human papilloma virus

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

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

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

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

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

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

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

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

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

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

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

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

Frontline Cancer: vaccines for HPV near guarantee

Source: www.lajollalight.com
Author: Dr. Scott Lippman

Dear Scott: “Our son, who is 25, went to the GP yesterday and his doc wasn’t sure about giving the Gardasil I had been bugging him to get. Didn’t you tell me about the benefits of the HPV vaccination?”

The note was from a friend. It was personal, but also a topic of wide public interest and one that remains much discussed among cancer researchers and physicians. That’s why I’m answering my friend here.

Roughly 12 percent of all human cancers worldwide — more than 1 million cases per year — are caused by viral infections (called oncoviruses) and attributed to a relatively small number of pathogens: human papilloma virus (HPV), hepatitis B virus (HBV), hepatitis C virus (HCV) and Epstein-Barr virus (EBV). Given the emphasis upon other causal factors of cancer, such as genetic mutations or environmental sources, it’s a statistic that’s not well known nor, I would argue, fully appreciated.

Human viral oncogenesis is complex, and only a small percentage of the infected individuals develop cancer, but that 12 percent translates into more than 500,000 lives lost each year to virus-caused malignancies. Many of those deaths are preventable because effective vaccines already exist for HPV and HBV. Right now. No future discoveries required.

I want to specifically talk about the HPV vaccine. Controversy has constrained its proven effectiveness as a public health tool, but if used as prescribed, the HPV vaccine could essentially eliminate cervical and other HPV-caused cancers. Infection with HPV is very common. It’s estimated that at least 80 million Americans are affected. HPV is actually a group of more than 200 related viruses. There is no cure for HPV, but the infection typically clears on its own without lingering effect.

Forty types of HPV are easily spread through direct sexual contact. They fall into two categories: Low-risk HPVs that do not cause cancer, but can cause skin warts on or around the genitals, anus, mouth or throat. And high-risk HPVs (mostly two strains, type 16 and type 18) that cause approximately 5 percent of all human cancers worldwide. High-risk HPV strains drive the rates of cervical (the leading cause of cancer deaths in women in many developing countries), anal and a dramatically increasing subset of oropharyngeal (the tonsil and parts of the throat and tongue) cancers among men in the United States and other developed countries.

The Food and Drug Administration has approved three vaccines for preventing HPV infection: Gardasil, Garadsil-9 and Cervarix. They have strong safety records and a near-guarantee of dramatically reducing the risk of infection. But they are not widely used. The HPV vaccination rate in the U.S. is just 36 percent for girls and 14 percent for boys (and even lower for Hispanics, blacks and the poor).

The chief reason, it has been argued, relates to the recommended age of vaccination: 11-12 years. Because cancer-causing HPV viruses are transmitted through sexual contact, the idea of vaccinating a young girl or boy as a preventive measure strikes many people (i.e. parents) as premature, unsettling or enabling. My friend and colleague, Howard Bailey, M.D., director of the University of Wisconsin Carbone Cancer Center and a national leader on this topic, believes this attitude costs lives. “We need to shift focus from behavior associated with infection to preventing major cancers,” he says.

There are other factors as well. For example, full vaccination requires three doses, so persistence is required. Safety concerns continue about the vaccine (perhaps part of a larger misplaced mistrust of vaccines in general). And there remains limited public understanding of HPV or HPV-related diseases, especially in men.

The reality is that these vaccines work best if they are given at an early age before exposure to HPV. However, as Howard explained, if this window is missed, the FDA includes indications where the recommendation rises to age 26, to get vaccinated for at least some cancer-causing strains of HPV. Howard recommends every young, unvaccinated adult receive at least the 9-valent HPV vaccine, “which can provide protection against five additional HPV types that cause cancer and are less common than types 16 and 18.” There is the potential for protection against HPV types that a person hasn’t yet been exposed to and if a person hasn’t been exposed to the common HPV types (6, 11, 16 and 18), it can provide protection against them as well.

In a recently published statement paper, the American Society of Clinical Oncology called for a broad, concerted effort by health care professionals and policymakers to increase awareness of the evidence and effectiveness of HPV vaccination. It should be routine. The public health benefit is obvious and indisputable. I completely agree.

Here’s a corollary to consider: Vaccines for HBV have been available for many years and are a routine part of pediatric immunizations in the United States. In the past, countries like Taiwan and Korea suffered endemic HBV infections and high rates of hepatocellular carcinoma (HCC) or liver cancer. In the 1980s, these countries implemented universal infant HBV vaccination policies that have resulted in a dramatic 80 percent decline in HBV infections, cases of hepatitis and, more importantly, reductions in HCC incidence and mortality.

Every day, you can read headlines about research to find new treatments and cures for the many diseases called cancer. Progress is painfully slow and uneven. We’ve been fighting this war for decades. Preventing cancer altogether is a better approach and with cancers caused by HPV, we have the right weapon already at hand. We just need to use it.

Suicide: A Major Threat to Head and Neck Cancer Survivorship

Source: www.jco.ascopubs.com
Authors: Nosayaba Osazuwa-Peters, Eric Adjei Boakye, and Ronald J. Walker
, Mark A. Varvares
 

TO THE EDITOR: The article by Ringash that was recently published in Journal of Clinical Oncology provided a compelling narrative of both the improvements made in head and neck cancer survivorship, as well as the challenges created by longer-term treatment and associated toxicities. There are currently at least 280,000 head and neck cancer survivors in the United States. As the article by Ringash stated, the upturn in head and neck cancer survivorship in the last three decades has coincided with the emergence of human papilloma virus-positive oropharyngeal cancer, as well as a decrease in tobacco use in the general population. These make it a challenge to isolate survival gains as a function of improved therapy from the natural prognostic value of a diagnosis of human papilloma virus-positive oropharyngeal cancer. Whatever the case, the fact that more than one-quarter million Americans are currently alive after a diagnosis of head and neck cancer means there needs to be a more deliberate effort in longer-term management of treatment-related toxicities, some of which are lifelong.

We agree with Ringash’s conclusion that new models of care need to be developed in response to the significant quality-of-life issues faced by patients with head and neck cancer. The Institute of Medicine publication From Cancer Patient to Cancer Survivor: Lost in Transition, also cited by Ringash, called for a clear individualized survivorship plan for cancer patients. There is a serious need for this model to be implemented universally in head and neck cancer management. Although we agree with Ringash that patients with head and neck cancer face competing mortality risks from second primary cancers and other noncancers, what we found lacking was recognition of an important competing cause of mortality in head and neck cancer survivors: suicide.

Suicide associated with head and neck cancer is not just a competing cause of death; it is also a quality-of-life issue. Many authors agree that head and neck cancer is among the top cancer sites associated with suicide. One national study of 1.3 million cancer patients even found that head and neck cancer carried the highest risk of suicide among cancer survivors. As a quality-of-life issue as well as a competing cause of death, the elevated risk of head and neck cancer-related suicide, although it peaks during the first few years after diagnosis, remains virtually throughout the course of the cancer survivor’s life. Additionally, some other well-known quality-of-life issues associated with head and neck cancer (eg, pain, disability, esthetic compromise and body image issues, psychosocial function, anxiety, emotional distress, and depression) are all associated with suicide. Therefore, it is difficult to have a discussion of quality-of-life interventions in head and neck cancer without addressing the issue of suicide.

Thus, we believe that suicide in patients with head and neck cancer should be addressed as a major threat to cancer survivorship. Cardiovascular disease, for example, is a known competing cause of death among patients with head and neck cancer, and is listed in Figure 4 of Ringash’s article. Cardiovascular disease may be managed for a long time; however, when a cancer patient decides that he/she is “better off dead,” a finality, or terminality, is invoked. This is quite unique to suicide compared with other competing causes of death.

Thus, in the urgent call for “new strategies and models of care to better address quality-of-life issues and meet the needs of survivors of head and neck cancer,” we believe it is pertinent that suicide is recognized as an important threat to head and neck cancer survivorship.

DOI: 10.1200/JCO.2015.65.4673; published online ahead of print at www.jco.org on January 19, 2016

To read or download the full article, please visit: http://jco.ascopubs.org/content/34/10/1151.full.pdf+html

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
March, 2016|Oral Cancer News|

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

March, 2016|Oral Cancer News|

Cancer Centers urge increase in HPV vaccinations

Source: www.wsj.com
Author: Ron Winslow

The top cancer centers in the U.S. jointly called for an increase in vaccination against the human papilloma virus, or HPV, saying low uptake of the three-shot regimens amounts to a “public health threat” and a major missed opportunity to prevent a variety of potentially lethal malignancies.

In a statement issued Wednesday, all 69 of the nation’s National Cancer Institute-designated centers urged parents and health-care providers to “protect the health of our children” by taking steps to have all boys and girls complete the three-dose vaccination by their 13th birthdays, as recommended by federal guidelines, or as soon as possible in children between 13 and 17 years old.

Currently, just 40% of girls and 21% of boys in the U.S. have received the vaccine, according to a report last year by the U.S. Centers for Disease Control and Prevention. The U.S. Department of Health and Human Services Healthy People 2020 initiative has set the goal for HPV vaccination for both boys and girls at 80%.

The first HPV vaccine, Merck & Co.’s Gardasil, was approved by the U.S. Food and Drug Administration in 2006. A second version of Gardasil and GlaxoSmithKline PLC’s Cervarix are now on the market. Neither company was involved in development of the cancer centers’ statement, those involved in the effort said.

The CDC estimates that 79 million Americans are infected with HPV, a sexually transmitted virus that causes 14 million new infections each year. While the body’s immune system fights off the virus in most cases, certain high-risk strains are responsible for cancers of the cervix, anus, and various genital sites as well as a growing rate of oropharyngeal or throat cancers, all told affecting about 27,000 patients a year in the U.S.

“We have everything we need to eliminate at least cervix cancer and many other HPV-related cancers and we haven’t taken advantage in this country,” said Lois Ramondetta, professor of gynecologic oncology at University of Texas MD Anderson Cancer Center, Houston. She said she is already seeing patients in their 20s and 30s who have developed precursors to cancer that she says could have been prevented had they been vaccinated.

The U.S. rates stand in contrast to those in some other countries, including Australia, where 75% of boys and girls are fully vaccinated; the U.K., with a rate between 84% and 92%;, and Rwanda, where 93% of children are in compliance with World Health Organization recommendations for HPV shots.

When the first vaccine hit the market a decade ago, it was targeted at girls in hopes of preventing cervix cancer. But the rising incidence of HPV-related head and neck cancers, especially among men, in recent years, led to including boys in the prevention effort as well.

Factors responsible for the low U.S. rates include resistance among antivaccination groups, a “misunderstanding” that vaccination might promote sexual activity and a reluctance of pediatricians to discuss prevention of a sexually transmitted virus for children, said Sarah Krobin, acting chief of health systems and interventions research at the NCI. Research shows no link between the vaccine and sexual activity, she said. Early administration is required because “for the vaccine to work, the child shouldn’t have yet had sex,” she said.

The three-dose vaccine can cost around $500, including doctor fees, according to the American Cancer Society, though it is often covered by insurance. It is available free to beneficiaries of the Medicaid program, a key reason why children in low-income families are more likely to have been fully vaccinated than those from wealthier families, Dr. Krobin said.

The statement emerged from a meeting of HPV experts from many of the cancer centers at MD Anderson in November, which in turn resulted from a special NCI initiative among 18 designated centers to study factors affecting HPV vaccination rates in their local markets. NCI designation recognizes centers for excellence in cancer research and care. The NCI wasn’t involved in drafting the document.

The statement urges physicians and other providers “to be advocates for cancer prevention by strongly recommending the vaccine for children. It encourages men up to age 21 and women up to 26 to get vaccinated if they missed the younger age targets.

“This is really a sentinel event to have all the centers get together and say we’re really not doing the best for our kids,” said Dr. Ramondetta, who is also co-director of MD Anderson’s HPV-related Moon Shot initiative. “We feel this is an effective, safe and long-lasting vaccine that we’re not taking advantage of.”

January, 2016|Oral Cancer News|

Manitoba expands HPV vaccination program to include boys

Source: www.rapidnewsnetwork.com
Author: Cody Griffin
 
Human-papillomavirus-HPV-va

While most HPV infections go away over time with no treatment, a few can go on to cause cancer.

Health Minister Sharon Blady said the province’s vaccine program will be expanded next year to include Grade 6 and Grade 9 boys as part of Manitoba’s cancer strategy.

The province will also be doing a catch-up period in grade 9. About 59 percent of the physicians recommended HPV vaccination more often for adolescents who they perceived to be at higher risk for getting an HPV infection, as opposed to recommending it routinely for all adolescents.

“Human papillomavirus can cause abnormal cell changes that can lead to cervical cancer, as well as cancer of the vagina, vulva, penis, anus, mouth and throat”, said Dr. Sri Navaratnam, president and CEO, CancerCare Manitoba.

A study in Texas found that a more rigorous, information driven outreach program increased the number of children receiving the vaccine, and other recent studies have reinforced the efficacy of the vaccine to prevent cancer and not promote promiscuity among teenagers.

Any girl or boy who misses the vaccine in Grade 6 will be eligible to get it in later years free of charge under the province’s “once eligible, always eligible”, program. But now we know it causes cancer in men as well.

Gilkey and colleagues found that 27 percent of physicians across the country reported that they do not strongly endorse HPV vaccination, and 26 percent and 39 percent reported that they do not provide timely recommendations for vaccinating girls and boys, respectively.

“The vaccine’s definitely most effective when you’re younger because you have A better immune response to vaccines and when you haven’t been exposed to the virus yet”, he said.

Routledge also said parents will need to give consent for their kids to receive the shot.

Saskatchewan Health Minister Dustin Duncan says offering the HPV vaccine for free to boys is something the province is looking at. “Vaccinating boys with the HPV vaccine will help prevent transmission of the virus and help reduce the incidence and mortality of all HPV-related cancers”. Nova Scotia has announced it plans to do the same.

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

October, 2015|Oral Cancer News|

The case for funding the HPV vaccine for boys

Source: www.thespec.com
Author: Camilla Cornell, Hamilton Spectator

If Tiffany Bond could have had her 25-year-old son inoculated against the human papilloma virus (HPV), she’d have done it in a heartbeat. After all, Bond knows well the pain HPV virus can cause.

Eight years ago, at age 39, Bond flicked back her long hair and touched a lump in her throat. Her doctor’s diagnosis? Bond had oral pharynx cancer — a type of throat cancer caused by the HPV virus. Worse, the cancer had spread into her lymph nodes. She began a seven-week regimen of radiation and chemotherapy treatments so intense that Bond couldn’t eat a thing. She was fed through tubing in her stomach for months and lost about a third of her body weight.

“I was sick to my stomach every day for seven weeks,” Bond says. “There came a point where I just gave up — I wanted to die. It was horrific for my son to watch.”

The good news, says Joanne Di Nardo, a spokesperson for the Ontario branch of the Canadian Cancer Society: There is an HPV vaccine that is 100 per cent effective against many forms of HPV. The bad news? Although all provincial governments administer the vaccine free to girls, in many provinces boys don’t have the same privilege. Only Alberta, Nova Scotia, British Columbia and P.E.I. (either currently or will soon) offer the vaccine free to boys.

“We really need to do some catching up here in Ontario,” says Di Nardo. “Boys are just as much at risk as girls are when it comes to getting HPV-related cancers.”

Bond sees it as a prevention issue. Most people — like her — don’t even know they’ve been exposed to HPV, she says, so it’s easy to pass back and forth. And yet, points out Eduardo Franco, chair of the department of oncology at McGill University, “about one in 20 of all human cancers are caused by one or more of the different strains of human papillomavirus.”

Cervical cancer in women is the most significant, Franco says, but HPV is also associated with genital and anal cancers in men and women, as well as vulva or vaginal cancer and penile cancer. And oral pharyngeal cancer — diagnosed three times more often in men than in women — is rapidly gaining ground. “We’re seeing an upsurge of pharyngeal and oral cavity cancer because of oral HPV transmission,” confirms Franco.

The vaccine would do double duty, he says, by preventing cancers directly in the vaccinated boys, and also by extending “herd protection” to society generally.

“It would be interrupting the chain of transmission both for men and women,” Franco says, “because even those who aren’t vaccinated will eventually have decreased probability of having sex with someone who has been infected.”

Vaccinating boys against HPV is particularly important in provinces like Ontario, says Franco, because only about 60 per cent of girls are vaccinated, compared to 85 per cent in Quebec.

On the plus side, the cost of the HPV vaccine has dropped in recent years, from about $130 per dose to $100 per dose. And at the beginning of this year, the National Advisory Commission on Immunization recommended that for young people, ages 9 to 14, only two doses are needed over a six-month period, instead of the previously recommended three.

If girls got two doses of the vaccine instead of three and the government reaped the economies of scale associated with bulk buying for both boys and girls, that would make it cost-effective to vaccinate boys, points out Franco.

As it stands now, says Di Nardo, if you want to have “your young men” vaccinated, you’ll pay hundreds of dollars out of pocket. Di Nardo believes that policy is short-sighted and urges people to contact their MPPs about the issue or to visit the CCS’s advocacy site (takeaction.cancer.ca). “If you have a vaccine to prevent cancer, should we not all be getting it?” she asks. “Boys and girls.”

August, 2015|Oral Cancer News|

Professor Harald zur Hausen: Nobel scientist calls for HPV vaccination for boys

Source: www.independent.co.uk
Author: Charlie Cooper & Gloria Nakajubi
 

The UK should vaccinate all boys against the cancer-causing human papilloma virus (HPV), the Nobel Prize-winning scientist who discovered the link between HPV and cancer has said.

Professor Harald zur Hausen, the German virologist whose theory that HPV could be a cause of cervical cancers led to global efforts to vaccinate girls against the virus, said that boys should also be protected.

There is now a wealth of evidence that HPV also causes cancers in men, including anal, penile and throat cancer. Professor zur Hausen added that there was now a chance to “eradicate” HPV viruses altogether if the world developed global vaccination programmes for all children.

Since 2008 the UK has offered free vaccinations against HPV to girls aged 12 to 13 – a programme that had an almost 87 per cent uptake from 2013 to 2014 and has led to falls in the number of pre-cancerous abnormalities of the cervix, according to research carried out among vaccinated girls in Scotland.

Capture

Vaccine authorities in the UK, traditionally an international leader in the field of immunisation, are yet to make a judgement on a publicly funded vaccination programme for boys, which would follow in the wake of those already in place in Australia, Austria, Israel and parts of Canada.

HPV is the name for a common group of viruses that can affect the moist membranes of the cervix, anus, mouth and throat. It is usually spread through sexual contact.

Most sexually active people will contract it in their lifetime but usually it causes no ill-effects. However, in some cases it causes changes to cells, which can become cancerous. It is the cause of almost all cases of cervical cancer, a discovery made by Professor zur Hausen in the 1970s, for which he won the Nobel Prize in physiology or medicine in 2008.

Speaking to HPV Action, in an interview to be published by the campaign group this week, Professor zur Hausen said that vaccinating boys was of “the utmost importance”, not only because boys can also contract HPV-related cancers of the throat, anus and penis, but because protecting boys is key to ending transmission of the virus altogether.

“The vaccination programme for girls [in the UK] is marvellous – it reaches a very high proportion,” he said. “In my opinion, the vaccination of boys is also of the utmost importance because virus transmission is due to male partners and men are affected by oropharyngeal [cancers of the throat], anal and penile cancers as well as genital warts.”

Last year the UK’s vaccination authority, the Joint Committee on Vaccination and Immunisation (JCVI), recommended that the UK introduce a vaccination programme for gay men, to be delivered via sexual health clinics. The rationale behind the recommendation is that heterosexual men will be protected from HPV infection because most women will have been immunised, but that men who have sex with men will miss out on “herd immunity”.

However, campaigners and some experts say this reasoning is flawed, as many gay men will have been sexually active before their first visit to a sexual health clinic, and would most likely have already contracted or transmitted the virus.

The JCVI is due to consider the cost-effectiveness of vaccination for boys but campaigners do not anticipate any decision until 2017.

However, the NHS in London is currently planning what would be the first pilot of routine HPV vaccination for boys, with a likely start date of February 2016. The “field test” will work across four sites to establish whether school-age young males would “embrace the uptake of HPV vaccination as part of a community programme”, NHS England’s London office said.

Rolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer.

Scientists say changes in sexual behaviour – with more couples having oral and anal sex – may be the cause of increased cases of anal and throat cancers in both men and women in recent decades.

Margaret Stanley, emeritus professor at the University of Cambridge and a leading expert on HPV, said that cases could continue to rise. “It’s very much under-thirties [having more anal and oral sex] so you can predict there will be a rise in both those cancers. It’s a time bomb,” she said. “Wider exposure to different sexual practices – in other words porn on the internet – is also changing sexual behaviour in teenagers.”

HPV is also the cause of genital warts, the second-most common sexually transmitted infection in the UK. There are nearly 90,000 cases annually, costing the NHS around £55m. Campaigners hope that figure will be taken into account when the JCVI weighs up the cost-effectiveness of a vaccination programme.

Despite safety concerns being raised about the vaccine’s alleged side effects in some parts of the world, including Japan, no causal links have been established between the vaccine and reported long-term health problems. It is approved by the World Health Organisation, as well as European and UK vaccine-safety authorities. Professor zur Hausen added that it was “one of the safest vaccines we have”.

8-Injection-GetRolling out the vaccine to boys would require a public-information campaign because it has previously been presented to parents and children as a girls-only jab to prevent cervical cancer (Getty)

 

A Department of Health spokesperson said: “The HPV-prevention programme is key in helping us prevent cervical cancer. We have successfully given more than a million doses in the UK since 2008.

“Our independent vaccination experts are assessing whether it should be extended to prevent cancers in adolescent boys, men who have sex with men, or both.”

Time for an update?

Parents are currently advised and asked for consent for their daughters to have the HPV vaccination through a form and information leaflet sent out via schools.

The vaccine’s preventative effects against cervical cancer and the protection it offers against genital warts are explained. The protection against other cancers is not mentioned.

Parents and children are told that the vaccine, which is now given in just two doses instead of three, protects against 70 per cent of cervical cancers and that girls will still require cervical screening tests when they are older. Newer versions of the vaccine may protect against more cases in the future.

Parents are told that the vaccine may cause “soreness, swelling and redness in the arm” that will wear off in a couple of days. The leaflet states that “more serious side effects are extremely rare” and reassures parents that it meets European and UK safety standards. However, parents have the option to deny permission for their daughters to have the jab – and are told it would be “helpful” if they gave reasons for refusal.

The leaflet is directly targeted at girls and their parents and focuses on cervical cancer. If the Government were to extend the HPV-vaccination programme to boys, they would have to reconsider how the vaccine was presented to parents and children. The current programme has had impressive uptake, possibly in part because the key reason for taking the vaccine – to prevent cervical cancer – is straightforward and well understood. It may be that in a new HPV vaccination programme, the jab could be presented more broadly as protection against “a range of cancers”.

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

Merck immunotherapy appears effective in head and neck cancer – study | Reuters

Source: www.firstpress.com
Author: Bill Berkrot

 

A Merck & Co drug that helps the immune system fight cancer was about twice as effective as the current standard therapy for patients with recurrent or advanced head and neck cancers, according to study data released on Friday.

A quarter of the 132 patients who received the drug, Keytruda (pembrolizumab), saw their tumors shrink by at least 30 percent. Fifty-six percent of patients experienced at least some tumor shrinkage in the ongoing single drug Phase I study dubbed Keynote-012, researchers reported.

“This is remarkable because we don’t usually see this level of activity with new agents. We have a track record of failure,” said Dr. Tanguy Seiwert, lead investigator of the study from the University of Chicago.

Advanced head and neck cancer is currently treated with Eli Lilly’s Erbitux, known chemically as cetuximab, which typically has a response rate of 10 percent to 13 percent.

“The only thing that works is cetuximab and this looks at least twice as good,” said Seiwert, who was presenting the Keytruda data at the American Society of Clinical Oncology meeting in Chicago.

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Merck shares rose more than 1 percent to $60.43 on the New York Stock Exchange.

Keytruda and Opdivo from Bristol-Myers Squibb Co are at the forefront of a promising new class of drugs called PD-1 inhibitors that block a mechanism tumors use to evade the immune system. Keytruda is approved to treat advanced melanoma and awaits a decision for use in lung cancer. It is being tested against 30 types of cancer alone and in various combinations.

While overall survival data was not yet available, Keytruda and Opdivo have extended survival for some patients in other cancers.

“Response rate doesn’t do this justice,” Seiwert said. “A fraction of those patients will probably have long term survival. It can really make a difference for some patients who have incurable metastatic disease.”

The drug appeared to work as well for patients whose cancer tested positive for human papillomavirus as those who were HPV negative. Some older treatments may be less effective in HPV positive patients, researchers said.

Keytruda was well tolerated with few side effects, Seiwert said. Serious immune-related side effects, such as inflammation of the lungs or colon, were reported in a very small number of patients in the study.

Head and neck cancer is the sixth most common cancer worldwide. Patients with recurrent or metastatic head and neck cancer are usually expected to live about 10 to 12 months.

Reporting by Bill Berkrot in New York; Editing by Diane Craft.

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

Cure Possible for Some HPV-Positive Oropharyngeal Cancers

Source: www.medscape.com
Author: Fran Lowry

In a subset of patients with human papillomavirus (HPV)-related oropharyngeal cancer, the goal of achieving a “cure” is a realistic one, even in patients who have limited distant metastases, a prospective study has shown.

Of the patients with HPV-positive oropharyngeal cancer and distant metastases, 10% survived more than 2 years after intensive treatment, which the researchers defined as a cure.

The study was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) in Nice, France.

The research was praised by Jean Bourhis, MD, head of the Department of Radiation Oncology at Centre Hospitalier Université Vaudois in Lucerne, Switzerland, and cochair of the ICHNO conference scientific committee.

“This important piece of research adds substantially to what we know about the role and the importance of the human papillomavirus in oropharyngeal cancers and gives real hope of improvement in both diagnosis and treatment to those who are affected by the condition,” he said in a statement.

This study, from a world-leading group of head and neck cancer experts, is very interesting, and related to relevant clinical and interdisciplinary questions,” said Daniel Zips, MD, professor of radiation oncology at the University of Tübingen in Germany.

“HPV status is also important for the management of metastatic disease,” he told Medscape Medical News.

He agrees that for some patients with HPV-positive oropharyngeal cancer, using the researchers’ definition, a cure is possible.

“I also agree that the results from this study might begin to change the view of this disease and provide some hope for patients and their families,” Dr Zips explained.

Distant Metastases Are Main Form of Failure
“The majority of patients with HPV-related oropharyngeal cancer can be cured, but distant metastasis can occur in about 15% of patients. In fact, distant metastasis has become the main form of failure for this patient population,” lead author Sophie Huang, a radiation therapist and assistant professor at the University of Toronto. Dr Huang was a physician in China but is an MRT(T) — a radiation therapist — in Canada.

“When distant metastasis occurs, it is generally viewed as incurable disease. However, long-term survival after distant metastasis has been observed in nasopharyngeal cancer patients, which is another viral-related head and neck cancer, associated with the Epstein–Barr virus. Also, long-term survival in HPV-related OPC patients with distant metastasis has also been reported, but anecdotally,” Dr Huang told Medscape Medical News. “Are these just miracles? And would more miracles be found if we were able to understand how they happen?”

Dr Huang and her colleagues established a prospective database in which they collected data on enough patients to allow them to study how distant metastasis is manifested, how the cancer behaves after distant metastasis, and whether there are any factors that influence survival after distant metastasis.

“We felt that the answers to these questions would help us tailor surveillance strategies for the early detection of distant metastasis and explore optimal management algorithms to improve outcomes,” she explained.

Prospective Follow-up of Patients
The team evaluated 1238 consecutive oropharyngeal cancer patients treated at the Princess Margaret Cancer Centre in Toronto from 2000 to 2011. They identified 88 patients with HPV-related cancer and 54 with smoking-related cancer who were HPV-negative, all with distant metastases.

They assessed the pace of the manifestation of the distant metastases, characteristics, and patient survival, and identified factors that might predict longer survival.

The proportion of patients with distant metastases was similar in the two groups. However, metastases associated with HPV-positive oropharyngeal cancer had a later onset, different characteristics, and longer survival than those associated with HPV-negative oropharyngeal cancer.

Specifically, more than 94% of metastases occurred in the first 2 years after treatment in HPV-negative patients, whereas only a quarter occurred in HPV-positive cancers. In the HPV-positive group, some occurred after 5 years.

“This observation indicates that HPV-related OPC patients who are disease-free for 2 years are not out of the woods. A longer surveillance period for HPV-related OPC patients is needed to detect, and hopefully cure, distant metastases,” Dr Huang said.

Additionally, the researchers found two phenotypes of distant metastases in HPV-positive patients.

The disseminating phenotype is aggressive and spreads to multiple organs in a short period of time. This phenotype was found in 55% of the HPV-positive group but in 0% of the HPV-negative group.

The indolent phenotype is characterized by a few lesions growing at a slow pace, and manifesting as oligometastasis, with five or fewer lesions. In patients with metastases in a single organ, this phenotype was found in 24% of the HPV-positive group and in 26% of the HPV-negative group.

The lung was the most common site for distant metastasis in both groups.

“This indolent phenotype has longer survival and might be curable,” Dr Huang reported.

More HPV-positive than HPV-negative patients were specifically treated for distant metastasis (60% vs 31%)

table1

More HPV-positive patients with distant metastases than HPV-negative patients survived to 3 years (25% vs 15%; P = .01).

“The survival advantage in HPV-positive patients is due to a number of factors. The cancer is more sensitive to radiotherapy and chemotherapy, patients tend to be younger by about 10 years, and they have fewer other health problems, including those caused by smoking. This allows them to receive the more aggressive treatment necessary to eradicate metastatic disease,” Dr Huang explained.

table2

“This research shows that metastatic HPV-positive patients who receive active treatment can survive considerably longer. One of the reasons patients with metastatic disease fail to receive aggressive treatment is due to the physician and patient perception that this is an incurable state. We hope these results will motivate researchers to optimize management strategies for these patients,” Dr Huang said.

“The first distant metastasis site is mostly in the chest region,” she noted. In fact, most of the cured patients had lung metastasis. “Computed tomography of the thorax for the early detection of distant metastases” might enhance the cure rate for this disease, she added.

Future studies should look for ways to identify patients at initial presentation who are at high risk for distant metastasis, and which type of distant metastasis will develop.

“We know there is a degree of correlation between the initial stage and the risk of distant metastasis, but we did not find a strong relationship between this stage and the type of metastasis,” Dr Huang reported. “The intensity of cigarette smoking in the years prior to the time of diagnosis is a possible factor. Being able to identify such relationships could be a huge help in deciding appropriate treatment at an early stage.”

Note:

1. Dr Bourhis, Dr Zips, Dr Huang, have disclosed no relevant financial relationships.
2. 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO): Abstract OC-044. Presented February 13, 2015.

March, 2015|Oral Cancer News|