Monthly Archives: June 2010

New strategies in head and neck cancer: understanding resistance to epidermal growth factor receptor inhibitors

Source: HighWire
Author: Staff

The epidermal growth factor receptor (EGFR) is a validated target in squamous cell carcinoma of the head and neck (HNSCC). However, despite high expression of EGFR in these cancers, EGFR inhibitor monotherapy has only had modest activity. Potential mechanisms of resistance to EGFR-targeted therapies involve EGFR and Ras mutations, epithelial-mesenchymal transition, and activation of alternative and downstream pathways. Strategies to optimize EGFR-targeted therapy in head and neck cancer involve not only the selection for patients most likely to benefit but also the use of combination therapies to target the network of pathways involved in tumor growth, invasion, angiogenesis, and metastasis.

June, 2010|Oral Cancer News|

Molecular targeted therapies in head and neck cancer – An update of recent developements

Source: HighWire
Author: Staff

ABSTRACT: Targeted therapies have made their way into clinical practice during the past decade. They have caused a major impact on the survival of cancer patients in many areas of clinical oncology and hematology. Indeed, in some hematologic malignancies, such as chronic myelogenous leukemia or non-Hodgkin’s lymphomas, biologicals and antibodies specifically designed to target tumour-specific proteins have revolutionized treatment standards. In solid tumours, new drugs targeting EGF- or VEGF- receptors are now approved and are entering clinical practise for treatment of colon, lung, kidney and other cancers, either alone or in combination with conventional treatment approaches.Recent data have now shown that molecular targeted therapy might display efficacy in patients with head and neck squamous cell carcinoma (HNSCC) as well. The evaluated biologicals are generally well tolerated from HNSCC patients, who usually have the burden of multiple co-morbidities that interfere with conventional systemic treatment options. Therefore, molecular targeted therapies offer new treatment options even for heavily pretreated and seriously ill patients usually unable to tolerate chemotherapy or radiation therapy.The two most promising and advanced strategies are the blockage of growth-factor based cellular signalling and interference with angiogenesis-related pathways. But inhibitors of alternative targets, such as Scr and proteasomes, have already been evaluated in early clinical trials with HNSCC patients.

June, 2010|Oral Cancer News|

Advances in radiotherapy of head and neck cancers.

Source: Highwire
Author: Staff

PURPOSE OF REVIEW: Radiation therapy plays a key role in the management of head and neck cancers (HNCs). We reviewed the recent advances in radiotherapy of HNCs and the role of imaging in treatment planning. RECENT FINDINGS: As shown in a recent update of meta-analysis of chemotherapy in head and neck cancer (MACH-NC), concurrent chemoradiotherapy was confirmed to be a standard of care in the management of locally advanced HNCs. Two recent large-scale randomized trials [Groupe d’Oncologie Radiothrapie Tte et Cou (GORTEC) and Radiation Therapy Oncology Group (RTOG)] failed to show additional benefit when combining accelerated radiotherapy with concurrent chemoradiotherapy. Updated 5-year results of a phase III pivotal trial confirmed the benefit of targeting epidermal growth factor receptor with cetuximab when combined with radiotherapy. Taxane-platinum-fluorouracil-based induction chemotherapy has been established as a reference induction regimen and has been explored as a possible part of the treatment of locally advanced HNCs, which was particularly successful in larynx preservation. The superiority of intensity-modulated radiation therapy compared with conventional radiotherapy for parotid protection has been shown in a prospective phase III trial. PET-based treatment planning is still to be validated in the HNCs. SUMMARY: Concurrent chemoradiotherapy could still be considered as a standard of care; several new treatment combinations and new radiation technologies have been recently successfully evaluated in clinical trials.

June, 2010|Oral Cancer News|

Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium

Source: CEBP
Authors: Carlotta Galeone, Alessandra Tavani, Claudio Pelucchi, Federica Turati, Deborah M. Winn, Fabio Levi, Guo-Pei Yu, Hal Morgenstern, Karl Kelsey, Luigino Dal Maso, Mark P. Purdue, Michael McClean, Renato Talamini, Richard B. Hayes, Silvia Franceschi, Stimson Schantz, Zuo-Feng Zhang, Gilles Ferro, Shu-Chun Chuang, Paolo Boffetta, Carlo La Vecchia, and Mia Hashibe


Background: Only a few studies have explored the relation between coffee and tea intake and head and neck cancers, with inconsistent results.

Methods: We pooled individual-level data from nine case-control studies of head and neck cancers, including 5,139 cases and 9,028 controls. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95% CI), adjusting for potential confounders.

Results: Caffeinated coffee intake was inversely related with the risk of cancer of the oral cavity and pharynx: the ORs were 0.96 (95% CI, 0.94–0.98) for an increment of 1 cup per day and 0.61 (95% CI, 0.47–0.80) in drinkers of >4 cups per day versus nondrinkers. This latter estimate was consistent for different anatomic sites (OR, 0.46; 95% CI, 0.30–0.71 for oral cavity; OR, 0.58; 95% CI, 0.41–0.82 for oropharynx/hypopharynx; and OR, 0.61; 95% CI, 0.37–1.01 for oral cavity/pharynx not otherwise specified) and across strata of selected covariates. No association of caffeinated coffee drinking was found with laryngeal cancer (OR, 0.96; 95% CI, 0.64–1.45 in drinkers of >4 cups per day versus nondrinkers). Data on decaffeinated coffee were too sparse for detailed analysis, but indicated no increased risk. Tea intake was not associated with head and neck cancer risk (OR, 0.99; 95% CI, 0.89–1.11 for drinkers versus nondrinkers).

Conclusions: This pooled analysis of case-control studies supports the hypothesis of an inverse association between caffeinated coffee drinking and risk of cancer of the oral cavity and pharynx.

Impact: Given widespread use of coffee and the relatively high incidence and low survival of head and neck cancers, the observed inverse association may have appreciable public health relevance. Cancer Epidemiol Biomarkers Prev; 19(7); 1723–36. ©2010 AACR.

June, 2010|Oral Cancer News|

Is drinking coffee as good as it is made out to be?

Author: Mini Swam

Studies about the drinking habits of coffee and tea drinkers have always managed to excite attention, and with more and more studies being conducted, newer information has surfaced. Nine existing studies were looked at and analyzed. Researchers determined how much of coffee was consumed by more than 5,000 cancer patients and 9,000 healthy people.

In the latest study conducted, researchers have found that the incidence of head and neck cancers appeared to decrease when four or more cups of coffee were drunk every day. The risk in such cases decreased by 39 percent in respect of oral cavity and pharynx cancers. However, it did not appear to have any effect on laryngeal cancer.

By and large, the results seemed really positive, but Mia Hashibe, lead researcher and an assistant professor in the department of family and preventive medicine at the University of Utah, cautioned against drinking lots of coffee.

Looking at the results from a logical point of view, Hashibe pointed out that the main risk factors for oral cancers were smoking and drinking alcohol, and the best way to prevent such cancers would be to stay away from smoking and drinking alcohol.

Further Hashibe indicated that it would be highly misleading to suggest that drinking lots of coffee without taking into account the real risk factors could prevent people from getting those cancers. Different people metabolize caffeine or coffee in different ways, and it was important to realize this fact before indulging in lots of coffee.

According to Dr. Donald Hensrud, chair of preventive medicine at the Mayo Clinic, there existed a perception that coffee was injurious to health. Recent studies said Dr. Hensrud have changed all that, and researchers appear to have come to the conclusion that drinking coffee was not all that bad..

However, when it came to establishing a link between drinking coffee and head and neck cancer, the benefits far outweighed the risks, and this fact appeared to be buttressed by the recent findings.

Going one step further, Hensrud said that it was difficult to ascertain how coffee really helped in such cancers, but with more than a 1,000 chemical compounds present, including cancer-fighting antioxidants, a plausible explanation could be arrived at.

Coffee does seem to have great potential in treating other diseases like dementia, diabetes, liver and Parkinson’ s disease. Although the new study is strongly suggestive of such an inclination, Dr. Dong Shin, a head and neck specialist at Emory Winship Cancer Institute, suggested that coffee alone may not be responsible for progress in such diseases.

Dr. Shin was concerned that the studies did not see it appropriate to address the side effects of coffee, and in addition, when it came to prevention of diseases, a combination approach was more sensible, rather than relying on coffee alone. Consumption of tea, vegetable, fruits and natural products could have better results rather than the narrow focus.

Hensrud concluded by cautioning against drinking too much of coffee, as it could contribute to liver damage and increased blood pressure. The caffeine present could also cause insomnia, gastric reflux, heartburn, palpitations and other undesirable effects.

In fact, coffee drinking could be so addictive that withdrawal symptoms could cause headaches. In addition, it was found that in some cases drinking too much coffee could make it harder to conceive and could increase the risk of miscarriage.

The lesson learned here is that everything should be done in moderation and going overboard could cause trouble all around. A pinch of common sense, a pinch of logic with lots of information thrown in for good measure is essential before embarking on anything.

The ultimate telemedicine tweak to dSLRs: cancer detection

Author: staff

Photography-loving doctors now have more reasons to love their digital cameras. MacGyvers at Rice University and MD Anderson Cancer Center have cleverly engineered your everyday dSLR into a portable, high-resolution fiber-optic fluorescence imaging system that can detect cancer in-vivo.

In this month’s PLoS ONE, they showed off the prowess of their camera system retrofitted with a LED light, an objective lens, a fiber-optic bundle in capturing sub-cellular images non-invasively and in real-time. In field tests of a fluorescence-labeled oral cancer cell culture, a surgically-resected human tissue specimen with dysplastic and cancerous regions, and a healthy human subject in vivo, the fiber-optic microscope resolved individual nuclei in all specimens and tissues imaged to distinguish qualitatively and quantitatively between normal, precancerous and/or cancerous tissues.

Portable and inexpensive at $2000 all-together, the clever device may be a useful tool to assist in the identification of early neoplastic changes in epithelial tissues in spartan clinical settings where MacGyver himself may have been.

Get moving: cancer survivors urged to exercise

Author: Lauran Neergaard

New guidelines are urging survivors to exercise more, even – hard as it may sound – those who haven’t yet finished their treatment.

There’s growing evidence that physical activity improves quality of life and eases some cancer-related fatigue. More, it can help fend off a serious decline in physical function that can last long after therapy is finished.

Consider: In one year, women who needed chemotherapy for their breast cancer can see a swapping of muscle for fat that’s equivalent to 10 years of normal aging, says Dr. Wendy Demark-Wahnefried of the University of Alabama at Birmingham.

In other words, a 45-year-old may find herself with the fatter, weaker body type of a 55-year-old.

Scientists have long advised that being overweight and sedentary increases the risk for various cancers. Among the nation’s nearly 12 million cancer survivors, there are hints – although not yet proof – that people who are more active may lower risk of a recurrence. And like everyone who ages, the longer cancer survivors live, the higher their risk for heart disease that exercise definitely fights.

The American College of Sports Medicine convened a panel of cancer and exercise specialists to evaluate the evidence. Guidelines issued this month advise cancer survivors to aim for the same amount of exercise as recommended for the average person: about 2 1/2 hours a week.

Patients still in treatment may not feel up to that much, the guidelines acknowledge, but should avoid inactivity on their good days.

“You don’t have to be Lance Armstrong,” stresses Dr. Julia Rowland of the National Cancer Institute, speaking from a survivorship meeting this month that highlighted exercise research. “Walk the dog, play a little golf.”

But how much exercise is needed? And what kind? Innovative new studies are under way to start answering those questions, including:

  • Oregon Health and Science University is training prostate cancer survivors to exercise with their wives. The study will enroll 66 couples, comparing those given twice-a-week muscle-strengthening exercises with pairs who don’t get active.
    Researchers think exercising together may help both partners stick with it. They’re also testing if the shared activity improves both physical functioning and eases the strain that cancer puts on the caregiver and the marriage.
    “It has the potential to have not just physical benefits but emotional benefits, too,” says lead researcher Dr. Kerri Winters-Stone.
  • Demark-Wahnefried led a recent study of 641 overweight breast cancer survivors that found at-home exercises with some muscle-strengthening, plus a better diet, could slow physical decline.
  • Duke University is recruiting 160 lung cancer patients to test if three-times-a-week aerobic exercise, strength training or both could improve their fitness after surgery. Lung cancer has long been thought beyond the reach of exercise benefits because it’s so often diagnosed at late stages. But Duke’s Dr. Lee Jones notes that thousands who are caught in time to remove the lung tumor do survive about five years, and he suspects that fitness – measured by how well their bodies use oxygen – plays a role.

People with cancer usually get less active as symptoms or treatments make them feel lousy. Plus, certain therapies can weaken muscles, bones, even the heart. Not that long ago, doctors advised taking it easy.

Not anymore: Be as active as you’re able, says Dr. Kathryn Schmitz of the University of Pennsylvania, lead author of the new guidelines.

“Absolutely it’s as simple as getting up off the couch and walking,” she says.

Exercise programs are beginning to target cancer survivors, like Livestrong at the YMCA, a partnership with cycling great and cancer survivor Lance Armstrong’s foundation. The American College of Sports Medicine now certifies fitness trainers who specialize in cancer survivors.

But anyone starting more vigorous activity for the first time or who has particular risks – like the painful arm swelling called lymphedema that some breast cancer survivors experience – may need more specialized exercise advice, Schmitz says. They should discuss physical therapy with their oncologist, she advises.

For example, Schmitz led a major study that found careful weight training can protect against lymphedema, reversing years of advice to coddle the at-risk arm. But the average fitness trainer doesn’t know how to safely offer that special training, she cautions.

Mary Lou Galantino of Wilmington, Del., is a physical therapist who specializes in cancer care – and kept exercising when her own breast cancer was diagnosed at Penn in 2003. Then 42, she says she was on the treadmill within 24 hours of each chemo session, to stay fit enough to care for her two preschoolers.

“You can feel more energy” with the right exercise, says Galantino, a physical therapy professor at the Richard Stockton College of New Jersey. “I was giving my body up to the surgeons and chemo, but I could take my body back through yoga and aerobic exercise.”

Quantifying the effects of promoting smokeless tobacco as a harm reduction strategy in the USA

Authors: Adrienne B Mejia et al.

Snus (a form of smokeless tobacco) is less dangerous than cigarettes. Some health professionals argue that snus should be promoted as a component of a harm reduction strategy, while others oppose this approach. Major US tobacco companies (RJ Reynolds and Philip Morris) are marketing snus products as cigarette brand line extensions. The population effects of smokeless tobacco promotion will depend on the combined effects of changes in individual risk with population changes in tobacco use patterns.

To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US.

A Monte Carlo simulation of a decision tree model of tobacco initiation and use was used to estimate the health effects associated with five different patterns of increased smokeless tobacco use.

With cigarette smoking having a health effect of 100, the base case scenario (based on current US prevalence rates) yields a total health effect of 24.2 (5% to 95% interval 21.7 to 26.5) and the aggressive smokeless promotion (less cigarette use and increased smokeless, health-concerned smokers switching to snus, smokers in smokefree environments switching to snus) was associated with a health effect of 30.4 (5% to 95% interval 25.9 to 35.2). The anticipated health effects for additional scenarios with lower rates of smokeless uptake also overlapped with the base case.

Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population level.

Authors: Adrienne B Mejia1, Pamela M Ling2, Stanton A Glantz3

Authors’ affiliations:
1Center for Tobacco Control Research and Education, University of California, San Francisco, USA
2Division of General Internal Medicine, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, USA
3Division of Cardiology and the Philip R Lee Institute for Health Policy Studies, Department of Medicine, Center for Tobacco Control Research and Education, University of California, San Francisco, USA

U.S. scores dead last again in healthcare study

Author: edited by Sandra Maler and Cynthia Osterman

The United States ranked last when compared to six other countries — Britain, Canada, Germany, Netherlands, Australia and New Zealand, the Commonwealth Fund report found.

“As an American it just bothers me that with all of our know-how, all of our wealth, that we are not assuring that people who need healthcare can get it,” Commonwealth Fund president Karen Davis told reporters in a telephone briefing.

Previous reports by the nonprofit fund, which conducts research into healthcare performance and promotes changes in the U.S. system, have been heavily used by policymakers and politicians pressing for healthcare reform.

Davis said she hoped health reform legislation passed in March would lead to improvements.

The current report uses data from nationally representative patient and physician surveys in seven countries in 2007, 2008, and 2009. It is available here.

In 2007, health spending was $7,290 per person in the United States, more than double that of any other country in the survey.

Australians spent $3,357, Canadians $3,895, Germans $3,588, the Netherlands $3,837 and Britons spent $2,992 per capita on health in 2007. New Zealand spent the least at $2,454.

This is a big rise from the Fund’s last similar survey, in 2007, which found Americans spent $6,697 per capita on healthcare in 2005, or 16 percent of gross domestic product.

“We rank last on safety and do poorly on several dimensions of quality,” Schoen told reporters. “We do particularly poorly on going without care because of cost. And we also do surprisingly poorly on access to primary care and after-hours care.”

Netherlands ranked first overall.

The report looks at five measures of healthcare — quality, efficiency, access to care, equity and the ability to lead long, healthy, productive lives.

Britain, whose nationalized healthcare system was widely derided by opponents of U.S. healthcare reform, ranks first in quality while the Netherlands ranked first overall on all scores, the Commonwealth team found.

U.S. patients with chronic conditions were the most likely to say they gotten the wrong drug or had to wait to learn of abnormal test results.

“The findings demonstrate the need to quickly implement provisions in the new health reform law,” the report reads.

Critics of reports that show Europeans or Australians are healthier than Americans point to the U.S. lifestyle as a bigger factor than healthcare. Americans have higher rates of obesity than other developed countries, for instance.

“On the other hand, the other countries have higher rates of smoking,” Davis countered. And Germany, for instance, has a much older population more prone to chronic disease.

Every other system covers all its citizens, the report noted and said the U.S. system, which leaves 46 million Americans or 15 percent of the population without health insurance, is the most unfair.

“The lower the performance score for equity, the lower the performance on other measures. This suggests that, when a country fails to meet the needs of the most vulnerable, it also fails to meet the needs of the average citizen,” the report reads

Role of esophageal stents in the nutrition support of patients with esophageal malignancy

Authors: Matthew Bower, MD et al.

Endoluminal stents are commonly used for palliative treatment of dysphagia in patients with advanced esophageal malignancies. The most frequently used esophageal stents are self-expanding metal stents. Removable self-expanding plastic stents have recently been used in the management of esophageal cancer patients treated with curative intent. Esophageal stents effectively alleviate dysphagia in most patients, and stent placement is associated with a low rate of complications. This article reviews the use of self-expanding esophageal stents in patients with esophageal cancer. Nutrition considerations following stent placement are addressed.

Authors: Matthew Bower, MD, Whitney Jones, MD, Ben Vessels, MD, Charles Scoggins, MD, MBA, Robert Martin, MD, PhD

Authors’ affiliation: Division of Surgical Oncology, Department of Surgery, and James Graham Brown Cancer Center, University of Louisville School of Medicine, Louisville, Kentucky