HPV

HPV-related oral cancers have risen significantly in Canada

Source: www.ctvnews.ca
Author: Sheryl Ubelacker, The Canadian Press

The proportion of oral cancers caused by the human papillomavirus has risen significantly in Canada, say researchers, who suggest the infection is now behind an estimated three-quarters of all such malignancies. In a cross-Canada study, published Monday in the Canadian Medical Association Journal, the researchers found the incidence of HPV-related oropharyngeal cancers increased by about 50 per cent between 2000 and 2012.

“It’s a snapshot of looking at the disease burden and the time trend to see how the speed of the increase of this disease (is changing),” said co-author Sophie Huang, a research radiation therapist at Princess Margaret Cancer Centre in Toronto.

Researchers looked at data from specialized cancer centres in British Columbia, Alberta, Ontario and Nova Scotia to determine rates of HPV-related tumours among 3,643 patients aged 18 years or older who had been diagnosed with squamous cell oropharyngeal cancer between 2000 and 2012.

HPV is the most common sexually transmitted infection worldwide. Most people never develop symptoms and the infection resolves on its own within about two years.

“In 2000, the proportion of throat cancer caused by HPV was estimated at 47 per cent,” said Huang. “But in 2012, the proportion became 74 per cent … about a 50 per cent increase.”

Statistics from a Canadian Cancer Society report last fall showed 1,335 Canadians were diagnosed in 2012 with HPV-related oropharyngeal cancer and 372 died from the disease.

HPV is the most common sexually transmitted infection worldwide. Most people never develop symptoms and the infection resolves on its own within about two years. But in some people, the infection can persist, leading to cervical cancer in women, penile cancer in men and oropharyngeal cancer in both sexes.

Most cases of HPV-related oral cancer are linked to oral sex, said Huang, noting that about 85 per cent of the cases in the CMAJ study were men.

HPV-related tumours respond better to treatment and have a higher survival rate than those linked to tobacco and alcohol use, the other major cause of oral cancer, she said, adding that early identification of a tumour’s cause is important to ensure appropriate and effective treatment.

While some centres in Canada routinely test oral tumours to determine their HPV status, such testing is not consistent across the country, the researchers say.

In the past, physicians generally tended to reserve tumour testing for cases most likely to be caused by HPV – among them younger males with no history of smoking and with light alcohol consumption – to prevent an unnecessary burden on pathology labs.

“Only as accumulating data have supported the clinical importance of HPV testing has routine testing been implemented in most (though not all) Canadian centres,” the researchers write.

The study showed that the proportion of new HPV-related oral cancers rose as those caused by non-HPV-related tumours fell between 2000 and 2012 – likely the result of steadily declining smoking rates.

Huang said males tend to have a weaker immune response to HPV than do females, which may in part explain the higher incidence of oral cancers linked to the virus in men.

HPV vaccines given to young people before they become sexually active can prevent infection – and the researchers say both boys and girls should be inoculated.

Currently, six provinces provide HPV immunization to Grade 6 boys as well as girls, with the other four provinces set to add males to vaccination programs this fall, said Huang.

“So vaccinating boys is very important because, if you look at Canadian Cancer Society statistics (for 2012), HPV- related oropharyngeal cancer in total numbers has already surpassed cervical cancers,” she said.
“The increase of HPV-related cancer is real, and it’s striking that there’s no sign of a slowdown.”

August, 2017|Oral Cancer News|

U.S. FDA removes clinical hold on CEL-SCI’s phase 3 head & neck cancer trial

Source: www.businesswire.com
Author: press release

CEL-SCI Corporation today announced it has received a letter from the U.S. Food and Drug Administration (FDA) stating that the clinical hold that had been imposed on the Company’s Phase 3 cancer study with Multikine* (Leukocyte Interleukin, Inj.) has been removed and that all clinical trial activities under this Investigational New Drug application (IND) may resume.

Multikine is being studied as a potential first-line (before any other cancer treatment is given) immunotherapy that is aimed at harnessing the patient’s own immune system to produce an anti-tumor response. Nine hundred twenty-eight (928) newly diagnosed head and neck cancer patients have been enrolled in this Phase 3 cancer study and all the patients who have completed treatment continue to be followed for protocol-specific outcomes in accordance with the Study Protocol.

The study’s primary endpoint is a 10% increase in overall survival for patients treated with the Multikine treatment regimen plus standard of care (SOC) versus those who receive SOC only. The determination if the study’s primary end point has been met will occur when there are a total of 298 deaths in those two groups. Current SOC for this indication is surgery, followed by radiation therapy alone or followed by concurrent radio-chemotherapy.

There is a clear and unmet medical need for a new treatment in this indication as the last FDA approved treatment for advanced primary head and neck cancer was over 50 years ago. The FDA has also designated Multikine an Orphan Drug for neoadjuvant therapy in patients with squamous cell carcinoma of the head and neck (SCCHN).

About Head and Neck Cancer
Head and neck cancer describes squamous cell carcinomas located inside the neck, mouth, nose, and throat. According to the World Health Organization, the annual incidence of head and neck cancer is approximately 550,000 cases worldwide, with about 300,000 deaths each year. Risk factors involved with head and neck cancer include heavy alcohol use, tobacco use, and the cancer causing type of human papilloma virus (HPV).

About CEL-SCI Corporation
CEL-SCI’s work is focused on finding the best way to activate the immune system to fight cancer and infectious diseases. The Company has operations in Vienna, Virginia, and in/near Baltimore, Maryland.

August, 2017|Oral Cancer News|

No HPV Vaccination for Boys in UK

Source: Peter Russell
Date: July 20, 2017
Source: www.medscape.com

Health bodies are condemning a decision not to include boys in the human papilloma virus (HPV) vaccination programme as “shameful” and a “missed opportunity”.

The Joint Committee on Vaccination and Immunisation (JCVI) has concluded that it “did not recommend vaccinating boys at this time as it was considered unlikely to be cost-effective”.

Girls aged 12 to 13 have routinely been offered the HPV jab since September 2008 as part of the NHS childhood vaccination programme.

The JCVI has been considering whether to include boys on the scheme since 2014.

Protection Against Some Cancers

HPV is the name for a group of viruses that are most commonly passed on through genital contact between straight and same-sex partners.

It is a very common infection. Almost every sexually active person will get HPV at some time in their lives.

Most people who get HPV never develop symptoms or health problems, but for some it can lead to cancer of the cervix, vulva, vagina, penis, anus, and head and neck, as well as cause genital warts.

According to health professionals, the virus has been linked to 1 in 20 cases of cancer in the UK.

Campaigners in favour of giving boys the jab argue that HPV does not discriminate between the sexes and that offering the vaccine to boys in school would save lives.

‘Few Additional Benefits’

The JCVI has decided that a high take-up of the vaccine among girls would provide ‘herd protection’ to boys, and that vaccination of boys “would generate little additional benefit to the prevention of cervical cancer, which was the main aim of the programme”.

Additionally, the committee found insufficient evidence that the jab would protect against cancers affecting males such as anal, head and neck cancers. However, it agreed to keep evidence under review, particularly for men who have sex with men.

‘An Astonishing Decision’

Several health bodies have issued statements criticising the JCVI’s decision. The Faculty of Sexual and Reproductive Healthcare says it’s a “missed opportunity” and is urging it to reconsider its stance in October after a period of public consultation. Peter Baker, HPV action campaign director, says: “It is astonishing that the government’s vaccination advisory committee has ignored advice from patient organisations, doctors treating men with HPV-related cancers, public health experts and those whose lives have been devastated by HPV.

“The interim decision not to vaccinate boys is about saving money not public health or equity.”

Dentists are also condemning the decision. Mick Armstrong, chair of the British Dental Association, says: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.

Dentists are also condemning the decision. Mick Armstrong, chair of the British Dental Association, says: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible. The state has a responsibility to offer all our children the best possible defence.

“Dentists are on the front line in the battle against oral cancer, a condition with heart-breaking and life-changing results. Ministers can choose to sit this one out, or show they really believe in prevention.”

‘Shameful’

Emma Greenwood, Cancer Research UK’s director of policy, comments: “We’re disappointed to hear that the JCVI has made an interim recommendation not to offer the HPV vaccine to boys. If boys were included in the vaccination programme, it would help reduce the risk of HPV related cancers for the whole population, compared to vaccinating girls alone.”

The Terrence Higgins Trust describes the JCVIs decision as “shameful”. Its chief executive, Ian Green, says: “A gender neutral policy on HPV vaccination is long overdue and would protect boys from cancers caused by untreated HPV, including penile, anal and some types of head and neck cancer.”.

Jonathan Ball, professor of molecular virology at the University of Nottingham, says: “As increasing numbers of girls take up the vaccine then risk of heterosexual transmission decreases and the benefit of vaccinating boys diminishes.

“But of course, this reliance on herd immunity doesn’t provide optimal benefit for boys who go onto have sex with other men in adulthood.  There is a pilot vaccination programme running for men who have sex with men, but not all men at risk are likely to enrol in this, and we know the vaccine is most effective before someone becomes sexually active.

Limited Health Resources

“Unfortunately, it isn’t a question of science – it’s one of cost – and at the moment the Vaccination and Immunisation Committee doesn’t consider that the benefits are worth the investment.”

Dr David Elliman, consultant in community child health, adds: “Although it always seems hard to have to consider cost, it is important to make sure that we spend the money available to the NHS in a way that gets us best value.”

August, 2017|Oral Cancer News|

Transoral robotic surgery cuts patient recovery time

Source: exclusive.multibriefs.com
Author: Carolina Pickens

Oral cancer is diagnosed in almost 50,000 Americans each year and has a 57 percent survivability rate past five years, according to research from the Oral Cancer Foundation.

3D illustration of surgical robot

The number of diagnoses has been fairly constant in oral and pharyngeal cancer for decades, but survivability has actually gone up slightly in the last 10 years. This can be attributed to the increasing percentage of patients with dental insurance attending annual appointments (when oral cancer is most often recognized and diagnosed earlier), the spread of HPV-related oral cancer (which is easier to treat) and advances in diagnostic tools for dentists and oral specialists.

These advancements aren’t limited to recognizing oral and throat cancer; strides in scientific approaches for surgical treatment are changing the way specialists treat oral phalangeal cancers. For example, Nepean Hospital of New South Wales has seen drastic improvement in patients’ quality of life and surgical recovery time by performing transoral robotic surgery (TORS) with the da Vinci System.

This technology provides surgeons the tools needed to perform successful, minimally-invasive surgeries for patients with T1 or T2 throat cancers.

“Without the robot, tongue and throat cancers are among the most difficult tumors to surgically remove,” said Dr. Chin, an otolaryngology, head and neck surgeon at the hospital.

Previous surgical methods required surgeons cut into the neck to access tumors in the throat and back of the mouth — and operations would often last for up to 12 hours at a time. This caused permanent scarring and required recovery time in ICU and months of physical or occupational therapy for patients to learn to talk and eat again.

TORS grants surgeons the ability to operate intraorally, reducing time spent on the operating table down to merely 45 minutes. Surgeons get a 3-D view of the tumor and a high-definition picture of the mouth and throat with this high-tech equipment — this also greatly reduces the likelihood parts of a tumor go unseen and remain in the body post-surgery.

A surgeon, who stays in control of the robot 100 percent of the time, then uses instruments on his or her own wrists to guide the robot during each step of the surgery. The TORS rotation is also far greater than that of a human wrist — granting the ability to access parts of the patient’s throat previously unreachable with conventional surgery.

As noted in Dentistry Today, this minimally-invasive technique has patients eating within 24 hours and cuts recovery time in the hospital from weeks to two days. Patients are able to maintain their independence post-surgery. This is revolutionary for older patients, for whom complicated surgeries often cause a decrease in their overall quality of life.

As more surgical practices obtain this valuable technology, oral and dental specialists expect to see more improvements in survivability rates for patients with pharyngeal and oral cancers.

Plan not to give HPV vaccine to boys causes concern

Source: http://www.bbc.com/news/health-40658791
Date: July 19th, 2017

A decision not to vaccinate boys against a cancer-causing sexually transmitted infection has attracted fierce criticism.

Reported cases of human papilloma virus (HPV) – thought to cause about 80% of cervical cancers – have fallen sharply since girls were given the vaccine.

But the Joint Committee on Vaccination and Immunisation (JCVI) found little evidence to justify treating boys too.

Critics said vaccinating boys could help reduce the risk still further.

Across the UK, all girls aged 12-13 are offered HPV vaccination as part of the NHS childhood vaccination programme.

Mary Ramsay, head of immunisation at Public Health England, said: “Evidence from around the world suggests that the risk of HPV infection in males is dramatically reduced by achieving high uptake of the HPV vaccine among girls.

“While there are some additional benefits to vaccinating both males and females, the current models indicate that extending the programme to boys in the UK, where the uptake in adolescent girls is consistently high (over 85%), would not represent a good use of NHS resources.”

This initial recommendation by JCVI will now be subject to a public consultation and a final decision will be made in October.

The British Dental Association said it would urge the committee to reconsider the evidence.

The chair of the BDA, Mick Armstrong, said: “HPV has emerged as the leading cause of oropharyngeal cancers, so JCVI’s unwillingness to expand the vaccination programme to boys is frankly indefensible.”

Shirley Cramer of the Royal Society for Public Health said: “We are deeply disappointed by the JCVI’s decision today, which suggests that fundamental priorities are focused more on saving money than on saving lives.

“Such a simple vaccination programme has the potential to make such a big impact on the public’s health on a national scale.

“We hope that the government’s advisory committee reconsider this decision as soon as possible and put the public’s health and wellbeing before cost-saving.”

The argument for vaccinating boys HPV

  • About 15% of UK girls eligible for vaccination are currently not receiving both doses, a figure which is much higher in some areas
  • Men may have sex with women too old to have had the HPV vaccination
  • Men may have sex with women from other countries with no vaccination programme
  • Men who have sex with men are not protected by the girls’ programme
  • The cost of treating HPV-related diseases is high – treating anogenital warts alone in the UK is estimated to cost £58m a year, while the additional cost of vaccinating boys has been estimated at about £20m a year

Source: HPV Action

July, 2017|Oral Cancer News|

Biotech exec facing death urges: Get the vaccine that prevents his cancer

Source: www.philly.com
Author: Michael D. Becker

Like most people who pen a new book, Michael D. Becker is eager for publicity.

But he has an unusual sense of urgency.

A former oncology biotech CEO, Becker has neck cancer. He expects his 49th birthday in November to be his last, if he makes it.

What also drives him to get his message out, however, is this: Children today can get a vaccine that prevents the kind of oropharyngeal cancer that is killing him.

As he collides with his mortality, Becker wants to share his story and raise awareness about the vaccine, which protects against dangerous strains of human papillomavirus, or HPV, the extremely common, sexually transmitted virus that caused his disease. His book, A Walk With Purpose: Memoir of a Bioentrepreneur (available on Amazon.com), was produced and self-published in a creative sprint between December, when his cancer recurred just a year after initial diagnosis and treatment, and April. He also has a blog, My Cancer Journey, and has been conducting media interviews.

“I had a lot of motivation to write the book quickly,” he said wryly at his home in Yardley.

In the final pages, he urges parents “to talk to their doctor about the HPV vaccine,” which “simply didn’t exist when I was a teenager, or it could have prevented my cancer.”

The leading vaccine brand, Gardasil, was hailed as a breakthrough when it was introduced in 2006. It is approved to prevent cervical cancer and less common genital malignancies, including anal cancer, that are driven by HPV infections. The vaccine was not clinically tested to prevent head and neck cancers, so it is not officially approved for that purpose, but research shows that it works. A study of young men presented last month found that vaccination reduced oral HPV infections by 88 percent.

Still, many adolescents are not getting the shots, for various reasons.

“It just kills me,” Becker says without a trace of irony, “that it’s underutilized. There are parents debating about whether to vaccinate their children. I’ve talked to immunologists about the safety. I had to make the decision to vaccinate my own kids. I was 100 percent convinced.”

From dropout to go-getter:
Becker describes his own youth as a bit misspent. He left home and dropped out of high school in his junior year, soon after his parents divorced.

“During my teens, I had experimented with sex, drugs, and alcohol while teaching myself how to play guitar and dreaming of becoming the next Eddie van Halen,” he writes in his book. “Making it through a number of near-death and reckless experiences during that period now seemed like a minor miracle.”

In his late teens, he wised up, got his equivalency diploma, and went to work for his father’s investment firm, where he discovered a talent for computer programming. Next came a job as a stock broker in Chicago, where he met and soon married Lorie Statland, an elementary school teacher who inspired him to get a college degree. The couple had two children, Rosie, now 19, and Megan, 16.

Becker went on to have a prolific career in biotechnology, complete with the occasional setbacks (lawsuits and soured partnerships) that are part of that high-stakes world. His resume includes Wall Street securities analyst, portfolio manager, founder of his own communications firm, and top executive of three biotech companies, two of which developed oncology products. During his cancer treatment, he used a prescription medicine that he played a major role in developing while at New Jersey-based Cytogen Corp: Caphosol, an electrolyte mouthwash that treats mouth ulcers caused by radiation therapy.

His diagnosis followed his discovery of a lump under his jaw line on the day before Thanksgiving in 2015. Tests revealed cancer that had spread from a tonsil to a lymph node and surrounding tissue.

At Memorial Sloan Kettering Cancer Center in New York, he opted for chemotherapy and radiation instead of surgery. The operation, he explains, can damage speech and swallowing, and if it doesn’t get all the cancer, chemo and radiation are still necessary.

He describes the main side effects of treatment – constant dry mouth and changes in taste – as manageable. And he says he was not unhappy to lose 30 pounds.

Although he sounds almost too stoic, he is frank about “the one major issue I tried to ignore … namely, depression.”

“On more than one occasion I burst into a crying session,” he writes. “I’m not talking about the quiet episode with sniffles and a tear or two. I mean full-fledged bawling your eyes out accompanied by nasal discharge and the near inability to speak normally.”

A sensitive subject:
Conspicuously missing from his book, though, is information about head and neck cancer. Over the last 30 years, the epidemiology has changed dramatically in the United States, with a decline in cases related to smoking and alcohol use, and a steady increase in HPV-related cancers. Men are three times more likely than women to develop these malignancies. Of an estimated 63,000 new head and neck cancer diagnoses this year, 11,600 will likely be caused by HPV, according to the U.S. Centers for Disease Control and Prevention.

This surge reflects changes in sexual practices, especially oral sex, research suggests. That’s a sensitive issue, as actor Michael Douglas discovered when his candor about his throat cancer and cunnilingus turned him into fodder for tweeters and late-night comics. The thing is, genital strains of HPV are so ubiquitous that almost all sexually active people — not just promiscuous ones — will be infected at some point. It is not clear why, for a fraction of these people, the immune system fails to wipe out the infection.

Becker says he did not wade into this subject in his book because of the scientific uncertainties.

In a recent blog post, he quoted the CDC: “Only a few studies have looked at how people get oral HPV, and some show conflicting results. Some studies suggest that oral HPV may be passed on during oral sex or simply open-mouthed (“French”) kissing, others have not. More research is needed to understand exactly how people get and give oral HPV infections.”

After his cancer recurred, Becker explored his options and entered a National Cancer Institute clinical trial of an experimental immunotherapy. It seems to have slowed, but not stopped, his cancer, which has spread to his lungs.

He is philosophical about his plight.

“I get up each morning feeling fine. It’s not a bad quality of life at the moment,” he said. “And I’ve had just a fabulous life. I’ve worked very hard, but the fruits of those labors were phenomenal. Being able to travel. Being able to give my daughters what they wanted. I wanted them to have a better youth than I had. I’ve got the best wife in the world. I’ve had 25 fabulous years with her. It’s hard to look at my situation and have a lot of self-pity.”

But he does have a hope: “That by sharing this experience freely, I can help create greater awareness for the disease and its impact.”

Thirty-second oral cancer test could save your life

Source: savannahnow.com
Author: Angela C. Canfield, DDS

Every 60 minutes, a person dies from oral cancer. The disease is typically associated with long-term tobacco use, but it is becoming more frequent in young adults who have never smoked.

According to the National Cancer Institute, 40 percent of those diagnosed with oral cancers will die within five years.

Besides tobacco use, the risk factors that could lead to oral cancer include DNA abnormalities or family history. But the main cause of oral cancers, especially in young adults who don’t smoke, is the human papillomavirus (HPV), which may be spread by sexually active people through intimate or even close contact.

HPV is the leading cause of cervical cancer, which used to be the leading cause of cancer deaths for women in the United States. Now that more women routinely get PAP tests that provide early detection of conditions that could lead to cervical cancer, those cancer rates are on the decline. In fact, these days, a person is three times more likely to die from oral cancer than cervical cancer.

According to the National Cancer Institute, 40 percent of those diagnosed with oral cancers will die within five years. While the disease has few, if any, early symptoms, early detection can make a dramatic difference, increasing survival rates to as much as 90 percent. Now, a routine test that takes only 30 seconds is available to provide that early detection and even offer prevention from the disease itself.

The test is basically a minty mouthwash or saline solution administered by a dentist or other oral health care provider. You swish and gargle and spit it back into the test cup. It’s that simple.

Oral cancer signs

While easily administered, this genetic test has a complex function, looking for oral cancer risk on a molecular level in three ways:

• Cell abnormalities. Changes to your cells could mean a precancerous condition or infection exists.

• HPV. This virus can lead to some cases of oral cancer, or clear up on its own. In either case, I monitor and test my patients more frequently, especially if an infection tends to linger.

• DNA damage. People with certain DNA damage seem to be at a higher risk for oral cancer. These abnormalities don’t mean you have oral cancer or that you are destined to get it, but more frequent monitoring is usually necessary, just to be safe.

While not always present, possible signs of oral cancer could include a mouth sore that bleeds easily and does not heal within two weeks, a lump or thickening in the oral soft tissues, soreness or a feeling that something is caught in the throat, difficulty chewing or swallowing, ear pain, difficulty moving the jaw or tongue, hoarseness, or numbness of the tongue. Some signs of oral cancer might also easily be mistaken for a toothache or a cold.

I recommend to my patients aged 18 and older that they be tested annually for oral cancer. Results can vary from negative to being high risk or positive. For patients who test positive for precancerous cells, I usually suggest a follow-up visit with an ear, nose and throat specialist, depending on the levels found. I will continue to monitor high-risk patients and administer follow-up tests as needed.

Please talk with your oral health care provider about your risk factors and the advantages of oral cancer screening.

Angela Canfield, DDS, is licensed by the Georgia Board of Dentistry and the National Board of Dentists.

Mayo Clinic Q and A: Throat cancer symptoms

Source: newsnetwork.mayoclinic.org
Author: Dr. Eric Moore, Otorhinolaryngology, Mayo Clinic

DEAR MAYO CLINIC: Are there early signs of throat cancer, or is it typically not found until its late stages? How is it treated?

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

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

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

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

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

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

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

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

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

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

HPV Vaccination Linked to Decreased Oral HPV Infections

Author: NCI Staff
Date: June 5th, 2017
Source: www.cancer.org

New study results suggest that vaccination against the human papillomavirus (HPV) may sharply reduce oral HPV infections that are a major risk factor for oropharyngeal cancer, a type of head and neck cancer.

The study of more than 2,600 young adults in the United States found that the prevalence of oral infection with four HPV types, including two high-risk, or cancer-causing, types, was 88% lower in those who reported receiving at least one dose of an HPV vaccine than in those who said they were not vaccinated.

About 70% of oropharyngeal cancers are caused by high-risk HPV infection, and the incidence of HPV-positive oropharyngeal cancer has been increasing in the United States in recent decades. In the United States, more than half of oropharyngeal cancers are linked to a single high-risk HPV type, HPV 16, which is one of the types covered by Food and Drug Administration (FDA)-approved HPV vaccines.

“In an unvaccinated population, we would estimate that about a million young adults would have an oral HPV infection by one of these vaccine HPV types. If they had all been vaccinated, we could have prevented almost 900,000 of those infections,” said senior study author Maura Gillison, M.D., Ph.D., of the University of Texas MD Anderson Cancer Center.

Dr. Gillison presented the new findings at a May 17 press briefing ahead of the 2017 annual American Society of Clinical Oncology (ASCO) meeting, held June 2–6 in Chicago.

A Rapidly Rising Cancer

Oropharyngeal cancer “is the fastest-rising cancer among young white men in the United States,” said Dr. Gillison, who was at Ohio State University when she conducted the study.

“The HPV types that cause oropharyngeal cancers are primarily transmitted through sexual contact,” explained lead study author Anil Chaturvedi, Ph.D., of NCI’s Division of Cancer Epidemiology and Genetics. The increased incidence of oropharyngeal cancers in white men has been linked to changes in sexual behaviors from the 1950s through the 1970s, he said. The exact reasons for the greater increase in oropharynx cancer incidence in men versus women are still unclear, Dr. Chaturvedi added.

Clinical trials have shown that FDA-approved HPV vaccines can prevent anogenital HPV infections and precancerous lesions that lead to HPV-associated cancers, including cervical and anal cancer. However, Dr. Gillison said, the potential impact of current HPV vaccines on oral HPV infections that lead to cancer has not yet been rigorously tested in clinical trials, and thus the vaccines are not specifically approved for preventing cancers of the oropharynx.

From 2006 through 2014, most HPV-vaccinated individuals in the United States received Gardasil®, an HPV vaccine that protects against infection with HPV types 6, 11, 16, and 18. In January 2015, FDA approved an updated HPV vaccine, Gardasil 9®, that protects against five additional HPV types.

Looking for a Link

To investigate the relationship between HPV vaccination and oral HPV infection, the researchers analyzed data for 2,627 young adults who participated in NHANES, a national survey that assesses the health of a representative slice of the US population.

Drs. Gillison, Chaturvedi, and their colleagues restricted their analysis to NHANES data from 2011 to 2014, focusing on 18- to 33-year-old men and women “because they were the first group [in the United States] to receive the vaccine,” Dr. Gillison said.

In the United States, routine vaccination against HPV, which causes nearly all cervical cancers, has been recommended since mid-2006 for 11- to 12-year-old girls and for females up to age 26 who have not previously been vaccinated. HPV vaccination has been recommended for males ages 9–26 since 2009.

The researchers analyzed mouth rinse samples (containing oral cells) from all study participants for the presence of 37 HPV types, including types 6, 11, 16, and 18, which are covered by Gardasil, Dr. Gillison said.

The prevalence of oral infections with these four HPV types was 1.61% in unvaccinated young adults versus 0.11% in vaccinated young adults—an 88% reduction in HPV prevalence with vaccination. Among men, the prevalence of oral infection with the four HPV types was 2.1% in unvaccinated individuals and 0.0% in vaccinated individuals.

By contrast, the prevalence of oral infection with 33 HPV types not covered by the vaccine was 4.0% in vaccinated groups and 4.7% in non-vaccinated groups, the researchers found, a difference that was not considered to be statistically meaningful.

Vaccination rates were low overall, with only 29.2% of women and 6.9% of men in the study population reporting having received at least one dose of an HPV vaccine before age 26.

Prevention Potential

Although the self-reported vaccination rates in this study were low, Dr. Gillison said, “there is considerable optimism because more recent data indicate that [roughly] 60% of girls and 50% of boys under age 18 have received more than one HPV vaccine dose.”

“HPV vaccines are already strongly recommended for cancer prevention,” Dr. Gillison continued. “Parents who choose to have their children vaccinated against HPV should realize that the vaccine may provide additional benefits, such as preventing oral HPV infections linked to oral cancers.”

However, she and Dr. Chaturvedi noted, only a randomized clinical trial that follows people over time could definitively show a cause and effect relationship between HPV vaccination and a lasting reduction of high-risk oral HPV infections, which experts agree is a more meaningful indicator of vaccine effectiveness.

In July 2013, NCI researchers and their collaborators reported findings from the NCI-sponsored HPV Vaccine Trial in Costa Rica that suggested that HPV vaccination can reduce oral HPV infections in women.

“Our study builds on those results by showing a reduction in oral HPV prevalence in vaccinated men, the group that bears the greatest burden of HPV-associated oropharynx cancers,” Dr. Chaturvedi said.

June, 2017|Oral Cancer News|

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

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

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

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

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

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

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

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

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

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