HPV

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.”

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.

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

Source: lubbockonline.com
Author: Ellysa Harris

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Screenings for oral HPV exist.

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

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

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

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

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

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

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

Symptoms of throat cancer depend on which throat structures are affected

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

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

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

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

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

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

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

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

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

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

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

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

Note: For information, visit www.mayoclinic.org

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Source: pipelinereview.com
Author: Bristol-Myers Squibb

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

April, 2017|Oral Cancer News|