Radiation alone may suffice for some nasopharyngeal cancer

Source: www.medpagetoday.com Author: Ed Susman, Contributing Writer, MedPage Today In selected patients with nasopharyngeal carcinoma, radiation alone may do as much against the disease as the combination of radiation and chemotherapy but with fewer adverse effects, researchers suggested here. About 90% of patients who received radiation alone achieved failure-free survival at 3 years versus 91.9% of patients treated with both radiation and chemotherapy (P=0.86; non-inferiority P<0.001), reported Jun Ma, MD, PhD, of Sun Yat-sen University Cancer Center in Guangzhou, China. In his virtual oral presentation at the annual meeting of the American Society of Clinical Oncology, Ma also reported that 98.2% of patients treated with radiation alone survived to 3 years compared with 98.6% of patients who got both radiation and chemotherapy (P=0.30). The multifaceted subgroup analysis almost entirely favored treatment with alone. There was no difference in distant metastasis-free survival (95% in both arms) or local-regional recurrence-free survival, with both arms hovering in the 90-92% level. And patients treated with both therapeutic modes paid a price in adverse events (AEs), Ma reported, noting that grade 3 to 4 mucositis was observed in 18.9% of patients on chemoradiation but in just 9.7% of those on radiation therapy alone. A similar story in AEs was observed for leukopenia, neutropenia, nausea (0.6% vs 13% grade 3-4), vomiting (1.2% vs 14.8%), anorexia (4.8% vs 29%), and weight loss. That differential in AEs was reflected in quality of life measurements, with better scores in the radiation-only group as far as their global health status, [...]

Docetaxel plus radiation new standard of care in cisplatin-ineligible head and neck cancer

Source: www.healio.com Author: Devin McLaughlin Perspective author: Marshall Posner, MD Docetaxel prolonged DFS (disease free survival) and OS (overall survival) when added to radiation for cisplatin-ineligible patients with locally advanced head and neck squamous cell carcinoma, according to study results presented at ASCO Annual Meeting. The addition of docetaxel also did not appear to worsen quality of life at 6 months, researchers concluded. “This now represents the new reference standard of care for cisplatin-ineligible patients planned for chemoradiotherapy,” Vanita Noronha, MD, of the department of medical oncology at Tata Memorial Center in Mumbai, India, said during a presentation. Background and methods Docetaxel has shown promise in phase 1 and phase 2 studies among patients unsuitable for cisplatin — a standard therapy in chemoradiation for locally advanced HNSCC, according to Noronha. However, limited prospective data exist in this setting. The open-label, randomized phase 3 study by Noronha and colleagues examined docetaxel as a radiosensitizer among 356 cisplatin-ineligible patients with locally advanced HNSCC set for treatment with radical or adjuvant chemoradiation. Researchers randomly assigned patients to radiation alone (n = 176) or with concurrent docetaxel dosed at 15 mg/m2 weekly for up to seven cycles (n = 180). Patients in the docetaxel group received a median six cycles of the treatment. The radiotherapy-alone and combination therapy groups had similar baseline characteristics, including median age (63 years vs. 61 years), ECOG performance status (59.7% vs. 50.6%) and reasons for cisplatin ineligibility (low creatinine clearance, 26.7% vs. 26.1%; hearing loss, 42.6% vs. 45%; ECOG [...]

Gabapentin may cut opioid needs for oral mucositis pain during radiotherapy

Source: medicalxpress.com Author: staff For patients receiving concurrent chemoradiotherapy for squamous cell carcinoma of the head and neck, higher doses of gabapentin are well tolerated and associated with delayed time to first opioid use for additional pain control during radiotherapy (RT), according to a research letter published online May 18 in JAMA Network Open. Sung Jun Ma, M.D., from the Roswell Park Comprehensive Cancer Center in Buffalo, New York, and colleagues performed a secondary analysis of two clinical trials involving 92 patients receiving concurrent chemoradiotherapy for nonmetastatic squamous cell carcinoma of the head and neck and prophylactic oral gabapentin (titrated to 900 mg versus 2,700 mg daily in one study and 3,600 mg daily in the other study). The researchers found that most patients tolerated gabapentin per protocol. The time to first opioid use for additional pain control was greatest in the 3,600-mg cohort in the multivariable competing risks model. The smallest proportion of patients requiring opioids during RT was seen in the 3,600-mg cohort compared with the 900-mg and 2,700-mg cohorts (37.5, 93.1, and 61.3 percent, respectively). Compared with the 3,600-mg cohort, the odds of feeding tube placement were significantly greater during RT in the 2,700-mg cohort; the odds were not significantly greater in the 900-mg cohort. "Although gabapentin, 3,600 mg, daily has been adopted as the standard regimen of the Roswell Park Comprehensive Cancer Center, additional studies are warranted to further investigate its role in pain control," the authors write.

Surveillance of ctDNA in HPV-positive head and neck cancers may predict recurrence

Source: www.targetedonc.com Author: Nichole Tucker The detection of circulating tumor DNA (ctDNA) in human papillomavirus (HPV) with an experimental blood test has been associated with high positive predictive value (PPV) and negative predictive value (NPV) for identifying disease recurrence in HPV-positive oropharyngeal cancer, according to a press release from the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center.1 “The major utility of this test is it’s going to improve our ability to monitor patients after they complete treatment,” said Bhisham Chera, MD, associate professor in the UNC School of Medicine Department of Radiation Oncology. “Currently, our methods to assess whether the cancer has recurred are invasive, expensive and not always accurate.” In a prospective biomarker clinical trial published in the Journal of Clinical Oncology, investigators obtained 1006 blood samples for their analysis, 999 of which were evaluable for plasma circulating tumor human papillomavirus DNA (ctHPVDNA). The goal was to determine if surveillance of ctHPVDNA can facilitate earlier detection of recurrence compared with normal clinical follow-up.2 Patients were followed for a median of 23.7 months (range, 6.1-54.7 months), and out of 115 patients, 13% developed disease recurrence (n = 15). Of these recurrences, 1 was local only, 1 was regional only, 10 were distant only, 1 was local and distant, and the remaining 2 were regional and distant. Following treatment, 87 patients had undetectable ctHPVDNA, and none developed recurrence (95% CI, 96%-100%). The development of a positive ctHPVDNA occurred in 28 patients during post-treatment surveillance. The median time to abnormal [...]

2020-02-07T08:57:22-07:00February, 2020|Oral Cancer News|

Machine learning improves the diagnosis of patients with head and neck cancers

Source: www.sciencedaily.com Author: materials from Charité - Universitätsmedizin Berlin Researchers from Charité -- Universitätsmedizin Berlin and the German Cancer Consortium (DKTK) have successfully solved a longstanding problem in the diagnosis of head and neck cancers. Working alongside colleagues from Technische Universität (TU) Berlin, the researchers used artificial intelligence to develop a new classification method which identifies the primary origins of cancerous tissue based on chemical DNA changes. The potential for introduction into routine medical practice is currently being tested. Results from this research have been published in Science Translational Medicine. Every year, more than 17,000 people in Germany are diagnosed with head and neck cancers. These include cancers of the oral cavity, larynx and nose, but can also affect other areas of the head and neck. Some head and neck cancer patients will also develop lung cancer. "In the large majority of cases, it is impossible to determine whether these represent pulmonary metastases of the patient's head and neck cancer or a second primary cancer, i.e. primary lung cancer," explains Prof. Dr. Frederick Klauschen of Charité's Institute of Pathology, who co-led the study alongside Prof. Dr. David Capper of Charité's Department of Neuropathology. "This distinction is hugely important in the treatment of people affected by these cancers," emphasizes Prof. Klauschen, adding: "While surgery may provide a cure in patients with localized lung cancers, patients with metastatic head and neck cancers fare significantly worse in terms of survival and will require treatments such as chemoradiotherapy." When trying to distinguish between metastases [...]

2019-09-13T05:44:12-07:00September, 2019|Oral Cancer News|

Patients with HPV-positive oropharynx cancer should receive chemoradiation

Source: medicalxpress.com Author: provided by European Society for Medical Oncology Patients with human papilloma virus (HPV)-positive throat cancer should receive chemoradiotherapy rather than cetuximab with radiotherapy, according to late-breaking research reported at the ESMO 2018 Congress in Munich. "Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as chemotherapy with radiotherapy and caused less side effects but there has been no head-to-head comparison of the two treatments," said study author Prof Hisham Mehanna, Chair, Head and Neck Surgery, Institute of Cancer and Genomic Sciences, University of Birmingham, UK. Throat cancer is rapidly becoming more common in Western countries. For example in the UK, incidence was unchanged in 1970 to 1995, then doubled in 1996 to 2006, and doubled again in 2006 to 2010.The rise has been attributed to HPV, a sexually transmitted infection. Most throat cancer was previously caused by smoking and alcohol and affected 65-70 year-old working class men. Today HPV is the main cause and patients are around 55, middle class, working, and have young children. HPV-positive throat cancer responds well to a combination of cisplatin chemotherapy and radiotherapy, and patients can survive for 30-40 years, but the treatment causes lifelong side effects including dry mouth, difficulty swallowing, and loss of taste. Patients deemed unable to tolerate chemotherapy, for example because of poor kidney function or older age, receive cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, and radiotherapy. This study compared side effects and survival with the two treatments in [...]

HMB/Arg/Gln does not reduce oral mucositis incidence in head and neck cancer

Source: www.oncologynurseadvisor.com Author: James Nam, PharmD The addition of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine (HMB/Arg/Gln) to opioid-based pain control (OBPC) and oral care programs does not effectively prevent chemoradiotherapy (CRT)-induced oral mucositis (OM) in patients with head and neck cancer (HNC), according to a study published in Supportive Care in Cancer. Chemoradiotherapy with a cisplatin-based chemotherapy regimen is the standard of care for patients with HNC, but is associated with a high incidence of CRT-induced OM. OBPC and oral care programs are insufficient in reducing OM incidence; there is a need for additional interventions to prevent and treat OM. For this phase 2 study, researchers treated 35 patients with HNC scheduled to receive definitive or postoperative cisplatin-based CRT with oral or percutaneous endoscopic gastrostomy-delivered HMB/Arg/Gln; all patients underwent OBPC and oral care programs. Results showed that 45.7% (16) of patients developed symptomatic or functional grade 3 or worse OM. Grade 1 or less OM occurred in 51.1% of patients at 2 weeks and in 82.9% of patients at 4 weeks postradiotherapy completion. Clinical examination, however, revealed that 28.6% (10) of patients developed grade 3 or worse OM, and the incidence of grade 1 or less OM was 80.0% and 100% at 2 weeks and 4 weeks after completing radiotherapy, respectively. The most frequently reported adverse events included diarrhea and an increase in blood urea nitrogen, but were easily managed with standard care. Evidence from the study demonstrates that HMB/Arg/Gln does not effectively decrease OM incidence; however, the authors concluded that “the [...]

New “soft” laser treatment to improve quality of life for cancer patients

Source: www.world-first.co.uk Author: staff A new "soft" laser therapy is to be used nationwide to help prevent patients undergoing treatment for neck and head cancer from suffering severe side effects. The low-level laser therapy (LLLT), or photomedicine, will help prevent patients suffering from soreness in the mouth and throat, dry mouth and swallowing problems. More than 90% of the 4,000 people a year in England and Wales who receive chemoradiotherapy for head and neck cancer experience side effects which can lead to hospital admissions and, in some cases, interrupt the course of radiotherapy. The new treatment, developed by the NHS foundation trusts of University Hospital Southampton and Newcastle Upon Tyne Hospitals, is being trialled nationwide as part of a £1.2 million study funded by the National Institute for Health Research (NIHR). One of the main complications of current treatments is oral mucositis (OM), which affects taste and speech. It causes excessive secretions of saliva, which result in nausea, vomiting and weight loss. Currently, patients are treated with a combination of painkillers and anti-sickness drugs and many require frequent hospital appointments to control their symptoms. Some also need nutritional support through nasal or stomach feeding tubes. LLLT is a drug-free treatment that stimulates damaged cells using a low energy laser beam to reduce pain and inflammation. It's more commonly used to treat musculoskeletal problems such as tendon, bone and nerve damage. Consultant clinical oncologist at Southampton General Hospital Dr Shanmugasundaram Ramkumar said the LLLT would improve quality of life for patients. [...]

Nonsurgical surveillance safe, cost-effective for head, neck cancer

Source: www.healio.com Author: Mehanna H, et al. Patients with head and neck cancer who underwent PET/CT–guided surveillance achieved similar survival outcomes as those who underwent planned neck dissections, according to the results of a prospective, randomized controlled trial. However, surveillance led to fewer surgical operations and complications and appeared more cost-effective than neck dissection, results showed. Patients with head and neck cancer frequently undergo invasive surgery following treatment to remove remaining cancer cells, according to study background. “After treatment, remaining cancer cells play something akin to hide and seek,” Hisham Mehanna, MBChB, PhD, FRCS, chair of head and neck surgery at University of Birmingham and director of the Institute of Head and Neck Studies and Education, said in a press release. “Our study shows that we can hunt them down, find them and remove them effectively.” Mehanna and colleagues sought to define the role of image-guided surveillance compared with planned neck dissection for the management of patients with advanced, nodal head and neck squamous cell carcinoma previously treated with primary chemoradiotherapy. The analysis included data from 564 patients (mean age, 58 years; 82% men) who researchers randomly assigned to PET/CT–guided surveillance (n = 282) performed 12 weeks after the end of treatment or planned neck dissection (n = 282). Oropharyngeal cancer served as the most common cancer subtype (84%). Seventy-five percent of patients had HPV-16–positive disease. Patients assigned surveillance only underwent neck dissection if their PET/CT scans showed incomplete or equivocal response to chemoradiotherapy. The trial was designed to assess [...]

Follow-up by advance practice nurses improves care for patients with head, neck cancer

Source: www.healio.com Author: Anthony SanFilippo The launch of an advance practice nurse outpatient follow-up clinic improved symptom management for high-risk patients with head and neck cancer following radiation therapy, according to findings from a study conducted at Cleveland Clinic. This initiative led to fewer ED visits and hospital admissions, results showed. “These results are significant as they suggest more intensive follow up in high-risk head and neck patients can improve patient outcomes,” Bridgett Harr, CNP, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today. “This intensive symptom management is an important role [advance practice nurses (APNs)] can fill in this and other patient groups by providing consistent, proactive management of symptoms during recovery from treatment. Our study suggests this will lead to improved patient experience, in addition to a reduction in cost to both the patient and health care system as a whole.” Patients with head and neck cancer often undergo radiotherapy or chemoradiotherapy, and many experience debilitating side effects that require ED management or admission to the hospital. In 2014, an APN-led clinic was launched to focus on the acute rehabilitation of patients with head and neck cancer undergoing these therapies. Harr and colleagues sought to evaluate the outcomes and incidence of adverse events among patients treated at an APN clinic compared with historical outcomes. The analysis included data from 25 high-risk patients with head and neck cancer who received care post-treatment at an APN clinic and 24 patients who received standard follow-up care identified using [...]

2015-11-03T10:14:55-07:00November, 2015|Oral Cancer News|
Go to Top