New Study Shows Variable Risk in HPV-Positive Oropharyngeal Cancer

by Kate Johnson for Medscape Deintensification of chemotherapy might not be the best option for all patients with oropharyngeal cancer whose disease is associated with human papillomavirus (HPV). However, such an approach might be reasonable for patients with a low risk for distant recurrence; namely, those with less advanced disease and limited exposure to smoking, according to a large retrospective institutional study conducted by Brian O'Sullivan, MD, from the Princess Margaret Hospital in Toronto, Ontario, Canada, and colleagues. The study was published in the February 10 issue of the Journal of Clinical Oncology. The findings "provocatively suggest there is a limit to the favorable biology of HPV-associated OPSCC [oropharyngeal squamous cell carcinoma]," write Harry Quon, MD, and Arlene Forastiere, MD, from the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University in Baltimore, Maryland, in an accompanying editorial. "It could be that today's treatment paradigms result in the over treatment of many patients (and the consequent late effects on swallowing function) and under treatment of a smaller subset," they add. There is growing concern among OPSCC experts about patients' risks for radiation-related morbidity, particularly severe late swallowing complications, Dr. Forastiere told Medscape Medical News. "The potential for this damage is increased when chemotherapy is added to the radiation," she explained. "One simple strategy is to drop the chemotherapy from the treatment of those with a low risk for recurrence of tumor in the oropharynx or the regional lymph nodes in the neck." However, she pointed out that Dr. O'Sullivan and colleagues "have refined this 'risk definition' [...]

2014-05-30T22:37:54-07:00May, 2014|Oral Cancer News|

In Some HPV-positive Head and Neck Cancers Lower Dose Radiation may be a possible future.

May 30, 2014. 2014 Annual Meeting of the American Society of Clinical Oncology (ASCO): Abstract LBA6006. CHICAGO — Oropharyngeal cancer patients who test positive for human papillomavirus (HPV) could be treated with lower than standard doses of radiation, which reduces the risk for adverse effects, suggest results from a phase 2 study. Patients were first treated with induction chemotherapy, and the results suggest that those who respond can safely forgo standard radiation therapy in favor of a lower dose with fewer adverse effects, according to results from the ECOG 1308 study. This "chemoselection" can guide radiotherapy treatment strategies aimed at lowering acute and late toxicities," researcher Anthony Cmelak, MD, professor of radiation oncology at the Vanderbilt-Ingram Cancer Center in Nashville, Tennessee, told Medscape Medical News. This story was vetted for accuracy by the Oral Cancer Foundation scientific review staff "The lower dose allows patients to avoid long-term dysphagia, fibrosis, xerostomia, dental problems, strictures, or long-term percutaneous endoscopic gastrostomy tubes," Dr. Cmelak commented. "The risks of these types of complications escalate rapidly after 54 Gy intensity-modulated radiation therapy (IMRT), and become the most commonly seen long-term problems in patients when treated to the standard dose of 70 Gy." The study, highlighted during a press briefing here at the 2014 Annual Meeting of the American Society of Clinical Oncology® (ASCO), included 90 patients with stage III/IV HPV-positive oropharyngeal squamous carcinoma who received induction chemotherapy with paclitaxel, cisplatin, and cetuximab. Based on having a complete clinical response to chemotherapy, meaning no signs of cancer on endoscopic exam, 62 patients were selected to [...]

2014-05-30T22:22:29-07:00May, 2014|Oral Cancer News|

Recent Study reveals over two thirds of Americans harbor HPV

Source: medscape.comAuthor: Pam Harrison More than two thirds of healthy US residents harbor at least 1 type of human papillomavirus (HPV), most of which are undetectable by widely used commercial screening kits, a large genetic analysis shows. However, the relevance of this is at present unclear, commented an expert not connected with the study. The study identified 109 different HPV types in tissue samples taken from 103 men and women whose tissue DNA was made available through the National Institutes of Health (NIH) Human Microbiome Project. Only 4 individuals carried either HPV 16 or 18, considered to be among the most oncogenic HPV types and associated in particular with cervical cancer. "There are more than 170 HPV types, so it's a very heterogeneous virus, and current methods only detect about 20 to 30 of them," senior investigator Zhiheng Pei, MD, PhD, associate professor of pathology, New York University School of Medicine, in New York City, told Medscape Medical News. "[Because] non-risk or low-risk HPV types have been very understudied, we would like to see if these non-cancer-causing HPV types play a role in cancers other than cervical cancer or, conversely, if HPV infection is in fact beneficial in an asymptomatic population," Dr. Pei commented. The study was presented at the annual meeting of the American Society for Microbiology in Boston, Massachusetts. Shotgun Sequencing For the study, researchers decoded DNA assembled by a technique called shotgun sequencing. In this method, researchers fragment long DNA strands into short fragments and then randomly sequence each [...]

2014-05-29T09:45:58-07:00May, 2014|Oral Cancer News|

Doxepin rinse relieves pain in patients with radiation-related oral mucositis

Source: Author: Lauren M. Green Doxepin rinse may prove to be a viable option for the relief of pain associated with oral mucositis (OM) in patients with head and neck cancers, according to findings of a phase III trial. This randomized, double-blind, placebo-controlled trial, conducted under the auspices of the Alliance for Clinical Trials in Oncology cooperative group, enrolled 155 patients who were being treated at 26 cancer centers across the country between December 2010 and May 2012. To be eligible, patients were undergoing radiotherapy to a minimum planned dose of 50 Gy and experiencing OM-related pain ≥4 on a 0 to 10 scale. Participants were randomized 1:1 to receive either doxepin (25 mg diluted to 5 mL with 2.5 mL of sterile or distilled water) on day 1, then crossing over to a placebo on a subsequent day (arm A), or placebo on the first day followed by the doxepin preparation (arm B). Patients in both arms were instructed to swish the solution in their mouth for 1 minute, gargle, and expectorate. The study’s primary endpoint was a reduction in pain as measured by the pain scale’s area under the curve (AUC), using assessments based on the Oral Mucositis Daily and Weekly Questionnaires–Head and Neck Cancer, administered at baseline and at 5, 15, 30, 60, 120, and 240 minutes for each treatment arm. Patients were allowed to leave after the first hour, instructed to complete the questionnaires at 2- and 4-hour intervals, and received telephone reminders. Researchers reported [...]

Cannabinoids may offer hope for patients with oral cancer pain

Source: Even the strongest available pain medications are largely ineffective for many cancer patients, particularly those with oral cancers. One of the nation’s leading oral cancer treating clinicians, speaking at the American Pain Society’s annual meeting, said he believes that while prospects for major treatment advances remain bleak, a new cannabinoid-based medication may have some promise for providing meaningful pain relief. Brian Schmidt, DDS, MD, PhD, professor, New York University College of Dentistry and School of Medicine, delivered the Global Year Against Pain Lecture and reported that today, more than 100 years since President Ulysses S. Grant died from oral cancer, there is only modest improvement in patient survival. Grant is the only American president to die from cancer. “Oral cancer is one of the most painful and debilitating of all malignancies,” said Schmidt, “ and opioids, the strongest pain medications we have, are an imperfect solution. They become dramatically less effective as tolerance to these drugs develops.” Now considered to be the fastest increasing cancer in the United States, oral and oropharyngeal malignancies usually begin in the tongue. Human papillomavirus transmitted through oral sex, tobacco use and excessive alcohol consumption are the leading causes of this increase in oropharyngeal cancer. In the United States, some 43,000 new cases of oral cancer are diagnosed every year and the disease is more widespread worldwide with 640,000 new cases a year. Schmidt said oral cancer patients often undergo multiple surgeries as tumors recur and also are treated with radiation and chemotherapy. [...]

Early nutrition intervention creates proactive approach for treating head and neck cancer patients

Author: Megan BrooksSource:  Oncologists treating patients with head and neck cancer are taking a proactive approach when it comes to home enteral nutrition support, a new study suggests. The study of 172 patients with gastrostomy tubes found that half had the feeding tubes placed prior to beginning treatment for head or neck cancer. Most of these patients were put on home enteral nutrition support to help them maintain their current weight during treatment, as opposed to being put on it after treatment to try to regain lost weight, researchers found. The study was presented at the Oncology Nursing Society 39th Annual Congress in Anaheim, California. An estimated 55,000 people in the United States develop head and neck cancers each year. "These patients have many nutritional concerns because of the location of the cancer, which often causes trouble swallowing," said investigator Noreen Luszcz, RD, MBA, CNSC, nutrition program director for Walgreens Infusion Services. "They can't eat, won't eat, or can't eat enough," she told Medscape Medical News. Many of these patients have impaired nutrition status at the time of diagnosis, she noted. In addition to losing weight prior to the diagnosis, they can lose 10% of their pretherapy body weight during treatment. Enteral nutrition can help head and neck cancer patients minimize weight loss, maintain quality of life, manage symptoms, and improve tolerance to treatment, Luszcz said. Home enteral nutrition coordinated by a multidisciplinary nutrition support team has been shown to be safe and beneficial in these patients, she added. Early Screening, Assessment [...]

2014-05-12T11:22:34-07:00May, 2014|Oral Cancer News|

Aspirin may stop deafness caused by chemotherapy

Source: Author: staff Aspirin could save the hearing of cancer patients receiving chemotherapy, scientists in Cardiff hope. A trial will be launched at the city's Velindre Hospital to see if high doses of the drug can prevent permanent loss. Conditions ranging from tinnitus to deafness are a common side effect for patients given the chemotherapy drug cisplatin. The trial, called Coast, has recruited 88 adults prescribed cisplatin in Cardiff and other UK hospitals. It is used to treat testicular cancer, germ cell cancer, head and neck cancer, bladder cancer, cervical cancer, non-small cell lung cancer and some types of children's cancer. 'Shock it was cancer' Father-of-four Andrew Millington, 66, was given cisplatin after a tumour was found at the base of his tongue. "I had a persistent sore throat and earache, and I went to see my GP last spring," he said. "I was referred to a consultant and had an MRI scan. It was a shock to be told it was cancer but... it was generally curable, which was such a relief to hear. I was offered cisplatin and, after hearing about the possible side effects, I was more than happy to take part in the Coast trial." Around 18,500 cancer patients receive cisplatin every year and around half suffer some form of permanent hearing loss. Ahead of the trial's launch on Thursday, professor Emma King, chief investigator and Cancer Research UK surgeon at the University of Southampton, said: "Aspirin can have serious side effects, including internal bleeding, [...]

High-Risk HPV Prevalent in Oropharyngeal Cancers

Author: Roxanne NelsonSource: A larger percentage of oropharyngeal cancers might be related to human papillomavirus (HPV) than previously thought. The Centers for Disease Control and Prevention (CDC) reports that in a large sample of invasive oropharyngeal squamous cell carcinomas, 72% were positive for HPV and 62% were positive for high-risk HPV types 16 and 18, which are covered by the 2 commercially available vaccines (Gardasil, Merck & Co.;Cervarix, GlaxoSmithKline). On the basis of these data, the CDC researchers suggest that vaccines could prevent most oropharyngeal cancers in the United States. The vaccines are marketed mainly for the prevention of cervical cancer, but there is hope, and some evidence, that the vaccines might also protect against oropharyngeal cancer. For example, last year, the Costa Rica HPV Vaccine Trial found that the Cervarix vaccine reduced oral HPV infections in women by more than 90%. However, the effect of the vaccines could vary by demographic factors; HPV prevalence differed by sex and race/ethnicity, the researchers note. In their study, Martin Steinau, PhD, senior scientist at the CDC, and colleagues report that the current global incidence of oropharyngeal cancers is estimated to be 85,000 annually, although there is considerable geographic variation. In the United States, there are about 12,000 new cases diagnosed every year, and most are classified histologically as squamous cell carcinoma (OPSCC). The retrospective analysis was published in the May issue of Emerging Infectious Diseases. Study Details Dr. Steinau and colleagues sought to determine prevalence of HPV types detected in oropharyngeal cancers in the American population, and to [...]

2014-05-02T14:43:57-07:00May, 2014|Oral Cancer News|
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