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.

2010-06-30T13:03:30-07:00June, 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.

2010-06-30T13:02:15-07:00June, 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.

2010-06-30T12:54:15-07:00June, 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 Abstract 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 [...]

2010-06-30T12:28:28-07:00June, 2010|Oral Cancer News|

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

Source: 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 [...]

The ultimate telemedicine tweak to dSLRs: cancer detection

Source: 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

Source: 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 [...]

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

Source: Authors: Adrienne B Mejia et al. Background: 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. Objective: To quantitatively evaluate the health impact of smokeless tobacco promotion as part of a harm reduction strategy in the US. Methods: 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. Results: 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. Conclusions: Promoting smokeless tobacco as a safer alternative to cigarettes is unlikely to result in substantial health benefits at a population [...]

U.S. scores dead last again in healthcare study

Source: 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 [...]

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

Source: 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

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