Monthly Archives: March 2016

Imaging, physical examination find most recurrences of HPV-positive oropharyngeal cancer

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

Posttreatment imaging at 3 months and physical examinations during the 6 months following treatment can detect most recurrences in patients treated with definitive radiation therapy for oropharyngeal cancer caused by human papillomavirus (HPV).1 This research was presented at the 2016 Multidisciplinary Head and Neck Cancer Symposium.

A dramatic increase in oropharyngeal squamous cell carcinoma (OPSCC) cases associated with HPV has been reported by the American Cancer Society. Survival rates after definitive radiation therapy have also increased. This has led to the need to determine general time to recurrence and the most effective modes of recurrence detection, to guide standards for optimal follow-up care by oncology teams.

This study examined 246 cases of HPV-positive or p16-positive non-metastatic OPSCC treated with definitive radiation therapy at a single, large-volume cancer center between 2006 and 2014.

Follow-up care included a PET/CT scan 3 months after completing treatment and physical examinations every 3 months in the first year following treatment, every 4 months in the second year and every 6 months in years 3 through 5. Median follow-up care length for all patients was 36 months. Patient outcomes, including recurrence and survival rates, were calculated using the Kaplan-Meier method from the end of radiation therapy.

Most recurrences were detected either by persistent disease appearing on 3-month post-treatment imaging or by patients presenting with symptoms at follow-up examinations.

Disease characteristics that increase the likelihood of recurrence include presenting with 5 or more nodes or having level 4 lymph nodes (P < .05). Distant metastases were a greater risk in patients with a lymph node larger than 6 cm or with bilateral lymphadenopathy (P < .05). “For most patients with HPV-associated oropharynx cancer, after a negative 3-month PET scan, physical exams with history and direct visualization are sufficient to find recurrences,” said Jessica M. Frakes, MD, an assistant member of the department of radiation oncology at the H. Lee Moffitt Cancer Center in Tampa, Florida, and lead author in the study. “Minimizing the number of unnecessary tests may alleviate the financial and emotional burden on these patients, including overall health care costs, time spent away from work and family, and the anxiety of waiting for scan results.” This study also supports the effectiveness of specialist teams in treating HPV-positive OPSCC with definitive radiotherapy (RT). Within 3 years, local control was achieved in 97.8% of all patients in the study; regional control in 95.3%; locoregional control in 94%; and freedom from distant metastases in 91.4%. The 3-year overall survival rate was 91%. “We were pleasantly surprised by the high cure rates and the low permanent side effect rates for these patients,” said Frakes. “These findings demonstrate that individuals with HPV-associated oropharyngeal cancer who are treated with definitive RT and cared for by multidisciplinary specialists have excellent outcomes.” Reference: 1. Frakes JM, Naghavi AO, Strom T, et al. Detection of recurrence in HPV associated oropharynx squamous cell carcinoma. Presented at 2016 Multidisciplinary Head and Neck Cancer Symposium; Scottsdale, AZ; February 18, 2016. Abstract 6.

March, 2016|Oral Cancer News|

Cancer gene may aid researchers find how immune system can help treat cancer or predict outcomes

Source: immuno-oncologynews.com
Author: Daniela Semedo, PhD

University of Cincinnati scientists have recently discovered that DEK, a human gene known to cause cancer, can be detected in the plasma of patients with head and neck cancer. DEK may help clinicians understand how a person’s immune system can be used to treat cancer or predict outcomes for patients.

The information, titled “The DEK oncogene can be detected in the plasma of head and neck cancer patients and may predict immune response and prognosis,” was presented via poster at the Multidisciplinary Head and Neck Cancer Symposium Feb. 18-20 in Scottsdale, Arizona.

“Head and neck cancer remains the sixth most common cancer worldwide,” said Trisha Wise-Draper, M.D., Ph.D., assistant professor in the Division of Hematology Oncology at the UC College of Medicine, in a news release. Wise-Draper is a member of both the Cincinnati Cancer Center and UC Cancer Institute and she was the principal investigator on this study.

“Although infection with the human papilloma virus, or HPV, has emerged as a factor for determining outcomes for head and neck squamous cell carcinoma [head and neck cancer], leading to less intense treatment strategies for patients, no plasma biomarkers exist to predict tumor response to treatment or possible relapse,” she said.

“One potential plasma biomarker is programmed by the human DEK gene, which has been found to promote cancer. DEK RNA and protein are highly increased in tissue specimens from several tumor types, including head and neck cancer, breast cancer, and melanoma, and antibodies to DEK also are detected in patients with autoimmune diseases like juvenile rheumatoid arthritis and lupus,” Wise-Draper said. “Our previous work has shown that DEK is highly and universally present in head and neck cancer tissue specimens regardless of stage or HPV infection, and has suggested tumor-association. In addition, white blood cells (macrophages) secrete DEK protein, leading to the hypothesis that DEK may be present in the plasma of cancer patients and could be correlated with aggressiveness of disease and patient outcomes.”

DEK mRNA and protein expression are up-regulated in the tissue of patients with head and neck cancer, with previous studies demonstrating that DEK is highly expressed in tissue samples of patients with head and neck cancer, regardless of the cancer stage or status of HPV infection.

Wise-Draper and colleagues used whole blood from either patients with newly diagnosed and untreated head and neck cancer or age-matched normal healthy participants. Plasma was separated from the samples, and an enzyme-linked immunosorbent assay (ELISA), a test that uses antibodies and color change to identify a substance, was administered.

The results revealed that DEK could be detected in the plasma of patients with head and neck cancer and in healthy controls. However, compared to people without cancer, those with cancer had decreased levels of DEK, which inversely correlated with plasma levels of interleukin-6.

“We found that DEK was present in the plasma of both healthy control subjects and those with head and neck cancer,” Wise-Draper said. “Overall, DEK was decreased in head and neck cancer patients compared to healthy patients, but it was inversely correlated with IL-6, which is secreted by T-cells (white blood cells that play a role in immunity) and triggers an immune response in the plasma.

“The immune system’s reaction to the tumor also appeared to be linked with high DEK plasma levels. So, although DEK presence is increased in head and neck cancer tissue, plasma DEK levels are decreased in patients when compared with healthy individuals and are further decreased in patients with advanced cancers,” she said.

The results from this study, along with DEK’s link to IL-6 levels, indicate that high levels of DEK may mean better outcomes for patients.

“Furthermore, high DEK levels in the plasma may predict better immunotherapy in terms of cancer treatment,” Wise-Draper said. “Further analyses are ongoing to determine whether DEK levels predict response to various treatments, correlate with the body’s immune response, and whether DEK presence in the serum (in blood, serum includes all proteins not used in blood clotting and all the electrolytes, antibodies, antigens, hormones or any external substances, like drugs) will predict remaining disease or early relapse.”

“This information will be important to verify DEK plasma measurements as a clinically useful test and may give insight to future personalized and targeted treatment strategies for head and neck cancer,” Wise-Draper said.

March, 2016|Oral Cancer News|

Why a Cure For Cancer Is Possible

Source: www.fortune.com
Author: Robert Mulroy
 

BERLIN, GERMANY - SEPTEMBER 05:  A doctor holds a stethoscope on September 5, 2012 in Berlin, Germany. Doctors in the country are demanding higher payments from health insurance companies (Krankenkassen). Over 20 doctors' associations are expected to hold a vote this week over possible strikes and temporary closings of their practices if assurances that a requested additional annual increase of 3.5 billion euros (4,390,475,550 USD) in payments are not provided. The Kassenaerztlichen Bundesvereinigung (KBV), the National Association of Statutory Health Insurance Physicians, unexpectedly broke off talks with the health insurance companies on Monday.  (Photo by Adam Berry/Getty Images)

Cutting drug prices is not out of the question.

A crapshoot is defined as a risky or uncertain matter; something that could produce a good or bad result. President Obama’s moonshot on cancer is different in terms of its greater complexity and higher moral purpose — but unfortunately, not in its probability of success.

The Audacity of Scope

President Obama has asked Congress for $755 million to “focus” on immunotherapy, combination therapy, vaccines that prevent cancer causing viruses, and early detection techniques. According to Vice President Joe Biden, who will coordinate 13 government institutions in this research, “Our job is to clear out the bureaucratic hurdles, and let science happen.”

It is hard not to welcome such an initiative. Cancer has deposed heart disease as the number one killer in 22 American states. Experts project the number of global cancer cases will double in the next 15 years. But we are better at projecting the demand for innovation than we are at producing it; and we are even better at making promises we can’t keep and polices that don’t work.

President Roosevelt created the National Cancer Institute in 1937. Nixon declared a “war on cancer” with the National Cancer Act in 1971. The Bush administration spoke in 2003 of spending $600 million per year to rid the world of cancer by 2015. Obama and Biden made campaign promises to fight cancer in 2008, and should be lauded for trying to keep them, but their approach needs a lot of work.

The underlying assumption is that we should spend as much money, and use as many public and private constituencies to do as much as we can on as many paths as possible. There are three things wrong with this: first, $755 million is a measly sum under the current paradigm drug development. It can cost a company up to $5 billion and a full decade to bring one cancer-fighting drug to market. Second, we have tried this strategy before. Doing the same thing again, only harder, will lead to numerous failures whose cost will be passed on to the insurance companies and their customers in the form of high drug prices. Third, the answer is right in front of us.

We use the term moonshot to reference JFK’s successful space program, but don’t apply its deepest insights. We in the cancer fighting community lack that program’s predictive models, which were the key to its success. Despite severe technological limitations, NASA believed in predictive models based in math, engineering and physics. They modeled, for example, gravity’s influence on earth launches, moon landings, and human tissue. The models told them exactly what tools were needed to do the job. Only then did they build spacecraft to accomplish our goals.

Meanwhile, back on earth, we build tools before we understand the problem of cancer. Two-thirds of published research cannot be reproduced. In the post-genomic era, the FDA approves only 7% of drugs that enter cancer clinical research. Over the past five years, twice as many trials have resulted in only a 10% increase in approvals. Industry investment in R&D has gone backwards, and with it comes a soaring cost of innovation that drives drug prices. Imagine the public tumult, the demand for our leaders to resign, if only one in 14 of rockets carried our astronauts safely!

Great Strategy is Reconciling what Others Believe are Opposites

The discussion we should be having is how to cure cancer and lower drug prices at the same time. Cancer is a multidimensional, ever-changing disease of the entire cell system. The standard focus on individual targets — while supporting publications to drive academic careers and intellectual property that supports high-risk industry investment — has failed. The secrets of biology lay in the interactions between molecules: the dynamics. We need to hack into a human cell as if it were a computer and decode the operating system: switch these proteins off to cure pancreatic cancer, turn others on to end heart disease, and deliver smart growth factors to regenerate neural tissue.

If predictive engineering was the impetus behind space travel, then systems biology can spur innovation and foster initiatives of “cell exploration.” Systems biology is the method of building models of complex biological environments so we can design the right drug from the start. These drugs would have fewer off-target effects and last longer at the disease site. They would also cost less because the cost of failure of the present “scattershot” system of drug discovery would not be passed along to the consumer.

The NIH is a national treasure that houses the tiny National Centers for Systems Biology, a network of our top academic institutions and thought leaders who are already on the path to uncovering cellular secrets. But last year, of the $25 billion in grants supported by the NIH, those aimed at the truly transformational opportunity of systems biology totaled a mere $8 million, or .032% of the total.

Many of us now know that a “war on cancer,” campaign promises massive infusions of capital, top-down political coordination and even the genomic revolution do not come close to the value created by a greater understanding of systems biology. If we call it a moonshot, but don’t comprehend the real key to putting a man on the moon, how is that different than a crapshoot?

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

March, 2016|Oral Cancer News|