surgery

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|

Critical Outcome Technologies and MD Anderson Cancer Center to evaluate COTI-2 in treating head and neck cancers

Source: www.marketwatch.com
Author: press release

Critical Outcome Technologies Inc. (“COTI”), the bioinformatics and accelerated drug discovery company, announced today that it recently executed a material transfer agreement (“MTA”) with Dr. Jeffery Myers, MD, PhD, FACS of The University of Texas MD Anderson Cancer Center for the continued evaluation of COTI-2 in the potential treatment of patients with head and neck squamous cell cancer (“HNSCC”).

There are approximately 500,000 new cases worldwide of HNSCC a year, making it the sixth leading cancer in terms of new cases. In the United States, HNSCC is considered to be a rare disease and therefore represents a second “Orphan Disease” opportunity for COTI-2.

If HNSCC is caught at an early stage, current therapies, which include surgery and radiation followed by chemotherapy, can be effective. Unfortunately, HNSCC tumors with p53 mutations tend to be more difficult to treat with such mutations occurring in 30-70% of HNSCC tumors. These mutations are associated with poorer patient outcomes as traditional chemotherapy, using the current first line chemotherapy, cisplatin, is often ineffective. The overall five-year survival rate of patients with HNSCC is 40-50%.

As a small molecule activator of misfolded mutant p53 protein, COTI-2 has demonstrated in preclinical studies its ability to restore p53 function and thus induce cancer cell death for many common p53 mutations. As previously announced, the Company is planning a Phase 1 study in gynecological cancers (ovarian, cervical and endometrial) at MD Anderson with Dr. Gordon Mills and his team and these studies in HNSCC with Dr. Myers will seek to extend the understanding of COTI-2’s ability to treat p53 mutations across multiple cancer types.

Dr. Jeffrey Myers, leader of MD Anderson’s Multi-Disciplinary Head and Neck Cancer Research Program, has been studying the impact of p53 mutation, a common event in HNSCC, on tumor progression and response to therapy. His group has evaluated a number of single agent and combination treatments for p53 mutant tumors, and his preliminary findings with single agent COTI-2 in HNSCC in vitro tumor models show tremendous promise. In addition to seeing sensitivity of HNSCC cells to COTI-2, his group has found that this drug sensitivity is associated with activation of p21, an important mediator of p53’s response to cellular DNA damage. This response is consistent with the p53-dependent mechanism of action studied by Dr. Mills in ovarian cancer. Dr. Myers and his colleagues are planning more extensive studies of COTI-2 and its dependence on p53 re-activation for its effects in both in vitro and in vivo HNSCC tumor models.

“We look forward to further exploring COTI-2’s impact on HNSCC tumors,” said Dr. Wayne Danter, President and CEO. “We continue to believe that COTI-2 represents a potential breakthrough treatment given the central importance of p53 gene mutations in many cancers, including HNSCC. This second indication would broaden the treatment opportunities for our lead oncology asset, which has already been granted the Orphan Drug Designation from the U.S. Food and Drug Administration for the treatment of ovarian cancer.”

October, 2014|Oral Cancer News|

Blood test could predict oral cancer recurrence

Source: www.livescience.com
Author: Rachael Rettner, Senior Writer

A new blood and saliva test that looks for traces of the human papillomavirus (HPV) can predict whether some people with oral cancers will have their cancer come back, early research suggests.

It helps to know as soon as possible that cancer has returned, because tumors that are caught early are easier to treat.

In the study, the researchers analyzed blood and saliva samples from 93 people with head and neck cancers; about 80 percent of these patients had cancers that tested positive for HPV. All of their cancers had previously been treated with surgery, radiation or chemotherapy.

The researchers looked for fragments of DNA from HPV-16, a strain of the virus that is strongly linked with head and neck cancer. The virus may be found in cancer cells that linger in the body after treatment, the researchers said.

Among people with HPV-positive tumors, the new test identified 70 percent of those whose cancer returned within three years, the researchers said.

“Until now, there has been no reliable biological way to identify which patients are at higher risk for recurrence, so these tests should greatly help [to] do so,” study researcher Dr. Joseph Califano, professor of otolaryngology at Johns Hopkins School of Medicine, said in a statement.

Patients with head and neck cancer typically visit the doctor every one to three months during the first year after their diagnoses to check for cancer recurrence. But new tumors in the tonsils, throat and base of the tongue can be difficult to spot, and are often not detected early, the researchers said.

Still, more research is needed to confirm the findings, Califano said. Because HPV infection is common, the test may identify HPV infections that are not related to the cancer. “We can’t be sure our test results are cancer-specific, and not due to other forms of HPV infection or exposure,” Califano said.

The researchers are now looking for additional genetic markers that would increase the accuracy of their test.

Note:
The study is published today in the journal JAMA Otolaryngology–Head & Neck Surgery.

August, 2014|Oral Cancer News|

Researchers find way to diagnose aggressiveness of oral cancer

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

Studying mouth cancer in mice, researchers have found a way to predict the aggressiveness of similar tumors in people, an early step toward a diagnostic test that could guide treatment, according to researchers at Washington University School of Medicine in St. Louis.

“All patients with advanced head and neck cancer get similar treatments,” said Ravindra Uppaluri, MD, PhD, associate professor of otolaryngology. “We have patients who do well on standard combinations of surgery, radiation and chemotherapy, and patients who don’t do so well. We’re interested in finding out why.”

Reporting in Clinical Cancer ResearchK/em>, the investigators found a consistent pattern of gene expression associated with tumor spreading in mice. Analyzing genetic data from human oral cancer samples, they also found this gene signature in people with aggressive metastatic tumors.

“We didn’t automatically assume this mouse model would be relevant to human oral cancer,” said Uppaluri, who performs head and neck surgeries at Barnes-Jewish Hospital. “But it turns out to be highly reflective of the disease in people.”

Rather than use genetic methods to induce tumors in the mice, the research team repeatedly applied a known carcinogen, in much the same way humans develop cancer of the mouth.

“Patients often have a history of tobacco and alcohol use, which drive the development of these tumors,” Uppaluri said. “We felt that exposing the mice to a carcinogen would be more likely to produce similar kinds of tumors.”

The researchers, including first author Michael D. Onken, PhD, research assistant professor of cell biology and physiology, showed that this exposure sometimes produced tumors in the mice that did not spread, but other times resulted in aggressive metastatic tumors, similar to the variety of tumors seen in people. Uppaluri’s team then collaborated with Elaine Mardis, PhD, co-director of The Genome Institute at Washington University, to find out whether the mouse and human tumors also were genetically similar. They compared their mouse sequences to human data sets from The Cancer Genome Atlas (TCGA).

“When we sequenced these tumors, we found that a lot of the genetic mutations present in the mouse tumors also were found in human head and neck cancers,” Uppaluri said.

Further analysis identified a common signature in the expression of about 120 genes that was associated with the more aggressive tumors, whether in mice or people. The researchers confirmed this signature using data collected from 324 human patients. Subsequently, using oral cancer samples from patients treated at Washington University, they developed a proof of concept test from their signature that identified the aggressive tumors with about 93 percent accuracy.

Working with the Washington University Office of Technology Management, Uppaluri has a patent pending on this technology and recently received funding from the Siteman Cancer Frontier Fund to develop a laboratory test that predicts aggressive disease and would be easily available for any patient diagnosed with head and neck cancer.

“These kinds of tests are available for other types of cancer, most notably breast cancer,” he said. “They are transformative genetic tests that can alter the clinical management of patients, tailoring therapies especially for them. It’s our goal to develop something like that for head and neck cancer.”

Source:
Washington University School of Medicine

Jim Kelly’s toughest game: Fighting oral cancer

Source: www.foxnews.com
Author: Dr. Manny Alvarez

Jim Kelly, the Hall of Fame quarterback who played for the Buffalo Bills until 1996, is one of the greatest football players that I have ever seen. During his football career, I followed him closely and was always in awe of his athletic abilities, his leadership qualities and his love of family.

Unfortunately, Jim Kelly is currently battling a second recurrence of oral cancer and has been scheduled to undergo surgery in an attempt to control the disease. His wife, Jill, told the Associated Press that her 54-year-old husband’s cancer is aggressive and beginning to spread.

I’ve been following Jim Kelly’s health struggles and have been thinking about him, praying that he gets better. It is easy to think of some humans as immortal – especially when you’re looking at an individual as physically fit as Jim Kelly. But we tend to forget that sometimes nature has a unique plan for all of us.

However, Jim Kelly’s struggles can serve as a reminder for us all to be vigilant about our health. Jim Kelly is suffering from oral cancer, which doesn’t get the attention that it deserves, despite the fact that 42,000 new cases will be diagnosed in 2014, according to the National Cancer Institute.

Oral cancers are any cancers occurring in the oral cavity, which starts in your throat and extends all the way to your lips. The sad part about this disease is that oral cancers are typically not identified early, which severely reduces survival rates.

The early signs of oral cancer are often missed because lesions are small, painless and often not irritating – especially in tongue cancers or cancers of the gums. But, as the cancer grows, these lesions become ulcerated, causing burning and severe tenderness in the affected areas. Because of the vascular nature of the mouth and throat, many of these cancers tend to metastasize, making matters much worse.

Some risk factors for oral cancer include tobacco use, excessive alcohol consumption and exposure to some strains of the humanpapilloma virus (HPV). HPV has also been linked to cervical cancers in women.

One very important fact to know about oral cancer is that diagnoses of the disease have increased every year for the past five years, according to The Oral Cancer Foundation. That is why it’s so important for people to schedule regular appointments with their dentist – and to make sure they get examined for signs of oral cancer.

If you catch oral cancers early, the survival rate can be over 80 percent. Treatments for oral cancer often include surgery, in addition to radiation and chemotherapy. Yet, once the tumor has metastasized, it can be very challenging for doctors to control or remove it.

Please join me in wishing Jim Kelly all our love and support, and keep his family in our hearts.

March, 2014|Oral Cancer News|

Recurrent mouth and throat cancers less deadly when caused by HPV

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

People with late-stage cancer at the back of the mouth or throat that recurs after chemotherapy and radiation treatment are twice as likely to be alive 2 years later if their cancer is caused by the human papillomavirus (HPV), suggests new research. This study was presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium, held in Scottsdale, Arizona.

Previous studies have found that people with so-called HPV-positive oropharyngeal cancers are more likely to survive than those whose cancers are related to smoking or whose origins are unknown.

The new study shows that the longer survival pattern holds even if the cancer returns. Oropharyngeal cancers, which once were linked primarily to heavy smoking, are now more likely to be caused by HPV, a virus that is transmitted by oral and other kinds of sex. The rise in HPV-associated oropharyngeal cancers has been attributed to changes in sexual behaviors, most notably an increase in oral sex partners.

For the study, the researchers used data provided by the Radiation Therapy Oncology Group on 181 patients with late-stage oropharyngeal cancer whose HPV status was known and whose cancer had spread after primary treatment.

There were 105 HPV-positive participants and 76 HPV-negative ones. Although the median time to recurrence was roughly the same (8.2 months vs 7.3 months, respectively), some 54.6% of those with HPV-positive cancer were alive 2 years after recurrence, whereas only 27.6% of those with HPV-negative cancers were still alive at that point in time.

The researchers also found that those whose cancers could be treated with surgery after recurrence—regardless of HPV status—were 52% less likely to die than those who did not undergo surgery. Surgery has typically been done in limited cases, as doctors and patients weigh the risks of surgery against the short life expectancy associated with recurrent disease.

“Historically, if you had a recurrence, you might as well get your affairs in order, because survival rates were so dismal. It was hard to say, yes, you should go through surgery,” said study leader Carole Fakhry, MD, MPH, an assistant professor in the Department of Otolaryngology-Head and Neck Surgery at the Johns Hopkins University School of Medicine in Baltimore, Maryland. “But this study shows us that surgery may have a significant survival benefit, particularly in HPV-positive patients.”

Although it remains unclear why patients with HPV-positive tumors have better outcomes than those with HPV-negative tumors, researchers speculate that it may be due to biologic and immunologic properties that render HPV-positive cancers inherently less malignant or better able to respond to radiation or chemotherapy treatment.

“Until this study, we thought that once these cancers came back, patients did equally poorly regardless of whether their disease was linked to HPV,” she said. “Now we know that once they recur, HPV status still matters. They still do better.”

March, 2014|Oral Cancer News|

Surgery beats chemotherapy for tongue cancer, U-M study finds

Source: www.eurekalert.org
Author: press release

Patients with tongue cancer who started their treatment with a course of chemotherapy fared significantly worse than patients who received surgery first, according to a new study from researchers at the University of Michigan Comprehensive Cancer Center.

This is contrary to protocols for larynx cancer, in which a single dose of chemotherapy helps determine which patients fare better with chemotherapy and radiation and which patients should elect for surgery. In larynx cancer, this approach, which was pioneered and extensively researched at U-M, has led to better patient survival and functional outcomes.

But this new study, which appears in JAMA Otolaryngology Head and Neck Surgery, describes a clear failure.

“To a young person with tongue cancer, chemotherapy may sound like a better option than surgery with extensive reconstruction. But patients with oral cavity cancer can’t tolerate induction chemotherapy as well as they can handle surgery with follow-up radiation. Our techniques of reconstruction are advanced and offer patients better survival and functional outcomes,” says study author Douglas Chepeha, M.D., MSPH, professor of otolaryngology – head and neck surgery at the University of Michigan Medical School.

The study enrolled 19 people with advanced oral cavity cancer. Patients received an initial dose of chemotherapy, called induction chemotherapy. Those whose cancer shrunk by half went on to receive additional chemotherapy combined with radiation treatment. Those whose cancer did not respond well had surgery followed by radiation.

Enrollment in the trial was stopped early because results were so poor.

Ten of the patients had a response to the chemotherapy, and of that group, only three had a complete response from the treatment and were cancer-free five years later. Of the nine patients who had surgery after the induction chemotherapy, only two were alive and cancer-free after five years.

The researchers then looked at a comparable group of patients who had surgery and sophisticated reconstruction followed by radiation therapy and found significantly better survival rates and functional outcomes.

“The mouth is a very sensitive area,” Chepeha says. “We know the immune system is critical in oral cavity cancer, and chemotherapy suppresses the immune system. If a person is already debilitated, they don’t do well with chemotherapy.”

“Despite the proven success of this strategy in laryngeal cancer, induction chemotherapy should not be an option for oral cavity cancer, and in fact it results in worse treatment-related complications compared to surgery,” Chepeha adds.

December, 2013|Oral Cancer News|

Swallowing exercises preserve function in head and neck cancer patients receiving radiation

Source: http://www.newsfix.ca/
Author: staff

A study at UCLA’s Jonsson Comprehensive Cancer Center has found that head and neck cancer patients receiving radiation as part of their treatment were less likely to need a feeding tube or suffer unwanted side effects such as worsening of diet or narrowing of the throat passage if they performed a set of prescribed swallowing exercises — called a “swallow preservation protocol” — during therapy.

The study, conducted from 2007 to 2012, was led by Dr. Marilene Wang, a member of the Jonsson Cancer Center and professor-in-residence in the department of head and neck surgery at UCLA’s David Geffen School of Medicine. The study was published online by the journal Otolaryngology–Head and Neck Surgery, and will appear later in the journal’s print edition.

Surgery and radiation have been the traditional treatments for head and neck cancer, but with the advent of improved and targeted chemotherapy, many types of this disease are treated with chemotherapy and radiation, (chemoradiation) in the hope of preserving the tissue and structure. But, even when tissue and structure are preserved, patients do not always retain their ability to swallow naturally and normally.

Most patients who receive chemoradiation have significant side effects during treatment and for a long time after recovery. Difficulty swallowing (dysphagia) is one of the most common unwanted side effects of radiation and chemoradiation, and is one of the main predictors of diminished quality of life for the patient after treatment.

Wang’s study was designed to evaluate the swallow preservation protocol, in which patients had swallow therapy before, during and after radiation treatment. The protocol’s effectiveness was measured by patients’ continued ability to swallow and how that affected their diets, whether they needed a feeding tube, and whether they developed narrowing of the throat (stenosis). The same attributes were also measured for a group of patients who were not compliant with the protocol.

Study participants received assessments of their swallowing ability by Wang’s team two weeks before their treatment, were taught what side effects they could expect from the treatment and were given an introduction to the swallowing exercise program. The exercises were designed to maintain the range of motion of mouth and neck muscles involved in swallowing and to counter the formation of excess tissue caused by the radiation (radiation fibrosis), which contributes to loss of swallowing ability. Compliance to the protocol was self-reported by patients during weekly visits to UCLA.

Among 85 participants, 57 were deemed compliant with the protocol and 28 were non-compliant. Patients’ ages ranged from 22 to 91, and there were more 66 men and 19 women.

Swallow preservation exercises before and during radiation treatment appeared to maintain patient’s ability to swallow, and patients who were compliant with the protocol had a faster return to normal diet and lower incidence of throat stenosis.

“Our results demonstrate that compliance with swallow therapy during radiation or chemoradiation treatment is beneficial to patients’ retaining their ability to swallow after treatment is over,” Wang said. “The real benefit of this compliance is that patients benefit immediately after treatment and for a prolonged time afterward. Attending our weekly program, fully committing to the exercises and being monitored by our staff appears to have a significantly measurable effect for these patients.”

Note:
1. The research was supported by the National Institutes of Health.

November, 2013|Oral Cancer News|

Researchers find overactive protein among mouth cancer patients

Source: http://www.ibtimes.co.uk/
Author: B.S. Akshaya

An overactive protein in mouth cancer encourages tumours to grow fast and scientists claim that the protein will help them to find an effective treatment for the disease. Cancer Research UK scientists have discovered FRMD4A, a protein that is overactive among mouth cancer patients. They claim that just deactivating the protein will help save many lives.

A study conducted on mice revealed that when FRMD4A protein is turned on, it helps the cancer cells to group and stick together, but when the protein is deactivated the stickiness of the cell is lost and ultimately it causes cancer cells to die.

Scientists have already found some potential drugs that could help them deactivate the protein. “What’s really exciting about this research is that we already have potential drugs that can be used to target this protein or compensate for the effects that it is having,” said Dr Stephen Goldie, researcher at Cancer Research UK, in a statement.

“These drugs could offer new options to patients where surgery and chemotherapy have not worked or could be used alongside them. We now need to start trials with these treatments, but we hope this could make a real difference to people with mouth cancer in the future,” he added.

Mouth cancer starts anywhere in the oral cavity area like in the cheek lining area, the floor of the mouth, gums or the roof of the mouth (palate). Symptoms of this cancer are chewing problems, mouth sores, speech difficulty, swallowing difficulty and swollen lymph nodes in the neck and weight loss, according to the National Center for Biotechnology Information (NCBI)

Mouth cancer is the 12th most common cancer among men in the UK. Mouth cancer incidence is strongly related to age, though the patterns by age are quite different for men and women. Age-specific incidence rates increase sharply from around age 45 and peak at ages 60-69, before falling in the over-70s in men. In women, mouth cancer occurs in and around 45 and it peaks in the 80s.

In 2009, nearly 6,000 people were diagnosed with mouth cancer in the UK. Among them, 4,097 (66%) were men and 2,139 (34%) were women, according to the Cancer Research UK report. Only around 50 per cent of people with this type of cancer survive for at least five years. But now there is hope as scientists have found that the FRMD4A protein plays a major role in mouth cancer. They claim that they have to develop some more drugs that could help them deactivate the protein.

“We hope that our approach would be more effective and specific than treating the pathway that FRMD4A is involved in, but we now need to test new potential drugs to see if this will work in patients,” said Dr Goldie.

“This research offers a number of approaches that we can now explore to help treat these cancers, including blocking the protein directly. These cancers often return and spread so it’s vital we find new ways to treat them more effectively,” said Dr Julie Sharp, senior science information manager, at Cancer Research UK, in a statement.

July, 2013|Oral Cancer News|

Quitting smoking before cancer surgery best, study finds

Source: health.usnews.com
Author: staff

Cancer patients who smoked up until their surgery were more likely to take up the habit again compared to those who quit earlier, a new study finds.

The study from the Moffitt Cancer Center in Tampa, Fla., included lung cancer and head and neck cancer patients who quit smoking before or immediately after surgery. They were followed for a year after the surgery.

“Sixty percent of patients who smoked during the week prior to surgery resumed smoking afterward, contrasted with a 13 percent relapse rate for those who had quit smoking prior to surgery,” study corresponding author Vani Nath Simmons said in a Moffitt news release.

The significantly lower smoking relapse rate for those who quit smoking before surgery shows the need to encourage patients to quit smoking when they’re diagnosed with cancer, the researchers said.

The investigators also noted that most of the patients who began smoking again did so shortly after surgery, which shows the importance of anti-smoking programs for patients both before and after surgery.

The study also found that patients were more likely to resume smoking if they had a high amount of fear about cancer recurrence, had a higher risk for depression, and were less likely to believe in their ability to quit smoking.

“Cancer patients need to know that it’s never too late to quit,” Simmons said. “Of course, it would be best if they quit smoking before getting cancer; but barring that, they should quit as soon as they get diagnosed. And with a little assistance, there is no reason that they can’t succeed.”

January, 2013|Oral Cancer News|