radiation therapy

Drug Target in Rare, Lethal Glandular Cancer Discovered

Source: www.dddmag.com
Author: Yale University

 

Using a novel cell culture approach, Yale Cancer Center researchers have discovered critical vulnerabilities in adenoid cystic carcinoma (ACC), a rare and lethal glandular cancer with a high recurrence rate and few treatment options. The findings, published April 15th in the journal

Clinical Cancer Research, offer data that ACC and similar cancers could be treated with already available drugs.

ddd1604_yale_cancer

ACC most often occurs in the salivary glands but can originate in the breast, trachea, skin, or other sites. Survival rates at five years are close to 90percent but drop significantly after that with just 40percent surviving at 15 years after diagnosis. It is a slow-growing cancer that affects about 1,200 people each year, with few symptoms in early stages.

Aside from surgery, there are few treatments for ACC, which until now has proven largely resistant to radiation therapy. It is this resistance that prompted Yale researchers to develop a novel cell culture technique to isolate and study ACC cancer stem cells, known to be the root of tumor growth, aggressiveness, and resistance to chemotherapy and radiation, said co-senior author Sergey Ivanov, research scientist in surgery (otolaryngology).

“Within ACC cells, we found the especially aggressive cancer stem cells. As important, we found the Achilles heel of these cells, which is their addiction to NOTCH1, a signaling molecule that helps these cells to survive therapy and multiply,” Ivanov said. “Fortunately, cancer stem cells can be killed by blocking NOTCH1 production.”

The similarities between the ACC stem cells and cancer stem cells derived from other cancers such as melanoma, neuroblastoma, and glioma surprised the researchers, according to co-senior author Wendell Yarbrough, M.D., professor and chief of otolaryngology.

“Our study suggests that drugs, which are now used in clinical trials to block NOTCH signaling in a variety of cancers, could be effective against ACC,” Yarbrough said. “Also, our study highlights that there are good targets for therapeutic development in ACC. These findings should form the basis for clinical trials.”

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

April, 2016|Oral Cancer News|

Minimizing Imaging for Recurrence of HPV-Associated Head & Neck Cancer

Source: www.journals.lww.com/oncologytimes
Author: Robert H. Carlson

 

SCOTTSDALE, ARIZ.—Most recurrences of HPV-positive oropharyngeal squamous cell carcinoma (OPSCC) can be found through imaging and physical exams within six months after treatment, according to a study from the H. Lee Moffitt Cancer Center & Research Institute in Tampa, Fla.

“For most patients with HPV-associated oropharyngeal cancer who have had a negative three-month PET scan, physical exams with history and direct visualization are sufficient to find recurrences,” said Jessica M. Frakes, MD, Assistant Member of the Department of Radiation Oncology at the institute and lead author on the study, in a presentation at the 2016 Multidisciplinary Head & Neck Cancer Symposium.

“Minimizing the number of exams that do not compromise outcomes not only helps decrease anxiety and stress for our patients, but also eases the financial burden of cancer care,” she said.

 
 

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The study also supports the effectiveness of specialist teams in treating HPV-positive OPSCC with definitive radiation therapy. Frakes said local control at three years was 97.8; regional control 95.3 percent; locoregional control 94 percent; and freedom from distant metastases 91.4 percent.

Three-year overall survival was 91 percent.

“The number of OPSCC patients and survivors is growing, so there is a great need to determine the general time to recurrence and the most effective modes of recurrence detection in order to guide optimal follow-up care,” Frakes said.

But National Comprehensive Cancer Network (NCCN) guidelines for treatment of OPSCC are “one size fits all,” she said, with the same follow-up recommendations whether the disease is HPV-associated or not.

To identify patterns in recurrence detection, the researchers examined 246 cases of HPV- or p16-positive non-metastatic OPSCC patients treated with definitive radiation therapy at Moffitt between 2006 and 2014. Of those, 84.6 percent received radiation therapy and a concurrent systemic therapy, and 15.4 percent received definitive radiation therapy alone.

Patients then underwent a PET/CT scan three months after completing treatment. They also had physical exams every three months in the first year following treatment, every four months in the second year, and every six months in years three through five.

Median follow-up care length for all patients was 36 months. Recurrence and survival rates were calculated from the end of radiation therapy.

“Our local control was excellent,” Frakes said, reporting 98 percent of local failures were detected by physical exam, with either direct visualization (two cases) or flexible laryngoscopy (four cases); 89 percent of regional failures were found due to symptoms—primarily a neck mass—or by three-month post-treatment imaging; and 71 percent of distant metastases were found due to symptoms or three-month post-treatment imaging.

Frakes described some disease characteristics that increased the likelihood of recurrence: patients with five or more nodes or with level IV low-neck nodes present were more likely to suffer regional failure; and there was increased risk of distant metastases with involved lymph nodes greater than 6 cm (N3 disease), bilateral lymph node involvement, five or more involved lymph nodes, or level IV lymph nodes.

Toxicity rates were low, she said, with only 9 percent of patients experiencing severe late side effects.

“And the majority of those patients had resolution of the side effects at the time of last follow-up, meaning the feeding tube was taken out or they were treated with hyperbaric oxygen for necrosis,” she said.

Sixty-four percent of toxicities and/or recurrences occurred within the first six months following treatment, and only four events occurred more than two years following treatment.

“We were pleasantly surprised by the high cure rates and the low permanent side effect rates for these patients,” Frakes said.

These findings show individuals with HPV-associated oropharyngeal cancer treated with definitive radiation therapy and cared for by multidisciplinary specialists have excellent outcomes, Frakes concluded.

Surveillance: Too Much or Too Little?

There is much debate as to whether whether the surveillance done for the HPV-positive subset of OPSCC is too much or too little, said Bhishamjit S. Chera, MD, Associate Professor and Director of Patient Safety and Quality in the Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, who was asked to comment on this study for OT.

“This study’s primary objective was to evaluate whether the standard cancer survivorship program that we have used for oropharyngeal cancer is appropriate, and this abstract shows that the standard cancer survivorship program adequately detected the majority of cancer recurrences.”

Chera said repeated imaging, such as with PET/CT every 3-6 months, is not likely to detect recurrences faster in these patients, and it would clearly be more costly.

“I conclude from this study that more frequent surveillance with imaging or visits is not necessary for HPV-positive OPSCC,” Chera said. “Their cancer control is so good that we may be following them too closely or too often.”

He said future studies should evaluate following these favorable prognosis HPV-positive OPSCC less often.

Imaging After Three Months Not Routine

Christine G. Gourin, MD, Associate Professor of Otolaryngology-Head and Neck Surgery, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Medical Institutions, Baltimore, and moderator of an online/audio preview of this meeting for the press, said she appreciated the Moffitt study’s findings.

“I think we probably do too much post-treatment surveillance imaging,” she said, “and the NCCN guidelines are fairly vague about when to perform imaging.”

Gourin said her institution has stopped routinely imaging patients after three months if a PET scan is negative.

“And it’s true we pick up recurrences more clinically than radiologically, and, of course, a false-positive causes much more morbidity.”

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

April, 2016|Oral Cancer News|

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

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

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

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

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

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

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

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

March, 2016|Oral Cancer News|

Laser Treatment Halts Oral Mucositis in Its Tracks

Source: www.medscape.com

Author: Fran Lowry

 

Spa-like treatment with a cool, low-level laser, similar to that use

for wrinkles, vanquishes oral mucositis, one of the most debilitating

toxicities of cancer therapy.

 

“I have been an oncology nurse for over 25 years, and in those 25

years, there has been nothing that helps prevent or is effective

against the treatment for oral mucositis, until now,” said Annette

Quinn, RN, MSN, from the University of Pittsburgh Cancer Institute.

 

“Patients say they rank it higher than nausea and vomiting when it

comes to adverse side effects, especially because we have good

medications to control nausea and vomiting. But the low-level laser

works better than we could have hoped,” Quinn told Medscape Medical

News.

 

She presented results from a pilot project at the Oncology Nursing

Society (ONS) 40th Annual Congress in Orlando, Florida.

 

Oral mucositis affects virtually all head and neck cancer patients

undergoing chemo and radiation therapy, and about 75% to 100% of

patients undergoing stem cell transplantation with whole-body

irradiation experience some degree of oral mucositis.

 

Low-level laser therapy (LLLT) has been used to treat oral mucositis

for a decade in Europe and South America, but it has not made its way

to the United States because there is no mechanism for reimbursement,

Quinn reported.

 

She hopes this study will change that.

 

“Reimbursement is the main obstacle to its use in the United States,

but for this study, I was able to secure the treatment through a

grant. Treating oral mucositis could easily add $20,000 to the cost of

patient care, but with the laser, we can decrease hospital

readmissions and the use of pain medication, IV antibiotics, and

feeding-tube placements. Even though we cannot receive reimbursement,

laser treatment is still cost-effective,” she said.

 

It is thought that LLLT works on the mitochondria to displace the

nitric oxide that is generated as a result of radiation or

chemotherapy, and helps to reoxygenate the cells, Quinn explained.

 

In the pilot project, 52 patients with head and neck cancer, all

deemed to be at high risk for oral mucositis, received LLLT 830 nm

wavelength three times a week, starting the first week of their

radiation treatment and continuing throughout the course of their

radiation therapy.

 

The initial intent was to see if the laser could control the oral

mucositis so patients would not be forced to have a break in their

treatment, Quinn explained.

 

“We know that patients who miss 5 days or more of radiation therapy

have poorer survival, so we wanted to focus on how to get these

patients through with no treatment breaks. We didn’t realize that we

would get them through with no mucositis. But we found that the very

first patient we treated made it all the way through,” she said.

 

None of the 52 patients treated with LLLT developed any oral mucositis.

 

When oncologists treating stem cell transplantation patients

discovered these results, they brought 23 of their stem cell

recipients for LLLT. These patients were treated until their absolute

neutrophil count was above 1000 cell/nm³.

 

Again, results were excellent, although two patients developed grade 3

oral mucositis.

 

“Normally, 100% of stem cell patients develop oral mucositis. It’s

unbelievable what the therapy has done for oral mucositis,” Quinn noted.

 

LLLT Simplicity Itself

 

“The treatment is administered immediately after the radiation

therapy. It takes only about 6 to 8 minutes to administer, and is all

done extraorally; none of the probes actually go into the mouth unless

the patient develops a lesion inside the mouth that we need to target

with the probe,” Quinn explained.

It is simplicity itself, and it works so incredibly well. We just have

to get the word out.

 

“We do five sites along their face, right along the jaw line, and then

we do their tongue. The patients love it. We call it their spa time.

It’s the same laser they use in cosmetics to prevent wrinkles. We have

not had one patient tell us they want to stop their treatment, and we

have had no adverse side effects,” she said.

 

The learning curve is very slight, Quinn added.

 

The training takes about half a day, and learning how to use the

equipment only takes about 30 minutes. “It’s just cold laser therapy,

there’s no heating, there’s no cutting. Nothing. It is simplicity

itself, and it works so incredibly well. We just have to get the word

out,” she said.

 

The poster generated a lot of buzz among the nurses attending the

Congress, noted Ruth C. Gholz, RN, MSN, from the Cincinnati Veterans

Administration Medical Center.

 

“There was a lot of excitement about the laser to treat oral

mucositis. So many people were talking about it,” Gholz told Medscape

Medical News.

 

Oral mucositis is a debilitating side effect that challenges us as we

move forward with patients and providers. Low-level laser therapy has

been a recognized treatment per guidelines, yet many have limited to

no experience in its use,” she said.

 

Gholz explained that these results challenge “all practices to

incorporate low-level laser therapy into their armamentarium.”

 

“The future is bright as we move forward in maximizing this therapy,”

she added.

 

Ms Quinn and Ms Gholz have disclosed no relevant financial relationships.

 

Oncology Nursing Society (ONS) 40th Annual Congress: Abstract 84.

 Presented April 24, 2015.

Medscape Medical News © 2015  WebMD, LLC Send comments and news tips to news@medscape.net.

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

May, 2015|Oral Cancer News|

Experience counts with radiation for head and neck cancer

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

When it comes to specialized cancer surgery, the more experienced the surgeon, the better the outcome is generally true. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study.

Published in the Journal of Clinical Oncology(1) with an accompanying editorial(2), the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG). It was conducted by researchers at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital in Columbus.

The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence compared with highly experienced centers (62% vs 42%, respectively, at 5 years) and had poorer overall survival compared with those at the highly experienced centers (51% vs 69% 5-year survival, respectively).

“Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” said first author Evan Wuthrick, MD. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.”

Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management by a carefully coordinated multidisciplinary care team.

National Comprehensive Cancer Network (NCCN) guidelines recommend that head and neck cancer patients receive treatment at experienced centers, but whether provider experience affects outcomes was previously unknown.

The research team used participation in previous RTOG head and neck cancer clinical trials as a surrogate for experience. They identified 88 low-accruing centers that enrolled an average of four patients yearly to the trials, and 13 high-accruing centers that enrolled an average of 65 patients annually. Next, the researchers compared outcomes based on whether patients were treated at the high-accruing (more experienced) or low-accruing (less experienced) centers.

They found that 5-year local recurrence rates were higher among patients treated at less experienced centers versus more experienced centers (36% vs 21%). The radiation therapy plan was more likely to deviate from protocol at less experienced centers (18% vs 6%).

Treatment at low-accruing centers was associated with a 91% increased risk of death and an 89% increase in progression or death when compared with high-accruing centers.

Institutional elements not assessed by the study that can also influence outcomes included use of a tumor board, the number of colleagues and their years of practice, and ancillary services such as speech and swallowing therapy, diet and nutrition support, and specialized nursing.

References:
1. (2014; doi:10.1200/JCO.2014.56.5218)
2. (doi:10.1200/JCO.2014.58.2239)

January, 2015|Oral Cancer News|

Study suggests that experience counts when it comes to head and neck cancer treatments

Source: medicalxpress.com
Author: staff
 

When it comes to specialized cancer surgery, it’s generally true that the more experienced the surgeon, the better the outcome. The same might hold true for radiation therapy used to treat head and neck cancer, according to a new study led by researchers Evan Wuthrick, MD, assistant professor of radiation oncology at The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James), and Maura Gillison, MD, PhD, professor of internal medicine and epidemiology at the OSUCCC – James.

Published in the Journal of Clinical Oncology with an accompanying editorial, the study compared survival and other outcomes in 470 patients treated with radiation therapy at 101 treatment centers through a clinical trial held from 2002 to 2005. The trial was sponsored by the National Cancer Institute and organized by the Radiation Therapy Oncology Group (RTOG).

The findings indicated that patients treated at the less-experienced centers were more likely to have cancer recurrence (62 percent versus 42 percent at five years) and had poorer overall survival compared with those at the highly-experienced centers (51 percent versus 69 percent five-year survival, respectively).

“Our findings suggest that institutional experience strongly influences outcomes in patients treated with radiation therapy for head and neck cancer,” says Wuthrick, the paper’s first author. “They indicate that patients do better when treated at centers where more of these procedures are performed versus centers that do fewer.”

Radiation therapy for head and neck cancer requires complex treatment planning that can vary considerably between institutions and physicians. In addition, significant short-term and long-term side effects can occur that require management by a carefully coordinated multidisciplinary care team. National Comprehensive Cancer Network guidelines recommend that head and neck cancer patients receive treatment at experienced centers, but whether provider experience affects outcomes was previously unknown.

Wuthrick, Gillison and their colleagues used participation in previous RTOG head and neck cancer clinical trials as a surrogate for experience. They identified 88 low-accruing centers that enrolled an average of four patients yearly to the trials, and 13 high-accruing centers that enrolled an average of 65 patients annually. Next, the researchers compared outcomes based on whether patients were treated at the high-accruing (more experienced) or low-accruing (less experienced) centers.

The study’s key findings include:

  • Five-year local recurrence rates were higher among patients treated at less experienced centers versus more experienced centers (36 percent and 21 percent, respectively);
  • The radiation therapy plan was more likely to deviate from protocol at less experienced centers (18 percent versus 6 percent);
  • Treatment at low-accruing centers was associated with a 91-percent increased risk of death and an 89-percent increase in progression or death when compared with high-accruing centers.

Institutional elements not assessed by the study that can also influence outcomes included use of a tumor board, the number of colleagues and their years of practice, and ancillary services such as speech and swallowing therapy, dietetic and nutritional support, and specialized nursing.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
December, 2014|OCF In The News|

In one study, lower dose treatment for HPV oropharyngeal cancers is successful

Author: Anthony Cmelak, M.D.
Source: medicalnewstoday.com
 

A new study suggests that lowering the dose of radiation therapy for some head and neck cancer patients may improve outcomes and cause fewer long-term side effects.

The research was presented by lead author Anthony Cmelak, M.D., professor of Radiation Oncology at Vanderbilt-Ingram Cancer Center (VICC), during the 50th annual meeting of the American Society of Clinical Oncology (ASCO), held recently in Chicago.

The study focused on patients with newly-diagnosed oropharyngeal cancers related to the human papilloma virus (HPV). More than two-thirds of new head and neck cancer patients have HPV-positive tumors and the number of these patients is on the rise. Cmelak’s prior cooperative group study found that patients with HPV-positive oropharyngeal cancer have significantly longer survival rates than patients whose tumors are HPV negative.

For the new study, 80 HPV-positive patients with stage III, or IVa,b squamous cell cancer of the oropharynx received inductionchemotherapy, including paclitaxel, cisplatin and cetuximab.

After chemotherapy, 62 of the patients showed no sign of cancer and were assigned to receive a 25 percent lower dose of intensity-modulated radiation therapy – an advanced technology that targets the radiation beam more accurately to treat the tumor without harming surrounding tissue. The rest of the patients received a standard IMRT dose. The drug cetuximab was also given to both groups of patients along with the IMRT treatment.

Two years after treatment, the survival for the low-dose IMRT patients was 93 percent. Those who did not have complete resolution of cancer following induction and went on to get full-dose radiation had an 87 percent two-year survival. Eighty percent of the low-dose patients and 65 percent of standard IMRT patients also showed no evidence of tumor recurrence. Ninety-six percent of those who had minimal or no smoking history had no evidence of tumor recurrence after two years following treatment, and long-term side effects were minimal.

The investigators concluded that patients with HPV-positive cancer who had excellent responses to induction chemotherapy followed by a reduced dose IMRT and cetuximab experienced high rates of tumor control and very low side effects particularly for those with a minimal smoking history.

Treating tumors in the delicate head and neck region often causes side effects that can be troublesome and long-lasting, including difficulty swallowing, speech impairment, dry mouth, problems with taste and thyroid issues, so any therapy option that reduces these side effects can have an impact on patient quality of life.

“Treatment for head and neck cancer can be quite grueling, so it’s very encouraging to see we can safely dial back treatment for patients with less aggressive disease and an overall good prognosis, particularly for young patients who have many years to deal with long-term side effects,” said Cmelak.

He noted that lower-dose IMRT is not recommended for patients with HPV-negative cancer or larger tumors.

The authors note that further studies of reduced-dose IMRT in HPV-positive patients are warranted.

Other investigators include Jill Gilbert, M.D., VICC; Shuli Li, Ph.D., Dana Farber Cancer Institute, Boston, Massachusetts; Shanthi Marur, M.D., William Westra, M.D., Christine Chung, M.D., The Johns Hopkins University School of Medicine, Baltimore, Maryland; Weiqiang Zhao, M.D., Ph.D., Maura Gillison, M.D., Ph.D., The Ohio State University, Columbus, Ohio; Julie Bauman, M.D., Robert Ferris, M.D., University of Pittsburgh Cancer Institute; Lynne Wagner, Ph.D., Feinberg School of Medicine, Northwestern University, Chicago, Illinois; David Trevarthen, M.D., Colorado Cancer Research Program, Denver; A. Demetrios Colevas, M.D., Stanford University, California; Balkrishna Jahagirdar, M.D., HealthPartners and Regions Cancer Care Center, St. Paul, Minnesota; Barbara Burtness, M.D., Fox Chase Cancer Center, Philadelphia, Pennsylvania.

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
June, 2014|Oral Cancer News|

Lower radiation dose may be given to HPV-positive head and neck cancer patients

Source: Vanderbilt University
Published: June 19, 2014
By: Dagny Stuart

 

A new study suggests that lowering the dose of radiation therapy for some head and neck cancer patients may improve outcomes and cause fewer long-term side effects.

The research was presented by lead author Anthony Cmelak, M.D., professor of Radiation Oncology at Vanderbilt-Ingram Cancer Center, during the 50th annual meeting of the American Society of Clinical Oncology (ASCO), held May 30 to June 3 in Chicago.

The study focused on patients with newly diagnosed oropharyngeal cancers related to the human papilloma virus (HPV). More than two-thirds of new head and neck cancer patients have HPV-positive tumors and the number of these patients is on the rise. Cmelak’s prior study found that patients with HPV-positive oropharyngeal cancer have significantly longer survival rates than patients whose tumors are HPV negative.

For the new study, 80 HPV-positive patients with stage III, or IVa,b squamous cell cancer of the oropharynx received induction chemotherapy, including paclitaxel, cisplatin and cetuximab.

After chemotherapy, 62 of the patients showed no sign of cancer and were assigned to receive a 25 percent lower dose of intensity-modulated radiation therapy (IMRT) — an advanced technology that targets the radiation beam more accurately to treat the tumor without harming surrounding tissue. The rest of the patients received a standard IMRT dose. The drug cetuximab was also given to both groups of patients along with the IMRT treatment.

Two years after treatment, the survival for the low-dose IMRT patients was 93 percent. Those who did not have complete resolution of cancer following induction and went on to get full-dose radiation had an 87 percent two-year survival. Eighty percent of the low-dose patients and 65 percent of standard IMRT patients also showed no evidence of tumor recurrence. Ninety-six percent of those who had minimal or no smoking history had no evidence of tumor recurrence after two years following treatment, and long-term side effects were minimal.

The investigators concluded that patients with HPV-positive cancer who had excellent responses to induction chemotherapy followed by a reduced dose IMRT and cetuximab experienced high rates of tumor control and very low side effects, particularly for those with a minimal smoking history.

Treating tumors in the delicate head and neck region often causes side effects that can be troublesome and long-lasting, including difficulty swallowing, speech impairment, dry mouth, problems with taste and thyroid issues, so any therapy option that reduces these side effects can have an impact on patient quality of life.

“Treatment for head and neck cancer can be quite grueling, so it’s very encouraging to see we can safely dial back treatment for patients with less aggressive disease and an overall good prognosis, particularly for young patients who have many years to deal with long-term side effects,” said Cmelak.

He noted that lower-dose IMRT is not recommended for patients with HPV-negative cancer or larger tumors.

The authors note that further studies of reduced-dose IMRT in HPV-positive patients are warranted.

Funding was provided by The National Cancer Institute, a division of the National Institutes of Health (CDR0000665170).

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

 

June, 2014|Oral Cancer News|

Study: Recurrence of SCCOP may differ in HPV-positive and HPV-negative patients

Source: News Medical
Published: February 21, 2014

 

Patients with HPV-positive squamous cell carcinoma of the oropharynx (SCCOP) had a longer time to development of distant metastasis (DM) after initial treatment, and had more metastatic sites in more atypical locations compared to HPV-negative patients, according to research presented today at the 2014 Multidisciplinary Head and Neck Cancer Symposium.

Culled from records of an IRB-approved registry, the study reviewed 285 patients with stage III-IV SCCOP (originally thought to be a smoking-related head and neck cancer) treated with chemotherapy and radiation from 2002 to 2013. HPV status was determined by in situ hybridization for HPV DNA and/or by strong and diffuse (>75 percent) staining for p16 immunohistochemistry. There were 245 HPV-positive and 40 HPV-negative patients.

Twenty-seven HPV-positive and eight HPV-negative patients failed with DM and were the subjects for more detailed evaluation. Radiation therapy (RT) was either 3-D RT (HPV-positive = 15/27; HPV-negative = 4/8) or intensity modulated radiation therapy (IMRT) (HPV-positive = 12/27; HPV-negative = 4/8) with doses from 66-79 Gy. Patients received concurrent chemotherapy of cisplatin (HPV-positive = 9/27; HPV-negative = 2/8), cisplatin/5 fluorouracil (FU) (HPV-positive = 10/27; HPV-negative = 3/8) or cetuximab (HPV-positive = 8/27; HPV-negative = 2/8). One HPV-negative patient received cisplatin/paclitaxel chemotherapy. One patient in each group was treated with adjuvant chemoradiotherapy after initial resection. Student t-tests were used to compare the difference between the means of the samples.

Both HPV-positive and HPV-negative patients were found to have similar rates of DM, however the mean time to develop DM was significantly longer for HPV-positive patients (HPV-positive = 21.6 months vs. HPV-negative = 7.0 months). The most common sites of metastasis for all patients were the lung (HPV-positive = 17/27 vs. HPV-negative = 5/8) and bone (HPV-positive = 12/27 vs. HPV-negative = 2/8). The average number of metastatic subsites was significantly higher for HPV-positive patients (HPV-positive = 2.0 vs. HPV-negative = 1.1, p = 0.026). Twenty-one of 27 HPV-positive patients had more than one metastatic deposit, and 12/27 had DM involving more than one organ system, compared to only 1/8 for HPV-negative patients. Metastases in less typical sites were more common in HPV-positive patients; sites included the liver (6), intra-abdominal lymph nodes (3), brain (2), pleura (2) and peritoneum (1). Locoregional failure (metastases in the original tumor region) was only seen in four of the 27 HPV-positive patients, compared to three of the eight HPV-negative patients.

“The late onset of DM in HPV-positive patients (almost two years) is unusual since the majority of aerodigestive tract malignancies tend to recur within 12-18 months of definitive treatment. The multiple and varied DM sites, which can present as distal localized pain, indicates that we may need to be more aggressive in working up suspicions for metastatic disease and that imaging such as PET/CT scans may be warranted even several years after treatment,” said Samuel Trosman, MD, a resident in otolaryngology at the Cleveland Clinic. “We were able to learn significant characteristics of HPV-positive SCCOP that will help us provide more tailored care and surveillance strategies for these patients.”

The abstract, “Distant Metastatic Failure Patterns in Squamous Cell Cancer of the Oropharynx (SCCOP) Treated with Chemoradiation: the Impact of Human Papillomavirus,” will be presented in detail as a poster presentation at the 2014 Multidisciplinary Head and Neck Cancer Symposium. To speak with Dr. Trosman, contact Michelle Kirkwood on February 20 – 21, 2014 in the ASTRO Press Office at the JW Marriott Camelback Inn Resort and Spa in Scottsdale, Arizona at 480-596-7085 or email michellek@astro.org.

The 2014 Multidisciplinary Head and Neck Cancer Symposium is sponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO) and the American Head & Neck Society (AHNS). The two-and-a-half day meeting includes interactive educational sessions focused on topics such as supportive care, directed therapy, new surgical and radiotherapeutic techniques, as well as 12 oral abstract presentations of the current science of relevance to the head and neck cancer community. A total of 189 abstracts will be presented including 177 posters. Keynote speakers include Jennifer Grandis, MD, of the University of Pittsburgh, to present “The Molecular Road to Defining and Targeting High-risk Head and Neck Patients;” and Julia H. Rowland, PhD, of the National Cancer Institute, to present “Cancer Survivorship: Research Opportunities on the Path to Where We Want to Be.”

 

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

 

February, 2014|Oral Cancer News|

Are combination therapies effective for advanced SCCHN?

Source:
Author: DrBicuspid Staff

In a recent study, researchers from the University of North Carolina (UNC) Lineberger Comprehensive Cancer Center examined whether the addition of multiple drugs to radiation therapy is superior to the current standard of care therapy with one drug and radiation for locally advanced squamous cell carcinoma of the head and neck (SCCHN).

Their data, published in the Journal of Clinical Oncology, suggests that it does not (March 4, 2013). Standard therapy for SCCHN is a combination of the drug cisplatin and radiotherapy.

This clinical trial compared this combination to the combination with the addition of a small-molecule inhibitor of the epidermal growth factor receptor (EGFR) erlotinib. For the study, 204 patients with locally advanced SCCHN were recruited between December 2006 and October 2011. Participants were assigned to receive either cisplatin and radiotherapy or the same chemoradiotherapy with erlotinab.

EGFR is a therapeutic target for this type of cancer, and at least one other EGFR is approved for multiple uses in treating head and neck cancer, including in combination with radiation. To date, no data have been published on the use of EGFR inhibitors in combination with chemotherapy and radiation.

The goal of the current study was to determine if adding EGRF inhibition improved efficacy when combined with standard of care radiation. Unfortunately, the researchers found that the addition of EGRF did not improve clinical response rate or progression-free survival.

“There has been great enthusiasm and some confusion about the combinations of chemotherapy and biologic therapy such as EGFR inhibitors in conjunction with radiation in the treatment of squamous cell carcinomas of the head and neck,” stated lead author Neil Hayes, MD, MPH, from UNC Lineberger Comprehensive Cancer Center, in a press release. “For the moment, the data are clearly showing no added benefit.”

Future investigations will rely more on patients selected by the molecular tumor characteristics, he added.

Other institutions participating in the study were the University of Washington, Fred Hutchinson Cancer Research Center, Multicare Health Systems, University of New Mexico, Medical University of South Carolina, University of Miami, Coastal Carolina Radiation Oncology, and the University of Tennessee. Funding for the study was provided to the University of Washington by Genentech and Astellas Pharma Global Development.

March, 2013|Oral Cancer News|