Monthly Archives: November 2011

Use and Acceptance of HPV Vaccine Still a Work in Progress

Source: National Cancer Institute

A bellwether moment in the history of cancer prevention came in 2006 when the Food and Drug Administration (FDA) approved the first vaccine to prevent cervical cancer. The vaccine, Gardasil, protects against the two primary cancer-causing, or oncogenic, types of the human papillomavirus (HPV)—HPV-16 and HPV-18. These types are responsible for more than 70 percent of cervical cancer cases worldwide. In 2009, the FDA approved a second HPV vaccine, Cervarix, which also targets HPV-16 and HPV-18.

Gardasil and Cervarix, vaccines that protect against the two primary cancer-causing types of the human papillomavirus (HPV), entail a three-shot regimen, with each dose delivered several months apart.

But what has transpired since these two vaccines received regulatory blessing in the United States has reaffirmed something that cancer and public health researchers have appreciated for some time: The translation of basic research to the clinic doesn’t end with FDA approval of a new drug or treatment. In many respects, FDA approval is just a beginning.

In March 2007, the CDC’s Advisory Committee on Immunization Practices (ACIP) gave its strongest recommendation for HPV vaccination for females ages 9 to 26, which is the FDA-approved indication for Gardasil. Cervarix is approved for females ages 10 to 25. Both vaccines entail a three-shot regimen, with the doses delivered several months apart. According to the most recent data, only 44 percent of adolescent girls 13 to 17 years of age have received at least one dose of the vaccine. Completion rates for the three-shot regimen are substantially lower, with only 27 percent of adolescent girls receiving all three doses.

“Uptake is low because of problems with policy, problems with clinical encounters, and problems with parents’ decisions,” said Dr. Noel Brewer of the University of North Carolina Gillings School of Global Public Health. These obstacles are by no means insurmountable, but addressing each obstacle will take time, patience, and research, say investigators working in this area. And a good bit of that research can be grouped into two categories: missed opportunities and teachable moments.

HPV Vaccines for Boys

Gardasil has also been approved by the FDA for use in boys. The initial approval in boys, in 2009, was for the prevention of genital warts because Gardasil, unlike Cervarix, also protects against two other HPV types—HPV-6 and HPV-11—that are the primary cause of genital warts.

But, in December 2010, the approval was expanded to include the prevention of anal cancer, another disease associated with HPV-16 and HPV-18 infection. Because the approval for boys is so recent, this article focuses only on the uptake of the HPV vaccines by females.

No vaccine has an uptake rate of 100 percent, although when vaccines are mandated, such as those required for school attendance, vaccination rates can reach 80 to 90 percent. Although there has been a flurry of legislative activity at the state level since Gardasil was approved in 2006, only Virginia and Washington, DC, require HPV vaccination for school entry, and Virginia’s law includes a provision that allows parents to opt out of the requirement.

Based on surveys that Dr. Brewer and his colleagues have conducted, concerns that HPV vaccination will encourage sexual activity seem to have had little to do with the lagging vaccination rates. Nor, he continued, has uptake of the vaccines been substantially affected by the antivaccine movement that was spurred by fears raised about the now-discredited links between autism and childhood vaccines.

In general, concerns about safety and other issues with vaccines “are not specific to the HPV vaccine,” said Dr. Gregory Zimet of the Indiana University Melvin and Bren Simon Cancer Center. “There is a general vaccine hesitancy that affects a lot of parents.”

The Power of Physician Recommendations

Factors affecting vaccination rates have “definitely been a mixed bag,” agreed Veronica Chollette, who oversees a portfolio of HPV vaccine-related research in NCI’s Division of Cancer Control and Population Sciences. Cultural issues, lack of awareness, and, initially, reimbursement issues that limited the amount of vaccine physicians were willing to keep in stock have all played a role, she noted.

Physician encounters have also had an effect in an entirely different way. In a study published last year, less than 60 percent of pediatricians reported that they strongly recommended HPV vaccination for their 11- to 12-year-old patients. Another study of women ages 19 to 26 showed that, among women whose doctors did not recommend HPV vaccination, only 5 percent were vaccinated. Among those who did receive a recommendation, 85 percent were vaccinated.

“Pediatricians and family physicians are missing a lot of opportunities when patients come in for office visits,” said Dr. Brewer. Part of the problem, he added, is a systemic issue: health care providers are not flagging the charts of patients who are eligible for the vaccines or using reminder systems in electronic medical records, for example.

Interactions with the health care system drop precipitously once kids reach adolescence, he continued. “So it’s a big deal to miss those chances.”

Sociocultural factors are also important to consider. A study conducted in Appalachia, for example, found that conservative religious beliefs and a mistrust of outside influences played a prominent role in the vaccines’ acceptability. Meanwhile, studies of college-age women have shown that, even when receipt of the initial HPV vaccine dose was similar among white and black women, completion rates for all three doses were substantially lower among black women.

The disparity is noteworthy, Chollette stressed, because black women and Hispanic women have significantly higher cervical cancer incidence and death rates than white women.

In some cases insurance status can affect vaccine uptake and adherence. But, because federal and state-level programs, such as the Vaccines for Children program, make the vaccines available for free or for a minimal charge to low-income children, it may not contribute as much to the disparities in vaccination rates, said Dr. Ruth Carlos of the University of Michigan Medical Center. In fact, a higher percentage of 13- to 17-year-old girls from families below the poverty line have received at least one dose of the vaccine compared with girls from families above the poverty line (52 percent versus 42 percent). Also, a provision in the federal health care reform law requires private insurers to cover all ACIP-recommended vaccines with no co-pay requirements.

It’s a complex problem, acknowledged Dr. Zimet. For example, based on studies he has done involving the hepatitis B vaccine, he explained, “practical obstacles, like transportation to the clinic and how many children the mom is taking care of at home” can have an impact, particularly on adherence to the three-shot regimen.

A variety of approaches are being tested to increase vaccination rates, many of which are focused on moments or interactions that can influence awareness and decision making. Drs. Zimet and Brewer lead initiatives in their respective states that are part of the national Cervical Cancer-Free America campaign. In North Carolina, Dr. Brewer said, they are focusing their efforts on school-located health centers, where many children already receive other vaccines.

Other studies and programs are testing whether social media and text messaging can be used as educational platforms and reminder systems for adolescents and women.

A Mother’s Attitude Is Key

For younger girls, the available data strongly indicate that a single factor heavily influences whether they get vaccinated: their mother. “The gateway to adoption of the vaccine[s] is through the parents,” Chollette stressed. In particular, she continued, mothers are the key. “The mother’s values play a prominent role in whether girls go to the doctor and get all three doses according to schedule.”

Dr. Carlos and her colleagues are attempting to use cancer screening appointments as “teachable moments” for mothers of adolescent girls. In two separate studies, women undergoing breast and cervical cancer screenings who have adolescent daughters will receive tailored information about cervical cancer and the HPV vaccines. The studies will test different means of providing the information, including using a Web-based platform, and vaccination rates will be tracked via electronic medical records.

“From a public health perspective, it makes perfect sense to target mothers who come in for cancer screening,” Dr. Carlos said. Women undergoing their own cancer screenings “may be more receptive to acting on educational information about HPV prevention,” she continued. “Part of what this study is doing is encouraging this receptivity after being screened, and using that to encourage them to get their daughters vaccinated. The message is: ‘You’ve done something to protect yourself against cancer, so why not protect your daughter against HPV?’”

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

November, 2011|Oral Cancer News|

Trial Confirms Efficacy of HPV Vaccine, Shows Cross-Protection

Source: National Cancer Institute

End-of-trial results from a trial testing Cervarix, a vaccine against human papillomavirus (HPV) types 16 and 18, showed that the vaccine continued to provide substantial protection against cervical precancers 4 years after vaccination. Cervarix provided almost complete protection in young women who had no evidence of exposure to HPV at the time of vaccination. The vaccine provided less protection for the total vaccinated cohort and was less effective with increasing age at vaccination. These findings reflect the vaccine’s lack of effectiveness against infections acquired before vaccination.

The vaccine also partially protected women against four types of HPV that are not targeted by the vaccine. (Although HPV-16 and -18 cause about 70 percent of cervical cancers worldwide, as many as 15 HPV types can cause cancer.) These results from the PATRICIA trial (Papilloma Trial against Cancer in Young Adults) were published online November 9 in Lancet Oncology in two separate papers, available here and here.

The PATRICIA trial enrolled 18,644 young women between the ages of 15 and 25 from 14 countries. The participants were randomly assigned to receive either three doses of Cervarix or three doses of a hepatitis A vaccine as a control. Results from the interim analysis, published in July 2009, showed that the vaccine greatly reduced the risk of grade 2 cervical intraepithelial neoplasias and higher (CIN2+).

The new analysis shows that, 4 years after vaccination, Cervarix provided complete protection against grade 3 cervical intraepithelial neoplasias or higher (CIN3+) associated with HPV-16 and -18 among women who had no evidence of exposure to HPV. The vaccine provided strong protection against CIN3+ caused by other HPV types in this same group of women. Among the total cohort of women who received at least one dose of Cervarix, some of whom may have had prior exposure to HPV, the vaccine provided some protection. (See the table below.)

Cervarix Vaccine Efficacy among Women Who Received at Least One Dose of Cervarix

Women with no evidence of HPV exposure at baseline Women who may have had prior exposure to HPV

Against CIN3+ associated with HPV-16 and -18


100 percent


45.7 percent


Against all CIN3+, regardless of HPV type


93.2 percent


45.6 percent


Against all adenocarcinoma in situ


100 percent


76.9 percent

The vaccine provided cross-protection against HPV-33, HPV-31, HPV-45, and HPV-51, all cancer-causing types of the virus. The researchers speculate that the observed cross-protection may be due either to the vaccine adjuvant (a substance that stimulates the immune system) or to similarities among proteins found on the surfaces of different HPV types.

In an accompanying editorial, Drs. Mark Schiffman and Sholom Wacholder of NCI’s Division of Cancer Epidemiology and Genetics, who were involved with the NCI Costa Rica HPV vaccine trial, noted the importance of the PATRICIA trial results. They also stated that “the practical aspects of vaccine uptake are now the most important issue in HPV vaccine research from a public health perspective.” To increase vaccine uptake in the developing world, where 90 percent of cervical cancer cases occur, next-generation HPV vaccines will need to be less expensive, provide protection in a single dose, and/or be stable without refrigeration, they explained.

Further reading: “Second Cervical Cancer Vaccine Protects against Additional HPV Types” and “Use and Acceptance of HPV Vaccine Still a Work in Progress

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

November, 2011|Oral Cancer News|

Men in doubt still don’t get checked out!

Author: staff

Men are almost twice as likely to die from mouth cancer and statistics consistently show they are less likely to consult with a doctor than their female counterparts. But with rates of incidence and mortality rising at an incredible rate, men can no longer afford to ignore the increasing threat of a killer disease.

Mouth cancer cases in the UK have almost doubled in the last decade, rising to 6,000 every year with almost 4,000 of those coming from men and although there are some clear early warning signs many postpone seeking professional advice, leaving fatality rates of the disease at 50 per cent.

This is supported by data from the Office of National Statistics, which reveals that women are twice as likely to see their GP as men, visiting the doctors an average of six times a year compared to just three for men. Chief Executive of the British Dental Health Foundation, Dr Nigel Carter, puts this failing down to a lack of general cancer health knowledge in men and warns that ignoring the issue can lead to severe problems in future.

Dr Carter said: “For almost all types of cancer, men will die more often than women. There’s no biological reason that this should be the case so the reason must be purely down to the timing of diagnosis. Unfortunately, when men do go to their GP their condition may be at a far more advanced stage and therefore much more difficult to treat.

“By ignoring or dismissing the early and minor symptoms the disease will become rapidly advanced so that when they do seek help it makes it so much harder for treatment to be successful. The message is simple… ‘If in doubt, get checked out.'”

Throughout November, leading oral health charity the British Dental Health Foundation, is running Mouth Cancer Action Month and hoping to improve rates of ‘early detection’, especially in men. One in two people who contract mouth cancer will die without early diagnosis, which can improve the five year survival rate to 90 per cent.

However, while the treatment of many cancers is resulting in an improvement of survival rates, the same cannot be said for mouth cancer, of which the proportion that dies has remained fairly constant over the last ten years.

Dr Carter added: “Regrettably, most men will only resort to seeing their GP because their partner has ‘told’ them to – this must change, as must the education of health issues to all men. The first stage in this process is being able to identify the risks factors. Smoking, drinking alcohol to excess, poor diet and the Human Papilloma Virus (HPV), transmitted via oral sex, are all risk groups of the disease. The good news is that these are environmental and lifestyle choices, which can be avoided and altered.”

Early detection is critical to the survival of mouth cancer sufferers. Learn and recognise the warning signs, which include ulcers which do not heal within three weeks, red and white patches in the mouth, and unusual lumps or swellings in the mouth.

November, 2011|Oral Cancer News|

Lab at Hershey Medical Center identifies a virus that could kill cancer

Author: Nick Malawskey, The Patriot-News

This is not the kind of lab we picture when we think of world-changing science. It’s not the clean, spotless modern laboratories of television or movies. It’s a cluttered, workaday environment, where plastic test tubes rub shoulders with petri dishes and tubs of chemicals on busy shelves.

The white board isn’t covered with the scrawl of complex mathematical formulas, but reminders of whose turn it is to buy the doughnuts. But it is here, on the fifth floor of the Penn State Milton S. Hershey Medical Center, where Dr. Craig Meyers and his team might have conducted a miracle.

What he and his lab claim discovery of is breathtaking in its simplicity.

A common virus, omnipresent in the world. When it infects humans, it does no harm. But introduce it into certain kinds of tumors and the virus appears to go wild, liquefying every cancer cell it comes into contact with.

It’s the type of discovery that could change the world. And like all great stories of scientific discovery, it begins with a moment of sublime serendipity, not unlike Isaac Newton nodding off beneath an apple tree.

A Tiny Virus

It’s one of the smallest, simplest viruses and yet adeno-associated virus type 2, or AAV2, could be among the most important agents in modern medicine. That’s because it’s almost perfectly imperfect. For whatever reason, through its evolution, AAV2 developed what would, in most cases, be a dead end — it cannot easily reproduce.

Viruses live and reproduce through asexual replication. In the simplest terms, they infect an organism and attack living cells, inserting viral genes inside healthy cells. The viral genes then hijack the cell, using it to reproduce and create more viruses. The new viruses are released into the environment, where they begin infecting other healthy cells.

AAV2 doesn’t work that way.

At the University of Florida in Gainsville, Nicholas Muzyczka has made a career studying AAV2 and he knows the virus about as well as anyone.

“And the deal with [AAV2] is that it will go into the cells in your body — and do nothing,” Muzyczka said. “It’ll just sit there.” By itself, the virus is harmless and, in some cases, won’t even replicate. Instead, it relies on a “helper” virus to poke it along. One of its helper viruses is believed to be the human papillomavirus, or HPV, which is widely believed to be one of the major causes of cervical cancer.

There has also been evidence that not only does HPV impact AAV2, but AAV2 might have some form of impact on HPV — and alter the chances of someone developing cervical cancer.

Which is exactly what Meyers’ lab at Penn State was studying when the lab had its Newton-under-the-apple-tree moment five years ago.

What happened involves a cervical cancer sample, some AAV2 and a few extra days in an incubator.

‘We Thought Something Had Gone Wrong’

Meyers has spent the last 18 years at Penn State, most of it studying HPV. He was one of the first scientists to grow the virus in a laboratory setting, and today his lab is one of the major suppliers of HPV for scientific studies. A few years ago, he was continuing his research into HPV, cervical cancer and the relationship with AAV2.

Other studies indicated that women with cervical cancer don’t have AAV2 and women with AAV2 don’t have cervical cancer. Meyers and his lab were trying to figure out why. Their method was simple: Infect groups of cervical cancer cells with AAV2 and harvest the cells after 24, 48 or 72 hours to note any changes taking place.

On a whim, Meyers told one of his research assistants to infect a cancer cell culture and let it sit for awhile — say, a week.

A week later, she walked into his office and said something strange had happened. That culture of cancer cells they had infected a week ago? They were all dead.

“We thought something had gone wrong,” Meyers said. “My first reaction was: ‘The incubator. I’ll have to get the incubator fixed.’”

The lab repeated the process five, 10, a dozen times. Each time, it had the same result. A week after being infected with AAV2, the cervical cancer cells were dead.

The lab began to spread out its research, collecting other types of cancer samples from other labs to infect with AAV2, including breast cancer. Each time, they had the same results: Infect the cancer cells, wait a week and the cells die. By replicating the experiment, the laboratory was able to gain some understanding of the mechanics of what was happening.

“What the virus seems to be doing is turning on [a gene in] all these cancer cells that causes them to die, to turn on themselves and commit suicide,” Meyers said. Even more encouraging, when his lab infected mice that had human breast cancer tumors with AAV2 earlier this year, they found the tumors had liquefied — a reassuring result because that isn’t always true.

“A lot of times in science, you tend to plan out your experiments and you have a goal, your hypothesis of what you’re trying to prove,” Meyers said. “But sometimes you see bits of data or someone else’s work and you get an idea … a lot of times some of the best things come from those little ideas.”

We’ve Been Here Before

The Penn State lab isn’t the first to announce what could be a major breakthrough using viruses to combat cancer.

Twenty years-ago, researchers at the University of California thought they found the silver bullet — a modified cold virus that killed about 60 percent of human tumors grown in laboratory mice.

News of the research caused The New York Times to ask: “Can the common cold cure cancer?” Headlines in The Los Angles Times and The Pittsburgh Post-Gazette proclaimed the research to be “a cancer-killer.” It didn’t turn out that way. During clinical testing in humans, the modified virus fizzled. But the research, which centered around a gene named P53 did rejuvenate an entire field of study — oncolytic virology.

The link between viruses and cancer isn’t anything new. For close to a century, scientists have believed there is some connection between the two. In 1904, doctors first noticed that leukemia patients occasionally went through periods where they appeared to get better — and those periods corresponded with outbreaks of the flu. The 1950s saw a flurry of activity, when several viruses — including hepatitis B and West Nile — were used in human trials in an attempt to treat cancer. While both viruses caused some tumor regression, the side effects, namely contracting hepatitis and West Nile, outweighed the benefits.

The study of viruses as anti-cancer agents petered out under the weight of a basic catch-22: Researchers needed something tough enough to survive the human immune system, but also a virus that wouldn’t adversely affect normal human cells.

When then-President Richard Nixon went before the nation in 1971 to declare a crusade against cancer, it was widely believed that cancer was caused by viruses altering the DNA of healthy cells. While that’s true in some cases, in others cases, cancer’s runaway growth of cells is caused by faulty genetics or cell mutation due to environmental conditions. It wasn’t until decades later that technology and basic scientific understanding — of cancer and virology — caught up to the idea of using viruses or “oncolytic viruses” to deliver anti-cancer treatments.

Since the first studies in the mid-1990s with the mutated cold virus, there have been a number of advances in the field, and numerous modified viruses are currently being tested around the world.

Five years ago in China, the first oncolytic virus, H101, was approved for clinical use, ironically a variant of the modified cold virus studied in the mid-’90s in California. The Chinese — their testing standards are a bit more lax than ours — use H101 in conjunction with chemotherapy to reduce or eliminate tumor growth in patients with head and neck cancers.

In the U.S., a Massachusetts-based biotechnology firm named BioVex is testing a modified version of herpes in patients with stages III and IV of melanoma. An earlier study by BioVex showed eight of the 50 patients treated with the virus recovered completely and a majority of the patients showed improvement.

The treatment holds enough promise that Amgen, one of the world’s largest biotechnology companies offered $1 billion to acquire BioVex earlier this year.

Bench To Bedside

The common cold viral study two decades ago highlights some of the major hurdles in moving a virus-based treatment from the laboratory to the bedside. There’s a world of biological complexity between mice and humans, and the vast majority of drugs, somewhere around 90 percent, never bridge that gap.

In the case of the modified cold virus, researchers didn’t account for the fact that most people, at one time or another, suffer from the cold and build biological defenses against it. So when they introduced the engineered virus, the body attacked and killed it, reducing its effectiveness in treating patients. Then they ran into their second major hurdle — discouraged, their industry partner, Pfizer, pulled its funding from the project.

The American Cancer Society, which funds cancer research, estimates it takes about 10 to 12 years to fully develop a drug or therapy from the laboratory to bedside use.

“There’s just tremendous challenges,” cancer society spokeswoman Lynne Ayres said.

Drugs have to go through a series of tests prior to their use on humans, then at least three levels of human testing. All of which requires time and money — roughly $2 billion annually. The American Cancer Society and the National Institute of Health are only able to pay for about 10 percent of the grant requests they receive.

That means a lot of research could be stalled in the pipeline. Even Meyers’ research wasn’t able to secure national funding for his preliminary testing of the AAV2 virus. His most recent research was funded through a roughly $35,000 grant from the Pennsylvania Breast Cancer Coalition.

Even once a drug or therapy passes through the FDA approval process, there’s one final step before it makes it to the general public — production and distribution.

“You’ve got to get funding to bring it to the market, which involves getting [pharmaceutical industry] support,” Ayres said.

And, she asked, what is the industry going to spend development costs on?

“Something they can make money on,” she said. “These are the realities.”

Human Trials are Years Away

Meyers’ research — and the resulting publicity — have made him something of a public figure overnight. Every day, he gets emails from people congratulating him on his findings. And every day, he receives just as many from people begging for a cure. It’s a request he simply cannot fulfill yet. Yes, the virus appears to work in a laboratory setting and has destroyed tumors in mice. But his research still has a long road ahead of it before it makes its way to hospitals.

His next step will be to push toward clinical trials in people. But first he has to complete pre-clinical testing before he can apply to the Food and Drug Administration for human testing. Bottom line: Even with unlimited funding, it could be another two to four years before Meyers injects AAV2 into the first patients. Until then, he’ll continue to receive the emails from desperate people, begging him for a cure.

“It’s a very emotional topic. Everyone has somebody they know who has one type of cancer or another,” Meyers said. “And cancer’s not like one day you’re alive and the next day you’re dead. It’s a long, debilitating, chronic problem.

“You need to be reminded sometimes that the research you’re doing could have an affect on people out there.”

In the meantime, Meyers isn’t the only one looking at AAV2. Remember Muzyczka at the University of Florida? He’s among the many researchers looking at AAV2 for its use as a transportation device for genes. Because the virus is so simple, it’s relatively easy for scientists to remove its small amount of genes and replace them with human ones.

The idea is to introduce the carrier virus into the body of a person who might be suffering from a genetic disorder due to a problem in their own body’s DNA structure.

AAV2 virus, carrying the human genes, enters the patient’s cells and inserts its DNA fragment into our genes, repairing or replacing the broken sequence. Because the virus is small, simple and doesn’t easily replicate, it reduces the chances of something going wrong.

“In a lot of different ways, it’s proving to be the safest way to deliver genes,” Muzyczka said. “And a lot of people are getting kind of excited about this because it does seem innocuous.”

It’s already being tested to treat hemophilia in England, where researchers used it to introduce healthy genes into people with the condition.

AAV2 then could be the key to one of the medical holy of holies — real, systemic gene therapy.

Not only could it kill cancer cells, but it could be the vehicle to treat other genetic conditions, such as Alzheimer’s disease, Parkinson’s disease and cystic fibrosis.

“No one’s at the point where the Food and Drug Administration has approved it,” Muzyczka said. “But it is getting to the point where people think it’s going to work.”

Steps to FDA approval
Source: Federal Food and Drug Administration
It’s a long, long road from the laboratory to the bedside, governed by the Food and Drug Administration. The vast majority of all drugs and therapies developed don’t make it. The American Cancer Society estimates it takes about 10 to 12 years to fully develop a drug or therapy from the laboratory to bedside use. Steps include:
1. Preclinical (animal) testing. This is where Dr. Meyers team is in the process.
2. Phase 1 studies (typically involve 20 to 80 people).
3. Phase 2 studies (typically involve a few dozen to about 300 people).
4. Phase 3 studies (typically involve several hundred to about 3,000 people).
5. Submission of a new drug application is the formal step asking the FDA to consider a drug for marketing approval.
6. After an application is received, the FDA has to decide whether to file it so it can be reviewed.
7. Review of the application resulting in application approval or the issue of a response letter.


November, 2011|Oral Cancer News|

Acupuncture can prevent radiation-induced chronic dry mouth

Author: staff

When given alongside radiation therapy for head and neck cancer, acupuncture has shown for the first time to reduce the debilitating side effect of xerostomia, according to new research from The University of Texas MD Anderson Cancer Center and Fudan University Shanghai Cancer Center.

The study, published in the journal Cancer, reported findings from the first randomised controlled trial of acupuncture for the prevention of xerostomia.

Xerostomia, or severe dry mouth, is characterised by reduced salivary flow, which commonly affects patients receiving radiotherapy for head and neck cancer. Most current treatments are palliative and offer limited benefit, according to Lorenzo Cohen, Ph.D., professor in MD Anderson’s Departments of General Oncology and Behavioral Science and director of the Integrative Medicine Program.

The condition impairs quality of life for patients, as it creates difficulties eating, speaking and sleeping, while also increasing the risk for oral infections.

“There have been a number of small studies examining the benefits of acupuncture after xerostomia develops, but no one previously examined if it could prevent xerostomia,” said Cohen, who is also the study’s principal investigator. “We found incorporating acupuncture alongside radiotherapy diminished the incidence and severity of this side effect.”

Cohen and his colleagues examined 86 patients with nasopharyngeal carcinoma, treated at Fudan University Shanghai Cancer Center. Forty patients were randomised to acupuncture and 46 to the standard of care. Those in the treatment arm received acupuncture therapy three times per week during the seven-week course of radiotherapy. Patients were evaluated before radiotherapy, weekly during radiotherapy, and then again one and six months later.

The results were based on data derived from two self-report questionnaires and measuring actual saliva flow. Patients completed the Xerostomia Questionnaire (XQ), an eight-item survey which assessed symptoms consistent with the condition. XQ scores under 30 corresponded to mild or no symptoms of xerostomia.

The second measure, MD Anderson Symptom Inventory Head and Neck (MDASI-HN), ranked the severity of cancer-related symptoms, other than xerostomia, and their interference with quality of life. The team also measured saliva flow rates using standardised sialometry collection techniques.

Benefits Noticed Quickly

“What was quite remarkable was that we started to see group differences as early as three weeks into radiotherapy for the development of xerostomia, cancer-related symptoms that interfere with quality of life, and saliva flow rates – an important objective measure,” said Zhiqiang Meng, M.D., Ph.D., co-principle investigator of the study and deputy chair of the Department of Integrative Oncology, Fudan University Shanghai Cancer Center.

The largest group differences in XQ scores were seen by the end of radiotherapy, but the differences persisted over time. By one month after the end of radiotherapy, 54.3 percent of the acupuncture group reported XQ scores greater than 30, compared to the control group at 86.1 percent. By six months after radiotherapy, the numbers dropped to 24.1 percent in the acupuncture group and 63.6 percent of the control group still reporting symptoms of xerostomia. Saliva flow rates were also greater in the acupuncture group, starting at three weeks into radiotherapy and persisting through the one and six month follow-up.

Acupuncture also helped cancer-related symptoms, other than xerostomia, as measured by the MDASI-HN questionnaire, with differences that emerged in week three and continued through six months.

“The medical implications are quite profound in terms of quality of life, because while chronic dry mouth may sound benign, it has a significant impact on sleeping, eating and speaking,” Cohen said. “Without saliva, there can be an increase in microbial growth, possible bone infection and irreversible nutritional deficits.”

Additional studies are needed to determine the mechanisms for the benefits of acupuncture, and while the study didn’t examine this issue, Cohen said it may have an impact on local blood flux, specifically at the parotid gland.

Further research is planned, including a large trial conducted at MD Anderson in collaboration with Fudan University Shanghai Cancer Center. Both centers will enroll 150 patients undergoing radiotherapy for head and neck cancer: 50 will receive acupuncture, 50 sham acupuncture and 50 will be enrolled in a control group. Researchers will also examine saliva constituents and a number of other measures to better determine the mechanisms of acupuncture.

Source: MD Andersen Cancer Center: Cancer

November, 2011|Oral Cancer News|

Fluoroscopically Guided Balloon Dilation of Benign Esophageal Strictures: Incidence of Esophageal Rupture and Its Management in 589 Patients

Source: American Journal of Roentgenology


OBJECTIVE. The purpose of this article is to investigate the incidence and management of esophageal rupture caused by balloon dilation in patients with benign esophageal strictures.

MATERIALS AND METHODS. Fluoroscopically guided esophageal balloon dilation was performed on 589 patients with benign esophageal strictures during an 18-year period. The strictures had a range of causes: postoperative anastomotic stricture, corrosive stricture, postradiation stricture, esophageal achalasia, esophageal reflux, congenital stricture, esophageal web, esophageal ulcer, medication fibrosis, chronic inflammation, and posttraumatic stricture (in descending order of frequency). Esophageal rupture was assigned to one of three categories: type 1 was intramural, type 2 was transmural with a contained leak, and type 3 was transmural with an uncontained mediastinal leakage.

RESULTS. A total of 1421 procedures were performed in 589 patients, with each patient undergoing 1–29 procedures. The technical success rate was 99.8%, and the clinical success rate was 91.7%. Patients with corrosive stricture underwent the highest number of procedures (mean, 4.38 procedures). The incidence of esophageal rupture was 14.7%. All esophageal ruptures were detected immediately after the procedure. Most ruptures (98.6%) were types 1 and 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. One of the type 3 ruptures was successfully treated with a retrievable covered stent. Two patients with type 3 ruptures (0.96% of ruptures) underwent surgery and were successfully treated. The rupture rate was not statistically related to the diameter of balloon used.

CONCLUSION. The incidence of esophageal rupture after fluoroscopically guided esophageal balloon dilation was 14.7%. Almost all ruptures were type 1 or 2 and were successfully managed conservatively. Only 1.4% of the ruptures were type 3 and required active management. There was no procedure-related mortality in any patient. Therefore, in spite of the high incidence of ruptures, fluoroscopically guided balloon dilation is a safe procedure, particularly if a rupture is identified early and managed appropriately.
This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.
November, 2011|Oral Cancer News|

Test Markets Reveal Women Choose Dissolvable Tobacco

Source: Convenience Store News

WINSTOM-SALEM, N.C. — Since starting a second round of testing, R.J. Reynolds Tobacco Co.’s dissolvable tobacco products are proving popular among women.

The product line — Camel Sticks, Camel Strips and Camel Orbs –do not require spitting, which could be a deciding factor among female tobacco users. According to a report in the Winston-Salem Journal, females represented 45 percent of all adult smokers who bought Camel Sticks, Camel Strips and Camel Orbs during September and October. Of all adult tobacco users, 31 percent were women.

By comparison, the news outlet reported that adult males make up 85 percent of moist snuff and Camel Snus users.

R.J. Reynolds’ dissolvable line is currently being sold in Denver and Charlotte, N.C. The first round of testing took place in Columbus, Ohio Indianapolis and Portland, Ore.

“We have seen a noticeable appeal and interest of the dissolvable products with adult female tobacco consumers,” Reynolds spokesman David Howard told the newspaper.

Stephen Pope, an industry analyst and managing partner of Spotlight Ideas in England, said Reynolds may have discovered a niche with adult female tobacco users. “Clearly the figures for the dissolvable products make for fascinating reading and actually show that here could be a product that, if handled correctly, could well offer an opportunity for a special female-targeted product that could be as significant as Virginia Slims was for Philip Morris,” he said.

The dissolvable products “could prove to be the first viable smokeless tobacco products for females,” stated Bonnie Herzog, an analyst with Wells Fargo Securities LLC.

Reynolds has not said when a national rollout of the products will occur.

As the popularity of dissolvable tobacco grows, tobacco companies are sure to draw the attention of advocacy groups. Jeff Middleswart, portfolio manager for the Vice Fund of USA Mutuals, said having the Camel and Marlboro brands in dissolvable products is likely to intensify the debate among advocacy groups. One set says that smokeless tobacco products serve as gateways for teenagers to cigarettes; the other set sees the products as a way to reduce the risk of tobacco use compared with cigarettes.

“Anything tobacco will create criticism — it’s just the way of the world,” Middleswart said. “A new product that has the potential to gain market share is going to be a target.”

John Spangler, a professor of family and community medicine at Wake Forest University School of Medicine, said he found it “disturbing that any smokeless tobacco product is now becoming popular among women.” His concern is that the dissolvable products may encourage women to use smokeless tobacco for the first time.

Dissolvable tobacco products have caught the eye of the Food and Drug Administration. The agency gained the authority to regulate the manufacturing, marketing and distribution of tobacco products under the 2009 Family Smoking Prevention and Tobacco Control Act. The FDA’s Tobacco Products Scientific Advisory Committee (TPSAC) took up the issue at its July meeting, the first step toward issuing regulations.

Colorado state officials have also put dissolvable tobacco products under the microscope. Just a few weeks after the TPSAC members began to take a closer look, the Colorado Department of Public Health and Environment held a hearing to begin their investigation into the products and their possible dangers, as CSNews Online previously reported.

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

November, 2011|Oral Cancer News|

Study Finds- Fewer Dying from Throat & Mouth Cancer in the U.S.

Source: HealthDay News, US News and World Report
Author: Staff

Death rates improved most for patients with more than 12 years’ education

Death rates for U.S. patients with throat and mouth cancers decreased between 1993 and 2007, a new study shows.

The finding comes from an analysis of National Center for Health Statistics data on white and black men and women, aged 25 to 64, in 26 states. The researchers also found that the largest decreases in death rates for mouth and throat (pharynx) cancers were among black patients with at least 12 years of education.

The study appears in the November issue of the Archives of Otolaryngology — Head & Neck Surgery. Death rates increased among white men with fewer than 12 years of education, according to Dr. Amy Y. Chen, of Emory University School of Medicine and the American Cancer Society, and colleagues.

Another study in the same issue of the journal found that poor overall quality of life, pain and continued tobacco use seem to be associated with poorer outcomes and a higher death rate two years after diagnosis for patients with head and neck cancer.

The study included 276 patients diagnosed between September 2001 and September 2008. The overall survival rate two years after diagnosis was 90.8 percent. The likelihood of death within two years of diagnosis was: four times higher for those who reported low quality of life than for those who reported a high quality of life; four times higher for those who continued to use tobacco than for those who had quit or never used tobacco; and two times higher for those who reported pain than for those who said they had no pain.

“In addition to older age and advanced stage, which are known to have a negative effect on survival, the presence of pain and continued tobacco use should flag patients who might need longer and more intense follow-up care to improve their observed and disease-specific survival rates,” concluded the researchers at the University of Iowa Hospital and Clinics in Iowa City in a journal news release.

“This information is useful for clinicians in the development of management plans for patients who are transitioning from treatment into survivorship,” they said.

November, 2011|Oral Cancer News|

CU Med School prof seeing red over wine benefit study

Author: Sara Castellanos

There’s a reason Robert Sclafani always chooses red wine over white wine, and it’s not just because he thinks it tastes better.

Sclafani, a professor of biochemistry and molecular genetics at the University of Colorado’s School of Medicine, prefers the darker of the two wines because of its health benefits.

Red wine contains much more of a compound called resveratrol, found in the skin of grapes and also in peanuts and leeks.

Sclafani and his colleagues are currently testing the effects of resveratrol on mice, and this month he received encouraging news from overseas that resveratrol can have health benefits for obese humans.

“There are a number of studies in animals where you can take an animal like a mouse and give it cancer by treating it with carcinogens or manipulating the genes in mice so they’ll get cancer,” Sclafani said. “If you treat the animal with resveratrol, it blunts the effect; they either get less cancers, cancers never develop or they never go anywhere.”

Here’s how it works: resveratrol causes damage to the DNA in cancer cells, he said.

“We think that’s the Achilles heel,” he said.

The compound has been known to have positive effects for more than a decade, but on Nov. 2, a group of scientists in the Netherlands showed for the first time that it can have health benefits in obese humans.

Eleven obese but healthy men had taken a relatively low dose of the compound daily for a month, which lowered their metabolic rate, cut the accumulation of fat in the liver, reduced blood sugar, blood pressure, triglycerides and inflammation, and boosted the efficiency of muscles, according to the Washington Post.

That news solidified Sclafani’s research on resveratrol.

“We’ve shown in our studies that moderate amounts of resveratrol, much lower than they’re using in these individuals, can have anti-cancer effects in mice and cell-culture studies,” he said.

The researchers in the Netherlands did say, however, that a person would have to drink at least 2 gallons of red wine a day to get the equivalent amount of resveratrol as the dosage used in the study, according to the Post.

But their research and Sclafani’s could help explain the “French paradox.”

Sclafani said French people eat fatty diets (foie gras, steak and fries) and drink a lot of red wine but have much less cancer and heart disease than one would expect.

“It’s still not understood, but that’s always been the idea, that there must be something in red wine that allows them to have this unhealthy diet and still have reduced disease,” he said.

Sclafani and, Rajesh Agarwal, a professor in the Department of Pharmaceutical Studies at the School of Medicine, also found recently that resveratrol is successful in preventing a specific type of cancer in mice.

“As recently as last month, we are in the position that we can have more convincing data in the mice showing that … resveratrol is extremely effective in preventing the appearance of oral cancer,” he said.

In a couple of years, they hope to test the effects of resveratrol in humans with oral cancer, which is a common affliction among people in countries like India. Agarwal said high quantities of concentrated resveratrol could be given to patients with oral cancer in the form of a mouth wash or a gel.

And the best part, he said, is there are no known side effects to resveratrol.

But just because the compound is found in red wine doesn’t mean that Agarwal encourages people to drink as much as they want, as often as they want, in hopes of living a cancer-free life.

“Anything in excess is not good,” he said. “People will say, ‘OK, so resveratrol is good, and it’s in the red wine’ so they’ll start drinking more red wine. But before they die of cancer, they’ll die of liver failure. It’s kind of a fine balance, and that needs to be taken into account.”

But consuming moderate amounts of foods that contain resveratrol certainly can’t hurt, he said.

“As my good friend Bob Sclafani says, he eats a lot of Thai food and drinks red wine so he can be healthier for a longer time,” Agarwal said.

November, 2011|Oral Cancer News|

Global oral cancer rates to rise 63% by 2030

Author: DrBicuspid Staff

The International Agency for Research on Cancer, part of the World Health Organization (WHO), predicts that more than 790,000 people worldwide will be diagnosed with oral cancer by 2030, an increase of more than 63% compared with 2008.

Mortality rates for mouth cancer are predicted to be even higher with more than 460,000 deaths forecast by 2030, more than 67% higher than 2008 rates, according to the International Dental Health Foundation (IDHF).

The WHO believes modifying and avoiding risk factors could result in up to 30% of cancers being avoided, noted Nigel Carter, BDS, chief executive of the IDHF.

“Although cancer is not wholly preventable, mouth cancer is very closely related to lifestyle choices. Making more people aware of the risks and symptoms for mouth cancer will undoubtedly save lives,” Dr. Carter stated in a press release. “Forecasts for the incidence and mortality of mouth cancer are very grim. We hope more countries will develop their own oral cancer action campaigns to raise awareness.”

November is Mouth Cancer Action Month, sponsored annually by the IDHF.

November, 2011|Oral Cancer News|