importance of the work OCF has undertaken. Sponsored by the Henry Schein Cares Foundation, the benevolent arm of the powerful Henry Schein Inc., known for its long-term commitment to improve issues related to oral care, The Global Oral Cancer Forum’s vision is to build partnerships that will promote the changes required for a substantial impact on the incidence, morbidity, and mortality of oral cancer worldwide. The importance of the Schein organization’s leadership in creating this venue cannot be overstated.

Top oral cancer experts and advocates from around the world, representing countries as far away as Japan, China, and India as well as from the Americas, convened over the weekend to attend the inaugural forum. Attendees included clinicians, scientists, epidemiologists, activists, public health experts, as well as OCF Directors and other NPO organization heads who are working hard to find impactful avenues to reduce the global oral cancer burden. Attendees met to exchange ideas and learn from one another about what is and isn’t working in the global realm of this disease. Delegates from thirty-three countries presented new research findings and discussed their unique challenges and approaches to understanding and addressing one of the leading burdens of the cancer world.

Globally, the incidence rate for oral cancer is growing and has reached what many experts are calling epidemic proportions. This year approximately half a million patients will be newly diagnosed with an oral or oropharyngeal cancer. Among the topics discussed by GOCF panelists were the rise in disease incidence and the regional disparities and factors affecting global populations. Communities throughout much of South East Asia report a high percentage of the population chewing betel and areca nut, a significant risk factor for the development of oral cancer. Meanwhile in the U.S. and other developed countries the prevalence of the HPV virus is the leading contributor to the rising rates of oropharyngeal cancers. Identifying these differences is vital to the development of effective prevention, public policy, and treatment strategies. Advancement of a universal understanding of what the problems are and what initiatives are working around the globe, reveals commonalities, and within them the group will find its beginning joint efforts to effect change.

Looking forward there is clearly much work to be done. The good news is that there are significant strides being made in research and treatment; but balancing those positives, there are also significant shortcomings in current governmental policies, prevention, and public awareness and understanding. Hill said, “While I and OCF are very proud to have been chosen by the organizers, and the global oral cancer community to receive this award, it only serves to motivate us to strive to accomplish more. We have built relationships here that will translate into new avenues of endeavor for OCF in the future.” Jamie O’Day, OCF’s Director of Operations, also attended the conference and spent her time networking with her counterparts from around the world. Many new ideas were garnered from these discussions that will be applied in future OCF initiatives and support OCF’s mission to reduce the suffering caused by this disease both nationally and globally.

About the Oral Cancer Foundation:
The Oral Cancer Foundation, founded by oral cancer survivor Brian R. Hill, is an IRS registered non-profit 501(c)(3) public service charity that provides vetted information, patient support, sponsorship of research, as well as disease and risk factor reduction advocacy related to oral cancer. Oral cancer is the largest group of those cancers that fall into the head and neck cancer category. Common names for it include such things as mouth cancer, tongue cancer, tonsil cancer, head and neck cancer, and throat cancer. The Oral Cancer Foundation maintains the websites: www.oralcancer.org , www.oralcancernews.org , www.oralcancersupport.org , which receive millions of hits per month. Supporting the foundation’s goals is a scientific advisory board composed of leading cancer authorities from varied medical and dental specialties, and from prominent educational, treatment, and research institutions in the United States. The foundation also manages the Bruce Paltrow Oral Cancer Fund, a collaboration between the Paltrow family represented by Ms. Blythe Danner (Paltrow), Gwyneth Paltrow, Jake Paltrow and the Oral Cancer Foundation.

Media Contact: Jamie O’Day / The Oral Cancer Foundation (949) 723-4400 jamie@oralcancerfoundation.org

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HPV rates down, CDC credits vaccine

Wed, Mar 2, 2016

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Source: www.thv11.com
Author: Winnie Wright

Researchers say the rates of a cancer causing virus are on the decline thanks to vaccinations. In recent years, vaccinations have become a hot-button issue for parents and the HPV vaccine was no exception.

When the CDC began recommending the Human papillomavirus vaccine in 2006, there was a lot of push back from parents. A new study from the CDC says the rates of HPV infection are down 63 percent among girls ages 14 to 19 in the last decade and it credits the HPV vaccination.

The vaccine was very controversial when it hit the main stream 10 years ago, and THV11 wanted to know, have those findings changed parents’ minds about the vaccination?

“I think there was a great fear that the HPV Vaccine was some sort of signal to adolescent girls that sex was safe. And that there would be an increase in sexual activity and promiscuity, and in fact, that’s not happened. We’ve seen sort of the opposite,” explained Dr. Gary Wheeler, CMO for the Arkansas Department of Health.

HPV is most commonly spread through sex. According to the CDC, an estimated 79 million females aged 14-59 are infected with HPV. 14 million new infections are reported in the U.S. each year.

When Gardasil, the HPV vaccine, was introduced in 2006, it was a hard pill for many parents to swallow. The vaccine is especially encouraged for children under the age of 12, because it’s most effective the younger you are. Parents didn’t want to think of their kids as being sexually active at that age.

“I mean, of course nobody likes to think ‘my child is going to be sexually active’, but life happens and just sticking your head in the sand and pretending like it’s never ever going to happen, to me is just somewhat foolish’,” said Kate Bueche, a pro-HPV Vaccine parent.

According to Cancer.gov, virtually all cases of cervical cancer are caused by HPV.

For Bueche, the subject hits close to home. She survived early stages of cervical cancer and had her daughter vaccinated for HPV, in hopes that she won’t have to go through that same ordeal.

“You get the flu vaccine and you may still get the flu, but why not go ahead and get the vaccine and cut your chances for it.”

But not all parents agree. We asked our THV11 Facebook friends if the CDC’s recent findings changed their opinions of the HPV vaccine. One mother said: “Not anymore. My daughter had the shot and she had a seizure right after.” Another mother said: “Not after reviewing the newest reports of side effects. “One mother even got the shot for her son. She said: “My son took the shots without any adverse side effects. If I had to make the choice again, I would have him take it again.”

Dr. Wheeler says vaccinating men is the next step in lowering the number of HPV infections. Most men who get HPV never develop symptoms, but they can still spread the infection.

“Males are at risk for cancer. They can have HPV-associated genital cancer, and also oral cancers because of sexual practices that would lead to HPV infection.”

The CDC now recommends the HPV vaccine for boys beginning at 11-years-old. There are also talks about including the HPV vaccine in infant vaccines, or even making it mandatory.

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Blue Jays welcome City of Toronto’s proposed ban on chewing tobacco

Wed, Mar 2, 2016

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Source: www.theglobeandmail.com
Author: Robert Macleod and Jeff Gray

For years, it was a right of passage at the Toronto Blue Jays’ spring training camp here. Manager John Gibbons would earnestly proclaim that he was finally giving up smokeless tobacco, a personal ban that would usually only last a couple of weeks before he would be seen “dipping” once again.

It is a terrible habit, Gibbons will tell you, and that’s the reason he said he would support a City of Toronto proposal to prohibit the use of chewing tobacco at all public parks, baseball fields and hockey rinks. The prohibition would also apply at Rogers Centre, where many of the players openly use chewing tobacco.

“Tobacco’s a nasty habit,” Gibbons said. “I did it for a long, long time. I’m not proud of that. And whatever they can do to get rid of it, especially kids from doing any of that, I’m all for it.”

Toronto’s proposal to ban chewing tobacco is being spearheaded by Councillor Joe Mihevc, who is chairman of the city’s board of health. Mihevc says he intends to introduce a motion at the board’s March 21 meeting asking that officials study a potential ban that’s being supported by the Canadian Cancer Society and various anti-tobacco groups.

“Professional athletes are role models for young people,” he said, “and we need to make sure they are not promoting bad habits or tobacco use as a part of sports culture.”

Mihevc cited statistics that show a rising number of students across Ontario in Grades 7 to 12 are using smokeless tobacco, with one survey estimating that it is being used by 6 per cent of students in this age group. That number is up from 4.6 per cent in 2011. It means an estimated 58,200 students could be using it across the province, although the survey suggests use in Toronto is much lower, at 3 per cent.

Cancer researchers and health experts say chewing tobacco causes oral, pancreatic and esophageal cancer, as well as lesions in the mouth and tooth decay.

Mihevc announced his intentions at a news conference at Toronto’s City Hall on Monday attended by anti-tobacco campaigners and representatives from the Canadian Cancer Society. Also in attendance was Stephen Brooks, senior vice-president of business operations with the Blue Jays. Mihevc praised the Blue Jays and Major League Baseball for their support. Brooks said the club’s management backs the idea of a ban, something that city officials in New York, Boston, San Francisco and Los Angeles have already done.

He said MLB cannot bring in a league-wide ban unless it negotiates one into the players’ collective agreement. However, players and coaches are expected to abide by local bylaws wherever they happen to be playing. Brooks acknowledged there could some resistance from players, but declined to say which Blue Jays players use chewing tobacco.

“While certainly, I’m sure there will be pushback from players, this is very much in the spirit of what Major League Baseball has been advocating,” Brooks said.

Mihevc said he doubted bylaw officers would actually be deployed into the Blue Jays’ and visitors’ dugouts to make sure players were adhering to the law should it be enacted. He said the bylaw would be enforced as most bylaws are actually enforced – through conversations between citizens and social pressure.

Michael Perley, director of the Ontario Campaign for Action on Tobacco, said it is not just baseball where chewing tobacco has a long history; the habit is also common among amateur hockey players. This is despite bans, he said, by the National Hockey League, the Greater Toronto Hockey League and Baseball Ontario. Bylaws would strengthen league policies, he said.

For Gibbons, it took a lot to finally give up chewing tobacco, but he is happy he did. He is closing in on the second anniversary of going tobacco-free. He said the death in June, 2014, of former MLB great Tony Gwynn prompted him to get serious about quitting.

Gwynn was only 54 when he died after battling parotid (mouth) cancer, an illness he always maintained was caused by a chewing tobacco habit he picked up during his playing career.

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Having a partner increases cancer survival rates: Australian study

Wed, Mar 2, 2016

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Source: www.theaustralian.com.au
Author: Sean Parnell

People diagnosed with cancer are more likely to die if they do not have a partner, according to a new Australian study.

Researchers from Cancer Council Queensland and Queensland University of Technology examined 176,050 cases of the 10 most common cancers in Queensland, diagnosed between 1996 and 2012. They found the chance of death was 26 per cent higher for men who did not have a partner compared to those who did, and 20 per cent higher for women who did not have a partner, across all cancers.

“The reasons for higher survival in partnered patients still remains unclear, but are likely to include economic, psychosocial, environmental, and structural factors,” CCQ professor Jeff Dunn said yesterday.

“Having a partner has been linked to a healthier lifestyle, greater financial resources and increased practical or social support while undergoing treatment.

“Support from a partner can also influence treatment choices and increase social support to help manage the psychosocial effects of cancer.”

The increased risk varied depending on the type of cancer. For men without a partner, it ranged from 2 per cent for lung cancer to 30 per cent for head and neck cancer, while for women without a partner it ranged from 2 per cent for kidney and lung cancer to 41 per cent for uterine cancer.

“Health professionals managing cancer patients should be aware of the increased mortality risk among unpartnered patients, and tailor follow-up treatment accordingly,” Professor Dunn said.

Of the 176,050 patients analysed for the study, 68 per cent had a partner, which included those who were married or in a de facto relationship. The researchers published their findings in the journal Cancer Epidemiology and suggested a better understanding of the relationship factor might help improve cancer management and outcomes.

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Imaging, physical examination find most recurrences of HPV-positive oropharyngeal cancer

Wed, Mar 2, 2016

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Source: www.oncologynurseadvisor.com
Author: Kathy Boltz, PhD

Posttreatment imaging at 3 months and physical examinations during the 6 months following treatment can detect most recurrences in patients treated with definitive radiation therapy for oropharyngeal cancer caused by human papillomavirus (HPV).1 This research was presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium.

A dramatic increase in oropharyngeal squamous cell carcinoma (OPSCC) cases associated with HPV has been reported by the American Cancer Society. Survival rates after definitive radiation therapy have also increased. This has led to the need to determine general time to recurrence and the most effective modes of recurrence detection, to guide standards for optimal follow-up care by oncology teams.

This study examined 246 cases of HPV-positive or p16-positive non-metastatic OPSCC treated with definitive radiation therapy at a single, large-volume cancer center between 2006 and 2014.

Follow-up care included a PET/CT scan 3 months after completing treatment and physical examinations every 3 months in the first year following treatment, every 4 months in the second year and every 6 months in years 3 through 5. Median follow-up care length for all patients was 36 months. Patient outcomes, including recurrence and survival rates, were calculated using the Kaplan-Meier method from the end of radiation therapy.

Most recurrences were detected either by persistent disease appearing on 3-month post-treatment imaging or by patients presenting with symptoms at follow-up examinations.

Disease characteristics that increase the likelihood of recurrence include presenting with 5 or more nodes or having level 4 lymph nodes (P < .05). Distant metastases were a greater risk in patients with a lymph node larger than 6 cm or with bilateral lymphadenopathy (P < .05). “For most patients with HPV-associated oropharynx cancer, after a negative 3-month PET scan, physical exams with history and direct visualization are sufficient to find recurrences,” said Jessica M. Frakes, MD, an assistant member of the department of radiation oncology at the H. Lee Moffitt Cancer Center in Tampa, Florida, and lead author in the study. “Minimizing the number of unnecessary tests may alleviate the financial and emotional burden on these patients, including overall health care costs, time spent away from work and family, and the anxiety of waiting for scan results.” This study also supports the effectiveness of specialist teams in treating HPV-positive OPSCC with definitive radiotherapy (RT). Within 3 years, local control was achieved in 97.8% of all patients in the study; regional control in 95.3%; locoregional control in 94%; and freedom from distant metastases in 91.4%. The 3-year overall survival rate was 91%. “We were pleasantly surprised by the high cure rates and the low permanent side effect rates for these patients,” said Frakes. “These findings demonstrate that individuals with HPV-associated oropharyngeal cancer who are treated with definitive RT and cared for by multidisciplinary specialists have excellent outcomes.” Reference: 1. Frakes JM, Naghavi AO, Strom T, et al. Detection of recurrence in HPV associated oropharynx squamous cell carcinoma. Presented at 2016 Multidisciplinary Head and Neck Cancer Symposium; Scottsdale, AZ; February 18, 2016. Abstract 6.

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Cancer gene may aid researchers find how immune system can help treat cancer or predict outcomes

Wed, Mar 2, 2016

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Source: immuno-oncologynews.com
Author: Daniela Semedo, PhD

University of Cincinnati scientists have recently discovered that DEK, a human gene known to cause cancer, can be detected in the plasma of patients with head and neck cancer. DEK may help clinicians understand how a person’s immune system can be used to treat cancer or predict outcomes for patients.

The information, titled “The DEK oncogene can be detected in the plasma of head and neck cancer patients and may predict immune response and prognosis,” was presented via poster at the Multidisciplinary Head and Neck Cancer Symposium Feb. 18-20 in Scottsdale, Arizona.

“Head and neck cancer remains the sixth most common cancer worldwide,” said Trisha Wise-Draper, M.D., Ph.D., assistant professor in the Division of Hematology Oncology at the UC College of Medicine, in a news release. Wise-Draper is a member of both the Cincinnati Cancer Center and UC Cancer Institute and she was the principal investigator on this study.

“Although infection with the human papilloma virus, or HPV, has emerged as a factor for determining outcomes for head and neck squamous cell carcinoma [head and neck cancer], leading to less intense treatment strategies for patients, no plasma biomarkers exist to predict tumor response to treatment or possible relapse,” she said.

“One potential plasma biomarker is programmed by the human DEK gene, which has been found to promote cancer. DEK RNA and protein are highly increased in tissue specimens from several tumor types, including head and neck cancer, breast cancer, and melanoma, and antibodies to DEK also are detected in patients with autoimmune diseases like juvenile rheumatoid arthritis and lupus,” Wise-Draper said. “Our previous work has shown that DEK is highly and universally present in head and neck cancer tissue specimens regardless of stage or HPV infection, and has suggested tumor-association. In addition, white blood cells (macrophages) secrete DEK protein, leading to the hypothesis that DEK may be present in the plasma of cancer patients and could be correlated with aggressiveness of disease and patient outcomes.”

DEK mRNA and protein expression are up-regulated in the tissue of patients with head and neck cancer, with previous studies demonstrating that DEK is highly expressed in tissue samples of patients with head and neck cancer, regardless of the cancer stage or status of HPV infection.

Wise-Draper and colleagues used whole blood from either patients with newly diagnosed and untreated head and neck cancer or age-matched normal healthy participants. Plasma was separated from the samples, and an enzyme-linked immunosorbent assay (ELISA), a test that uses antibodies and color change to identify a substance, was administered.

The results revealed that DEK could be detected in the plasma of patients with head and neck cancer and in healthy controls. However, compared to people without cancer, those with cancer had decreased levels of DEK, which inversely correlated with plasma levels of interleukin-6.

“We found that DEK was present in the plasma of both healthy control subjects and those with head and neck cancer,” Wise-Draper said. “Overall, DEK was decreased in head and neck cancer patients compared to healthy patients, but it was inversely correlated with IL-6, which is secreted by T-cells (white blood cells that play a role in immunity) and triggers an immune response in the plasma.

“The immune system’s reaction to the tumor also appeared to be linked with high DEK plasma levels. So, although DEK presence is increased in head and neck cancer tissue, plasma DEK levels are decreased in patients when compared with healthy individuals and are further decreased in patients with advanced cancers,” she said.

The results from this study, along with DEK’s link to IL-6 levels, indicate that high levels of DEK may mean better outcomes for patients.

“Furthermore, high DEK levels in the plasma may predict better immunotherapy in terms of cancer treatment,” Wise-Draper said. “Further analyses are ongoing to determine whether DEK levels predict response to various treatments, correlate with the body’s immune response, and whether DEK presence in the serum (in blood, serum includes all proteins not used in blood clotting and all the electrolytes, antibodies, antigens, hormones or any external substances, like drugs) will predict remaining disease or early relapse.”

“This information will be important to verify DEK plasma measurements as a clinically useful test and may give insight to future personalized and targeted treatment strategies for head and neck cancer,” Wise-Draper said.

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Why a Cure For Cancer Is Possible

Tue, Mar 1, 2016

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Source: www.fortune.com
Author: Robert Mulroy
 

BERLIN, GERMANY - SEPTEMBER 05:  A doctor holds a stethoscope on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday.  (Photo by Adam Berry/Getty Images)

Cutting drug prices is not out of the question.

A crapshoot is defined as a risky or uncertain matter; something that could produce a good or bad result. President Obama’s moonshot on cancer is different in terms of its greater complexity and higher moral purpose — but unfortunately, not in its probability of success.

The Audacity of Scope

President Obama has asked Congress for $755 million to “focus” on immunotherapy, combination therapy, vaccines that prevent cancer causing viruses, and early detection techniques. According to Vice President Joe Biden, who will coordinate 13 government institutions in this research, “Our job is to clear out the bureaucratic hurdles, and let science happen.”

It is hard not to welcome such an initiative. Cancer has deposed heart disease as the number one killer in 22 American states. Experts project the number of global cancer cases will double in the next 15 years. But we are better at projecting the demand for innovation than we are at producing it; and we are even better at making promises we can’t keep and polices that don’t work.

President Roosevelt created the National Cancer Institute in 1937. Nixon declared a “war on cancer” with the National Cancer Act in 1971. The Bush administration spoke in 2003 of spending $600 million per year to rid the world of cancer by 2015. Obama and Biden made campaign promises to fight cancer in 2008, and should be lauded for trying to keep them, but their approach needs a lot of work.

The underlying assumption is that we should spend as much money, and use as many public and private constituencies to do as much as we can on as many paths as possible. There are three things wrong with this: first, $755 million is a measly sum under the current paradigm drug development. It can cost a company up to $5 billion and a full decade to bring one cancer-fighting drug to market. Second, we have tried this strategy before. Doing the same thing again, only harder, will lead to numerous failures whose cost will be passed on to the insurance companies and their customers in the form of high drug prices. Third, the answer is right in front of us.

We use the term moonshot to reference JFK’s successful space program, but don’t apply its deepest insights. We in the cancer fighting community lack that program’s predictive models, which were the key to its success. Despite severe technological limitations, NASA believed in predictive models based in math, engineering and physics. They modeled, for example, gravity’s influence on earth launches, moon landings, and human tissue. The models told them exactly what tools were needed to do the job. Only then did they build spacecraft to accomplish our goals.

Meanwhile, back on earth, we build tools before we understand the problem of cancer. Two-thirds of published research cannot be reproduced. In the post-genomic era, the FDA approves only 7% of drugs that enter cancer clinical research. Over the past five years, twice as many trials have resulted in only a 10% increase in approvals. Industry investment in R&D has gone backwards, and with it comes a soaring cost of innovation that drives drug prices. Imagine the public tumult, the demand for our leaders to resign, if only one in 14 of rockets carried our astronauts safely!

Great Strategy is Reconciling what Others Believe are Opposites

The discussion we should be having is how to cure cancer and lower drug prices at the same time. Cancer is a multidimensional, ever-changing disease of the entire cell system. The standard focus on individual targets — while supporting publications to drive academic careers and intellectual property that supports high-risk industry investment — has failed. The secrets of biology lay in the interactions between molecules: the dynamics. We need to hack into a human cell as if it were a computer and decode the operating system: switch these proteins off to cure pancreatic cancer, turn others on to end heart disease, and deliver smart growth factors to regenerate neural tissue.

If predictive engineering was the impetus behind space travel, then systems biology can spur innovation and foster initiatives of “cell exploration.” Systems biology is the method of building models of complex biological environments so we can design the right drug from the start. These drugs would have fewer off-target effects and last longer at the disease site. They would also cost less because the cost of failure of the present “scattershot” system of drug discovery would not be passed along to the consumer.

The NIH is a national treasure that houses the tiny National Centers for Systems Biology, a network of our top academic institutions and thought leaders who are already on the path to uncovering cellular secrets. But last year, of the $25 billion in grants supported by the NIH, those aimed at the truly transformational opportunity of systems biology totaled a mere $8 million, or .032% of the total.

Many of us now know that a “war on cancer,” campaign promises massive infusions of capital, top-down political coordination and even the genomic revolution do not come close to the value created by a greater understanding of systems biology. If we call it a moonshot, but don’t comprehend the real key to putting a man on the moon, how is that different than a crapshoot?

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

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Immunotherapy Continues to Advance in Head and Neck Cancer

Mon, Feb 29, 2016

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Source: www.onclive.com
Author: Megan Garlapow, PhD
 

Concomitant administration of motolimod with cetuximab (Erbitux) increases the innate and adaptive immune response in the blood and the tumor microenvironment in head and neck squamous cell carcinoma (HNSCC), overcoming negative prognostic biomarkers of cetuximab therapy alone, according to the biomarker data from a recent phase Ib clinical trial that was presented at the 2016 Head and Neck Cancer Symposium. The trial was recently amended to add nivolumab to the combination of cetuximab and motolimod.

Robert-FerrisDr. Robert Ferris, MD PhD

 

“We know that PD-1 and PD-L1 are overexpressed in head and neck cancer, and so it was somewhat irresistible to combine our baseline treatment of cetuximab and motolimod with the PD-L1 inhibition pathway. EGFR itself drives PD-L1, so combining cetuximab with anti-PD-1 inhibitor makes sense. So, we’ve amended this trial. We’re now accruing to treatment with cetuximab, motolimod, and the anti–PD-L1 nivolumab in this trial,” said lead author Robert Ferris, MD, PhD, professor, Departments of Otolaryngology, Radiation Oncology, and Immunology, Cancer Immunology Program, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.

According to the authors of the phase Ib data presented at the symposium, the rationale for combining cetuximab with motolimod (VTX2337) as neoadjuvant therapy was that cetuximab induces cellular immunity that correlates with neoadjuvant clinical response. The phase I dose-escalation and safety of the combination had been established (NCT 01334177).

This study of neoadjuvant cetuximab and motolimod had accrued 14 patients with HNSCC that was stage II-IV, resectable, and located in the oropharynx, oral cavity, hypopharynx, or larynx. These patients were biopsied, treated with cetuximab and motolimod for 4 weeks, and then underwent surgery. The endpoints of the trial were the modulation of immune biomarkers.

Interferon-inducible cytokine IP-10 increased after the patients were administered neoadjuvant cetuximab and motolimod (P = .0001). After the neoadjuvant treatment, the peripheral blood lymphocytes had an increased frequency of EGFR-specific CD8 T cells. After the neoadjuvant treatment, regulatory T cells had decreased suppressive receptors and transforming growth factor-β, which induces Foxp3. Also, after the neoadjuvant treatment, circulating MDSCs had decreased PD-L1 (P <.07) and macrophages had increased CD16 expression (P <.07).

After the neoadjuvant treatment with cetuximab and motolimod, genotyping of T-cell receptors showed increased clonality in peripheral blood lymphocytes (P = .003 by Wilcox signed rank test) and tumor-infiltrating lymphocytes (P = .081 by Wilcox signed rank test). Most patients are more oligoclonal than healthy individuals, and some are very clonal with highly prominent expanded clones. Genotyping of T-cell receptors found that clonality was increased by the combination of cetuximab and motolimod compared with treatment with cetuximab alone.

Recent studies have indicated that the PD-1/PD-L1 pathway is upregulated in the HNSCC microenvironment, and that EGFR blockade prevents interferon-γ-mediated upregulation of PD-L1. Thus, this study has been amended to add nivolumab to the adjuvant treatment with cetuximab and motolimod. The endpoints are still the modulation of immune biomarkers.

The aim is to target the tumor microenvironment, such that tumor immune escape is reversed and T cells eliminate HNSCC. Antitumor T cells are reprogrammed to reverse inhibitory signals. Combining the toll-like receptor agonist, motolimod, with cetuximab and with PD-1 pathway inhibitors, such as nivolumab, may enhance the priming and activity of T cells.

“Targeting the tumor microenvironment requires understanding as well as reversal of immune escape mechanisms in the cellular compartment. Reprogramming antitumor T cells to reverse inhibitory signals can be done by directly disrupting those inhibitory signals, the so-called checkpoint receptor field, and can be done potentially by combining proinflammatory signals, such as toll-like receptor agonists, to chemo-attract cells into the microenvironment and to create good inflammation to overcome suppressive factors,” said Ferris.

Recent findings have shown tremendous promise for nivolumab in head and neck cancer. Bristol-Myers Squibb (BMS) announced in January 2016 that nivolumab improved overall survival versus investigator’s choice of therapy for patients with platinum-refractory squamous cell carcinoma of the head and neck in the phase III CheckMate-141 trial. Findings from the study are being discussed with the FDA and other health authorities, according to BMS.

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