radiotherapy

Google and UCLH to develop AI to improve cancer therapies

Source: www.phgfoundation.org
Author: Julian Harris

Google’s Artificial Intelligence research group announced a new partnership with University College London Hospitals, applying machine learning to radiotherapy treatment for head and neck cancer.

Abstract, Electronic circuit network grunge background

The new partnership is the third since the launch of DeepMind’s health division in February 2016.

The partnership aims to assist clinicians in the segmentation process – designating which areas of the body to target with radiotherapy – which in the case of head and neck cancer is highly time consuming, taking around four hours. The agreement will give DeepMind access to the anonymised scans of around 700 patients, as well as the expertise of UCLH’s world leading team at their specialised head and neck cancer centre.

Google DeepMind hopes to utilise machine learning to make the planning of radiotherapy treatment more efficient and reduce the duration of the segmentation process. Ultimately , clinicians will still be responsible for deciding on treatment plans, but the reduced workload will free up their time to focus on patient care.

If successful, the team hope that they will be able to adapt their segmentation algorithm to other parts of the body and other cancers which can also be treated with radiotherapy.

Machine learning continues to be a promising new area of health technology, with the potential to provide novel solutions to a range of problems in healthcare. In the UCLH press release, the Co-Founder of DeepMind, Mustafa Suleyman said that “this real-world application of artificial intelligence (AI) technology is exactly why we set up DeepMind… We hope this work could lead to real benefits for cancer patients across the country and for the clinicians who treat them.”

September, 2016|Oral Cancer News|

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

Source: www.healio.com
Author: Anthony SanFilippo

The launch of an advance practice nurse outpatient follow-up clinic improved symptom management for high-risk patients with head and neck cancer following radiation therapy, according to findings from a study conducted at Cleveland Clinic. This initiative led to fewer ED visits and hospital admissions, results showed.

“These results are significant as they suggest more intensive follow up in high-risk head and neck patients can improve patient outcomes,” Bridgett Harr, CNP, of the department of radiation oncology at Cleveland Clinic, told HemOnc Today. “This intensive symptom management is an important role [advance practice nurses (APNs)] can fill in this and other patient groups by providing consistent, proactive management of symptoms during recovery from treatment. Our study suggests this will lead to improved patient experience, in addition to a reduction in cost to both the patient and health care system as a whole.”

Patients with head and neck cancer often undergo radiotherapy or chemoradiotherapy, and many experience debilitating side effects that require ED management or admission to the hospital. In 2014, an APN-led clinic was launched to focus on the acute rehabilitation of patients with head and neck cancer undergoing these therapies.

Harr and colleagues sought to evaluate the outcomes and incidence of adverse events among patients treated at an APN clinic compared with historical outcomes.

The analysis included data from 25 high-risk patients with head and neck cancer who received care post-treatment at an APN clinic and 24 patients who received standard follow-up care identified using a database. Clinic patients were seen 2 to 4 weeks after treatment and then every 2 to 4 weeks thereafter until their symptoms stabilized. Standard follow-up patients were seen on average between 4 to 6 weeks after treatment and then not again until 3 months post-treatment.

Patients were considered high risk if they had limited social support (35%), resided in a nursing home (16%), required multiple hydrations during treatment (18%), underwent stereotactic body re-irradiation (15%) and/or required a feeding tube (16%).

Ninety percent of patients had stage IV or recurrent cancer. Primary tumor sites included oropharynx (47%), oral cavity (16%), larynx/hypopharynx (12%) and other (25%).

All patients underwent stereotactic body radiation therapy or intensity-modulated radiation therapy. Fifty-five percent of the patients received chemoradiotherapy with either a cisplatin-based regimen (81%) or cetuximab (19%), and 45% of the patients received radiation therapy alone.

Patients in the APN clinic were seen almost twice as often as those in the standard follow-up group (median, 2 vs. 1.2 visits).

Eighteen patients experienced 26 adverse events that required either a visit to the ED or hospital admission. Six of those patients (33%) were seen in the APN clinic, whereas 12 patients (67%) were from the standard follow-up cohort.

“Not only is there greater patient satisfaction when being managed in an outpatient setting, it is more cost-effective to avoid emergency room or hospital admissions,” Harr said in a press release.

The benefits of the APN clinic appeared more substantial among patients who received radiation alone. Significantly fewer patients treated only with radiation who received their follow-up care at the APN clinic experienced an adverse event in the 90 days immediately after radiation compared with patients who received standard follow-up (60% vs. 16.7%; P = .01).

Researchers observed no difference between the arms for patients who underwent chemoradiotherapy because standard follow-up is also intensive, according to the researchers.

“This study illustrates an important role for APNs in radiation oncology,” Harr said. “APNs are in a unique position to provide more intensive follow-up care, allowing them to better manage the post-treatment symptoms of high-risk head and neck cancer patients.”

November, 2015|Oral Cancer News|

Less Is More for HPV Oropharyngeal Cancer Reduced-intensity regimen clears disease in 86% of cases

Source: www.medpagetoday.com
Author: Charles Bankhead
 

SAN ANTONIO — Less intense treatment of low-risk human papillomavirus (HPV)-related oropharyngeal cancer achieved a high rate of pathologic complete response (pCR) and favorable patient-reported outcomes, a preliminary trial showed.

Overall, 37 of 43 (86%) patients achieved pCR with deintensified chemoradiation, including all but one evaluable primary tumor. The pCR rate was virtually identical to historical rates achieved with standard regimens, according to Bhishamjit Chera, MD, of the University of North Carolina (UNC) at Chapel Hill, and colleagues.

Selected patient-reported adverse events peaked during the first 6 to 8 weeks and then declined thereafter. About 40% of patients required feeding tubes for a median duration of 15 weeks, but no patients required permanent feeding tubes, they reported here at the American Society for Radiation Oncology meeting.

The regimen consists of lower doses of radiotherapy and concurrent cisplatin, administered over 6 weeks. With high-dose therapy, the radiation protocol requires an additional week.

“Though we have limited follow-up, the pathological complete response rate with this reduced-intensity chemoradiotherapy regimen is very high in patients with favorable-risk oropharyngeal squamous-cell carcinoma,” Chera said. “The early quality-of-life measurements are encouraging, particularly the data on swallowing. We are optimistic that these results with reduced-intensity treatment will translate into good long-term disease control with less toxicity.”

The study reflects the current trend and momentum in the management of HPV-positive oropharyngeal cancer, said Zain Husain, MD, of Yale Cancer Center in New Haven, Conn.

“This is the second study to show that de-escalation of therapy might work, and so far, the results really look good,” Husain told MedPage Today. “This is a really important issue, and all of our trials are moving in that direction.”

NRG Oncology (formerly RTOG) has already launched a trial using the UNC regimen, “which gives us a lot of confidence that this is a good regimen,” Husain added. Nonetheless, reduced-intensity treatment remains investigational and should not be used in clinical practice. Randomized clinical trials with adequate follow-up will be required to determine the ultimate role of less intense therapy for HPV-positive oropharyngeal cancer, he said.

Background

HPV-positive oropharyngeal cancer accounts for 60% to 70% of new cases of oropharyngeal cancer in the U.S., and the incidence has continued to rise. In general, HPV-positive disease has a more favorable prognosis as compared with HPV-negative oropharyngeal cancer.

At many institutions, standard therapy for newly diagnosed HPV-positive oropharyngeal cancer consists of total-dose radiotherapy of 70 Gy administered over 7 weeks, and concurrent cisplatin 100 mg/m2 for 3 weeks. The regimen achieves a high rate of pCR but causes substantial toxicity. Given the overall favorable prognosis of HPV-positive oropharyngeal cancer, many specialists have begun to ask whether reduced-intensity treatment might be just as effective with less toxicity.

Chera reported findings from a prospective phase II trial of reduced-intensity chemoradiation for low-risk HPV-positive oropharyngeal cancer. Eligible patients had diagnoses of T0-3, N0-2c, M0 disease associated with minimal or negative smoking history. Treatment consisted of a total radiation dose of 60 Gy administered in 2-Gy fractions daily for 6 weeks, plus concurrent weekly cisplatin 30 mg/m2. The regimen represented a 10-Gy reduction in the usual radiation dose and a 40% reduction in the usual chemotherapy dose, Chera said.

The primary outcome was pCR and was based on experience with usual high-dose therapy, which has been associated with a pCR rate of 87%. Patients undergo biopsy of the primary site 6 to 14 weeks after completing chemoradiation, as well as resection of any initially-positive lymph nodes. Secondary endpoints included toxicity, quality of life (QOL), and clinical outcomes of treatment.

Key Findings

The 86% pCR rate compared favorably with the 87% rate demonstrated by historical data. The overall results included pCR in 40 of 41 evaluable primary tumors (two of which were stage T0 at baseline) and pCR in the neck in 33 of 39 patients (four of whom had N0 status at baseline).

After a median follow-up of 21 months, all 43 patients remain alive and without evidence of disease, including 38 patients who have at least 1 year of follow-up.

Investigators evaluated QOL by means of an instrument developed by the European Organization for Research and Treatment of Cancer (EORTC QLQ H&N-35). Focusing on common adverse effects of chemoradiation for head and neck cancer, Chera noted that the severity score for dry mouth, sticky saliva, and swallowing all increased during the first 6 to 8 weeks, particularly dry mouth and sticky saliva.

The score for dry mouth peaked at about 70 on the 100-point scale and the score for sticky saliva rose to a maximum of about 60. Score for dry mouth remained at about 60 at 12 months, whereas the saliva score declined to about 40. The effect on swallowing was less severe, reaching a maximum of about 20 and then declining to less than 10 at 12 months.

Patient-reported symptoms exhibited a similar pattern as the dry mouth score averaged less than 0.5 (0 to 4 scale) at baseline, increasing to almost 2.5 at 6 to 8 weeks, and then declining to less than 2.0 by 1 year. Patient-rated swallowing difficulty was less than 0.5 at baseline, about 1.0 at 6 to 8 weeks, and slightly less than 1.0 at 1 year.

Physician-rated grade 3/4 toxicity and patient-rated severe/very severe toxicity included mucositis (34%/45%), pain (5%/48%), nausea (18%/52%), vomiting (5%/34%), dysphagia (39%/55%), and xerostomia (2%/75%).

Chera and colleagues have already closed enrollment for another phase II trial that will evaluate a reduced-intensity regimen that makes surgery optional, omits chemotherapy for patients with T1-2 N0-1 disease, and includes patients with as much as a 30 pack-year smoking history but who have a 5-year period of abstinence.

A planned “third-generation” phase II trial will evaluate the feasibility of cancer genetics risk-based stratification of patients and examine more specifically the question of whether reduced-intensity treatment is possible for patients with a >10 pack-year smoking history.

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

October, 2015|Oral Cancer News|

Imaging method has potential to stratify head and neck cancer patients

Source: www.eurekalert.org
Author: press release

Manchester researchers have identified a potential new way to predict which patients with head and neck cancer may benefit most from chemotherapy.

These patients commonly receive pre-treatment induction chemotherapy, before either surgery or radiotherapy, to reduce the risk of disease spread. However the effectiveness of such treatment is reduced in tumours with poor blood flow.

Previous studies have shown that CT scans can be used to assess tumour blood flow. Now researchers at The University of Manchester and The Christie NHS Foundation Trust – both part of the Manchester Cancer Research Centre – have explored the use of MRI scans in predicting which patients would benefit from induction chemotherapy.

Professor Catharine West, who led the study, said: “It’s also important to identify those patients who are unlikely to respond to induction therapy so that we can skip ahead in the treatment pathway and offer them potentially more effective treatments and hopefully improve their outcome.”

The team used an imaging technique known as dynamic contrast-enhanced MRI (DCE-MRI), where a contrast agent tracer is injected into a patient’s vein whilst they have a series of MRI scans taken. This allows scientists and doctors to investigate the blood flow and vessel structure of a patient’s tumour.

They found that the blood flow of a patient’s tumour before they received induction therapy could predict response to treatment. In a paper recently published in the journal Oral Oncology, the group report that those with high tumour blood flow were more likely to respond.

Jonathan Bernstein, a co-author on the paper, said: “Delivery and effectiveness of chemotherapy appears to be better in tumours with higher blood flow. However, amongst those patients with lower measured tumour blood flow, more work is needed to determine those who will and won’t respond.”

Source: ‘Tumor plasma flow determined by dynamic contrast-enhanced MRI predicts response to induction chemotherapy in head and neck cancer’, Bernstein et al. (2015) Oral Oncology

September, 2015|Oral Cancer News|

AstraZeneca joins the world of immunotherapy against cancer

Source: www.youthhealthmag.com
Author: staff

Cancer drug companies have been fighting lately in a completely different and interesting arena: immunotherapy. The competition is indeed heating up that firms such as AstraZeneca are willing to pay millions of dollars for promising treatments. AstraZeneca, through its research company called MedImmune, has just recently announced its decision to purchase a novel drug INO-3112 from Inovio, based in Pennsylvania, for a staggering price tag of $727 million.

INO-3112 is a drug for immunotherapy, a new way of combating cancer by boosting the body’s immune system. This then allows the antibodies and specific cells to fight off the tumor. The treatment may also provide synthetic proteins to boost the body’s fighting chance.

MedImmune believes that with the proper immunotherapy protocol for the patient, conventional methods such as chemotherapy and radiotherapy, which have plenty of serious risks, can now be significantly reduced, if not eliminated. In fact, patients may no longer have to go through surgery, which is a common first-line treatment.

While AstraZeneca already has immunotherapy products in the market, the acquisition of INO-3112 will make it an instrument for combination therapies.

As for Inovio, the drug, which is still not approved, is currently in the advanced stages of the clinical trials. It will be intended for treating head and neck cancers, as well as cervical cancer. While there are already cervical cancer vaccines, they cite the rather poor record of them. Their drug, on the other hand, will work on modifying DNA sequencing that will trigger the manufacture of certain T-cells, which will then curb tumor growth.

So far, MedImmune has already paid its down payment of $27.5 million. The remaining amount will be given as the research and drug reach certain milestones. The company will also pay for the research.

The partnership is also set to increase the revenues of Inovio as it receives a share in the drug’s sale. Both will also be working on cancer vaccines.

August, 2015|Oral Cancer News|

Keytruda doubles efficacy of only targeted therapy for head and neck cancer

Source: www.curetoday.com
Author: Lauren M. Green

The immunotherapy Keytruda (pembrolizumab), in a recent study, proved twice as effective for the treatment of head and neck cancer as Erbitux (cetuximab), the only targeted therapy indicated as a therapy for the disease.

The multisite study offers the largest experience to date of how immunotherapy can be deployed in patients with head and neck cancer, and could change the way the disease is treated. The findings were announced May 29 during the annual meeting of the American Society of Clinical Oncology, a gathering of nearly 30,000 oncology professionals taking place in Chicago.

Keytruda is an antibody designed to disable the protein PD-1 so it cannot do its job of keeping the immune system in check; this allows T cells to become more active in recognizing and fighting cancer cells. In the study, investigators found that the drug produced broad and durable responses in patients with advanced head and neck cancer.

Fifty-six percent of patients in the study experienced some tumor shrinkage with Keytruda, and 86 percent of those patients continued to respond to treatment at data cutoff on March 23, 2015. Keytruda produced an overall response rate (ORR) of 25 percent, and it proved active in both HPV (human papillomavirus)-positive and HPV-negative patients.

“The efficacy was remarkable — pembrolizumab seems to be roughly twice as effective, when measured by response, as our only targeted therapy, cetuximab,” said Tanguy Seiwart, an assistant professor of medicine and associate leader of the head and neck cancer program at the University of Chicago, who presented the results in a press briefing during the ASCO meeting. “We have high hopes that immunotherapy will change the way we treat head and neck cancer.”

Recurrent/metastatic head and neck squamous cell carcinoma (HNSCC) has a poor prognosis with a median overall survival (OS) of 13 months in patients treated in the first-line setting, and six months in previously treated patients. Previously treated patients made up the majority of the population of the study, which built on earlier findings from the KEYNOTE-012 study (NCT01848834). In that study, Keytruda — administered at 10 mg/kg every two weeks — had a 20 percent response rate in patients with advanced HNSCC whose tumors were positive for the protein PD-L1.

The findings reported May 29 were based on results from an expansion of that first trial, which involved 132 patients with advanced HNSCC who were recruited regardless of their PD-L1 or HPV status. Importantly, said Seiwert, patients in this cohort received a fixed dose of Keytruda (200 mg every three weeks), representing “a very convenient dosing schedule.”

Eligible patients had measureable disease based on RECIST 1.1 response evaluation criteria and an ECOG performance status of 0 or 1. The majority of enrollees were male (83 percent), and 56.8 percent had received two or more lines of therapy for disease recurrence. Radiographic imaging was used to assess tumor response every eight weeks. Patients were treated as long as they didn’t show progression of disease or as long as they demonstrated clinical improvement, Seiwert explained.

Of 117 evaluable patients, 29 (24.8 percent; [95 percent confidence interval (CI), 17.3–33.6]) responded to treatment with Keytruda. For patients with HPV-positive HNSCC, the ORR was 20.6 percent, and in the HPV-negative cohort, ORR was 27.2 percent.

“In addition to the 25 percent response rate,” said Seiwert, “about 25 percent also had stable disease, so when we take these together, we have a disease control rate of about 50 percent, which is remarkable in this disease, especially in a heavily pretreated population.”

Moreover, he said, about two-thirds of patients had received two or more prior lines of therapy, which generally is an indicator of a very poor prognosis.

For the 56 percent of patients whose tumors decreased in size, Seiwert said the responses often occurred early at eight or 16 weeks, although there were a few outliers with late responses.

“Importantly, those patients who did respond oftentimes continued to have responses — 86 percent of patients had durable responses in this cohort,” he continued, adding that not only are responders remaining on the therapy, but so are many patients who have stable disease, with a total of 40 patients staying on the drug.

“Overall, and in keeping with what we already know about pembrolizumab, this was a very well-tolerated agent,” said Seiwert, “certainly better tolerated than what we usually see in head and neck cancer with aggressive chemotherapy and radiotherapy.”

Serious side effects were reported in fewer than 10 percent of patients. The most common side effects were fatigue (15.2 percent of patients), hypothyroidism (9.1 percent), and decreased appetite and rash, each occurring in 7.6 percent of patients. Four patients discontinued treatment due to immune-related side effects: two due to grade 2 interstitial lung disease and grade 3 colitis, respectively, and two patients for grade 3 pneumonitis.

Analysis of the findings based on biomarker status is ongoing, and Seiwert is hopeful that with the emergence of new potential biomarkers, researchers will be able to pinpoint which patients with HNSCC are most likely to benefit from the immunotherapy.

For example, another related study that Seiwert and colleagues are reporting at ASCO (abstract 6017) has shown that the expression of the gene signature interferon-gamma in head and neck tumors had a very strong negative predictive value of response to Keytruda. “In the future, these results may help us, if validated, to determine which patients should or should not [be given] pembrolizumab,” Seiwert said.

Pembrolizumab versus standard treatment for HNSCC also is being evaluated in two phase 3 trials that are currently recruiting participants (NCT02252042 and NCT02358031).

Source:
Seiwert TY, Haddad RI, Gupta S, et al. Antitumor activity of the anti-PD-1 antibody pembrolizumab in biomarker-unselected patients with R/M head and neck cancer: preliminary results from the KEYNOTE-012 expansion cohort. J Clin Oncol. 2015;(suppl; abstr LBA6008) – See more at: http://www.curetoday.com/articles/keytruda-doubles-efficacy-of-only-targeted-therapy-for-head-and-neck-cancer/2#sthash.44VvpPH4.dpuf

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|

Researchers propose new staging model for HPV+ oropharyngeal cancer

Source: www.drbicuspid.com
Author: Donna Domino

Researchers are proposing a new tumor-staging model for predicting the outcomes and guiding treatments for patients with human papillomavirus (HPV)-related oropharyngeal cancer (OPC), according to a new study in the Journal of Clinical Oncology. Since HPV-related cancer differs significantly from smoking-related cancer, less intensive treatment strategies may be more appropriate, the study authors concluded.

Treatment regimens for oropharyngeal cancer have intensified over time and carry a toxicity burden, the Canadian researchers noted.

In the last few years, research has found that oropharyngeal cancer caused by HPV behaves differently than OPC caused by smoking and alcohol, yet both cancers use the same tumor classification model. Therefore, regardless of whether the OPC was caused by HPV or smoking, the treatment and perceived prognosis based on tumor staging has remained the same, even though patient outcomes vary considerably, the study authors noted (Journal of Clinical Oncology, February 10, 2015, Vol. 31:5, pp. 543-550).

A new tumor-staging model will help separate patients with promising prognoses from those with negative ones to design the most appropriate treatment strategies for each group, according to the researchers from Toronto’s Princess Margaret Cancer Centre.

The researchers analyzed 899 oropharyngeal cancer patients, including 505 (56%) patients with HPV who had been treated with radiotherapy or chemoradiotherapy from 2001 to 2009. The HPV-positive patients (382) had higher recurrence-free survival rates after about four years compared with HPV-negative patients (123). Disease recurrence was 16.7% (64) among HPV-positive patients; 38.2% among HPV-negative patients (47).

The tumor staging system classifies the disease into early, intermediate, or advanced stages of cancer. It helps determine treatment plans and can suggest likely outcomes.

For example, a stage IV patient with HPV-related cancer has an 80% survival rate, while a stage IV patient with smoking-related cancer has a 50% to 60% survival rate. But both are currently considered to have advanced-stage disease, which is recognized as a life-threatening prognosis.

“When you tell a patient they have stage IV cancer, it’s an indication of advanced disease, and they don’t expect it to be curable,” Huang said in a statement. “We need a staging system that more accurately reflects a patient’s prognosis, which in a case caused by HPV is highly curable.”

The study also highlights the fact that many HPV-related OPC patients are overtreated because of the stage IV tumor classification. High-dose chemotherapy combined with high-dose radiation is often given to such patients when radiation therapy alone or other less-intensive strategies can probably cure many of them, the researchers said.

Conclusion

“Our study shows that the current model derived for smoking- and alcohol-related cancers is not suited for throat cancer caused by HPV, a burgeoning throat cancer population in the Western world, including Canada,” Huang concluded.

A new tumor staging model will help separate patients with promising prognoses from those with negative prognoses to design the most appropriate strategies for each group, the study authors concluded.

Clinical trials have now begun to address these questions, but their descriptions and designs are hindered by inadequacies of the current stage classification, they stated.

“Providing a relevant stage classification for a rapidly emerging disease is important, but the additional feature of the classification is that it provides the opportunity to include factors beyond just the traditional description of disease extent into the prognostic classification we are trying to develop to assist in treating patients,” he said.

The structure used for disease classification follows a template that was developed at the Union for International Cancer Control in Geneva and is relevant to all cancers, according to Dr. O’Sullivan.

“Important factors that are emerging throughout oncology are not currently included in the international classifications,” he concluded. “This needs to change to facilitate our goal of providing personalized approaches to patients with cancer.”

The Princess Margaret Hospital is collaborating with six major cancer centers worldwide to validate the findings.

February, 2015|Oral Cancer News|

Possibility of cure For HPV positive throat cancer patients—new research

Source: au.ibtimes.com
Author: Samantha Richardson

A new research conducted by Dr. Sophie Huang, assistant professor in the Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada revealed that throat cancer caused by the Human Papilloma virus (HPV+) can possibly be cured. The research is of utmost importance as it is the first to provide substantial evidence to prove that patients suffering from oropharynx cancer can be healed.

The disease also spreads to other parts of the body. The press release disclosed that the tumours remain passive and go undetected for over two years in most case, which makes it incurable. The research was presented at the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) on Friday. She states that cure is possible among patients suffering from oropharyngeal cancer is possible for the first time.

“Our research, the largest study to date to explore survival predictors for metastatic HPV+ and HPV- oropharyngeal cancer patients,” says Dr. Huang.

For the research, 934 patients suffering from HPV+ OPC were studied. All subjects were patients treated at the Princess Margaret Cancer Centre between 2000 and 2011. The researchers found two types of distinct metastases or tumours in other parts of the body away from the source in HPV+ patients: “explosive” and “indolent” metastases. The former grows and spreads quicker while the latter is slower and manifests itself as oligometastasis. However, they found the lung as the most common metastatic site in both HPV+ and HPV- patients. According to Dr. Huang, more aggressive treatments solely aimed at disease control resulted in a long term disease-free period, suggesting that some may be cured.

“In the HPV+ group with oligometases 25% were still alive after three years, whereas the percentage in the HPV- group was 15%,” the press release stated. The reason for higher survival rates among HPV+ patients is the younger age of the patients. In addition, the cancer is more sensitive to radiotherapy and chemotherapy. Those who receive treatment are at an advantage and can survive longer than those who do not undergo the process. Early detection of metastases and aggressive treatment can cure the patient.

Dr. Huang explained that they were aware of the correlation between the initial stages and the risk of a tumour on another site of the body. However, the degree by which they are related remains unknown. She highlights that identifying such relationships could help find an appropriate treatment at an early stage.

Professor Jean Bourhis, co-chair of the conference scientific committee, says that this is a very important research with respect to finding the cure of oropharynx cancer. He states that it provides hope in both the treatment and diagnosis of the patients.

February, 2015|Oral Cancer News|

New research shows possibility of cure for HPV positive throat cancer patients

Source: Eurek Alert! The Global Source for Science News

Nice, France: Patients with cancer of the throat caused by the Human Papilloma virus (HPV+) have a better prognosis than those who are negative for the virus (HPV-). Now, for the first time, researchers have shown with convincing evidence that a group of patients with HPV+ cancer of the oropharynx (the part of the throat located behind the mouth, that makes up the region of the tonsils and the back part of the tongue where it connects to the swallowing part of the throat), can be cured in some cases even after disease has spread to distant organs in the body, like the lungs.

Dr Sophie Huang, Assistant Professor in the Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Canada, will tell the 5th International Conference on Innovative Approaches in Head and Neck Oncology (ICHNO) today (Friday) that her research has shown that, following intensive treatment, certain patients with HPV+ oropharyngeal cancer (OPC) and distant metastases (tumours appearing in an organ not directly related to the primary cancer site) can survive for more than two years without further evidence of disease. Such cancers are usually considered to be incurable, and the goal of treatment is usually limited to symptom control. “Our research, the largest study to date to explore survival predictors for metastatic HPV+ and HPV- oropharyngeal cancer patients, has shown that cure is a realistic goal in those patients with oligometastasis – metastases involving five or fewer lesions in one distant organ”, she will say.

Dr Huang and colleagues identified 934 patients with HPV+ OPC out of the 1238 OPC patients who had been treated at the Princess Margaret Cancer Centre between 2000 and 2011. Distant metastases were detected in 15% of these patients; 88 in the HPV+ group and 54 in those with HPV- disease. Oligometastasis was present in 24 HPV+ patients with distant metastases in a single organ.

The researchers found two types of distinct distant metastases in HPV(+) patients: “explosive” and “indolent” metastases. The explosive type metastasis, where more than ten lesions in one organ appear quickly in a short period (within three months of appearance of the first lesion), was present in 55% of the HPV+ group, as opposed to none in those who were HPV-. In both HPV+ and HPV- groups, lung was the most common metastatic site. The indolent type of metastases grow and spread at a much slower pace, most often manifesting as oligometastasis. This occurred in 24% of the HPV+ cases with metastases in a single organ as opposed to 26% of those who had HPV- cancer.

“In the HPV+ group of patients with oligometastases, when they were given definitive local treatment aimed at disease control – for example, a high radiation dose or surgical removal of the metastatic lesion, as opposed to a less aggressive treatment used to control symptoms -there was a long term disease-free period, suggesting that some may be cured,” Dr Huang will say. “In the HPV+ group with oligometases 25% were still alive after three years, whereas the percentage in the HPV- group was 15%.”

The survival advantage in HPV+ OPC patients is due to a number of factors, the researchers say. The cancer is more sensitive to radiotherapy and chemotherapy; the patients tend to be younger (an average age of 55 at diagnosis as opposed to 65) with fewer other health problems, including those caused by smoking-related illness, and this enables them to receive the more aggressive treatment necessary to eradicate metastatic disease.

The percentage of HPV positive to negative OPC cancers varies globally, depending on a number of factors, including the prevalence of smoking and the practice of oral sex. Overall the incidence of HPV+ throat cancers has increased over the past 20 years in developed countries, such as US, Canada, Japan, Australia, and some European countries. [1]

“This research has shown that metastatic HPV+ OPC patients who receive active treatment can survive considerably longer than those who did not receive treatment. One of the reasons patients with metastatic disease do not receive aggressive treatment is due to the physician and patient’s perception that this is an incurable state. We hope that these results will motivate researchers to optimise management strategies for these patients. This will not only help to produce a better quality of life and a return to work for them, but also reduce the cost to healthcare systems,” Dr Huang will say.

“We also hope that our study may trigger research to explore cost-effective methods for the early detection of metastases. Optimising and tailoring surveillance strategies for HPV+ patients are also important. For example, our research has shown that the surveillance period should be longer than the traditional two-year window, due to the possibility of later onset of metastases. Selecting the appropriate imaging method in order to detect asymptomatic oligometastasis (e.g. ultrasound for the early detection of liver metastasis) may allow salvage treatment of some patients before the cancer progresses. Finally, we hope that it will help clinicians identify patients who are best able to benefit from aggressive treatment, such as metastasectomy (surgical removal of the metastases) or stereotactic radiotherapy (highly focused high dose radiotherapy to small regions),” Dr Huang will say.

Whether it is possible to identify which patients at initial presentation are at high risk of developing distant metastasis, and which type of distant metastasis will subsequently develop are other important questions for future studies, say the researchers. “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. 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,” Dr Huang will say.

Although head and neck cancer is the sixth most common type of cancer worldwide, awareness of it is low, and hence the majority of diagnoses are not made until the disease is in an advanced stage, resulting in limited treatment choices and hence a reduction in the chance of survival.

Professor Jean Bourhis, co-chair of the conference scientific committee, said: This important piece of research adds substantially to what we know about the role and the importance of the Human Papilloma Virus (HPV) in oropharyngeal cancers and gives real hope of improvement in both diagnosis and treatment to those who are affected by the condition.”

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1Chaturvedi AK, Anderson WF, Lortet-Tieulent J, et al. Worldwide trends in incidence rates for oral cavity and oropharyngeal cancers. Journal of Clinical Oncology : official journal of the American Society of Clinical Oncology 2013;31(36):4550-9.

Abstract no OC-044: Proffered paper session, Auditorium Athena, Friday 16.00 hrs

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

February, 2015|OCF In The News|