No De-escalation of Therapy for HPV+ Throat Cancer

Source: www.medscape.com Author: Alexander M. Castellino, PhD Another trial has shown that de-escalating therapy does not work in patients with good prognosis human papillomavirus-positive (HPV+) oropharyngeal squamous cell carcinoma or throat cancers. Results from the De-ESCALaTE HPV study show that using the targeted drug cetuximab with radiotherapy does not improve side effects and, more importantly, has worse survival compared with the standard of care — chemotherapy with cisplatin and radiotherapy. The finding echoes the results from the US National Cancer Institute's Radiation Therapy Oncology Group (RTOG) 1016 trial, the top-line results of which were released earlier this year, and details of which were presented this week at the American Society of Radiation Oncology (ASTRO) 2018 meeting. "Do not change your clinical practice of using cisplatin with radiotherapy in these patients," cautioned Hisham Mehanna, MBChB, PhD, chair of head and neck surgery at the University of Birmingham, United Kingdom, and lead investigator of the De-ESCALaTe study. He presented the results during a presidential session here at the European Society for Medical Oncology (ESMO) 2018 Congress (abstract LBA9). "Cetuximab did not cause less toxicity and resulted in worse overall survival and more cancer recurrence than cisplatin. This was a surprise — we thought it would lead to the same survival rates but better toxicity. Patients with throat cancer who are HPV+ should be given cisplatin, and not cetuximab, where possible," Mehanna said in a statement. Hope for Fewer Side Effects Cetuximab with radiation is already approved by the US Food and Drug [...]

2018-10-28T11:45:33-07:00October, 2018|OCF In The News, Oral Cancer News|

HPV vaccine gains support of ADA

Source: Multi Briefs Date: October 24th, 2018 Author: Tammy Adams The American Cancer Society estimates there will be more than 50,000 new cases of oral cancer in 2018. And between 70 to 80 percent of these cases will be attributed to the human papillomavirus virus (HPV), a virus that has types associated with oropharyngeal cancer. These staggering numbers call for action; action the American Dental Society is willing to take. Why? Because the HPV vaccine could prevent the vast majority of these new cases, but compared to other vaccines in the U.S., it is underutilized. According to a resolution passed recently by the ADA House of Delegates, the ADA urges dentists to support the use and administration of the human papillomavirus virus vaccine, recognizing it as a way to help prevent infection of the types of HPV associated with oropharyngeal cancer. Resolution 53H-2018 cites recommendations from the Centers for Disease Control and Prevention Advisory Committee on Immunization Practices. It states that the vaccination is a "safe and effective intervention to decrease the burden of oral and oropharyngeal HPV infection." The policy is the result of a multifaceted ADA council proposal that includes input from the Council on Scientific Affairs, the Council on Advocacy for Access and Prevention and the Council on Dental Practice. A workgroup committed to the HPV issue and led by ADA volunteer members developed an evidence-based background report to help write the policy. Dr. Paul Eleazer, past chair of the ADA Council on Scientific Affairs, said that [...]

2018-10-25T15:38:39-07:00October, 2018|Oral Cancer News|

Lowering Radiation Dose Could Improve QoL, Cut Costs in Oral Ca

Source: MedPage Today, Medpage.com Date: October 25th, 2018 Author: Elizabeth Hlavinka SAN ANTONIO -- Radiation de-intensification was tied to a quicker rebound in a number of quality of life (QoL) measures and reduced costs for patients with HPV-associated oropharyngeal cancer, a pair of studies found. With lower doses of radiotherapy (RT), QoL measures including speech, pain, and socialization still generally worsened after treatment, but returned to baseline within 3 to 6 months, reported Kevin Pearlstein, MD, of the University of North Carolina in Chapel Hill. And more aggressive de-intensification led to a 22% cost reduction for treatment overall ($45,884 versus $57,845 with standard care), with 33% lower costs for RT itself and 50% lower costs for post-treatment care (P=0.01), according to findings presented by Mark Waddle, MD, of the Mayo Clinic in Jacksonville, Florida. The studies were presented here at the American Society for Radiation Oncology (ASTRO) meeting during a session on improving outcomes while minimizing toxicity in oropharyngeal cancer. In the research from Pearlstein's group, patients reported global QoL scores of 81 at baseline (using the 100-point EORTC QLQ-C30 questionnaire, where higher scores connote better health), which dipped to 69 at 3 months post-treatment, then rose to 75 at 6 months. Global QoL scores increased to 82 and 84 by months 12 and 24, respectively. Common long-term side effects such as sticky saliva, taste, and ability to swallow did not return to baseline within months 3 to 6, but continued to improve between months 12 and 24. Pearlstein noted [...]

2018-10-25T15:18:41-07:00October, 2018|Oral Cancer News|

HPV blood test shows promise for tracking head and neck cancer after treatment

Source: www.eurekalert.org Author: from UNC Lineberger Comprehensive Cancer Center A new blood test developed by University of North Carolina Lineberger Comprehensive Cancer Center researchers shows promise for tracking HPV-linked head and neck cancer patients to ensure they remain cancer-free after treatment. Researchers will present preliminary findings at the 60th Annual Meeting of the American Society for Radiation Oncology in San Antonio on Tuesday, Oct. 23. Their study evaluated a blood test for HPV-linked oropharyngeal squamous cell carcinoma, which is a cancer of the back of the throat. The findings demonstrated the test could be an effective and less costly alternative for monitoring for cancer recurrence after radiation treatment. "The goal of this study was to evaluate whether this test can be used to track patients who are completely asymptomatic, and thought to have no active cancer," said UNC Lineberger's Gaorav P. Gupta, MD, PhD, assistant professor in the UNC School of Medicine Department of Radiation Oncology. "We already knew that our test was very sensitive and specific, but we did not know the degree to which it would be useful in early detection of disease recurrence in patients who are otherwise thought to be disease-free." HPV, or the human papillomavirus, is the most common cause of sexually transmitted infection in the United States, according to the U.S. Centers for Disease Control and Prevention. Infection with certain strains of HPV can cause cervical cancer in women, genital cancers in both men and women, and cancer of the oropharynx, which is the [...]

University of Cincinnati researcher studies cancer-detecting mouthwash with help from ACS grant

Source: healthnews.uc.edu Author: staff Scott Langevin, PhD, assistant professor in the Department of Environmental Health and a member of both the Cincinnati Cancer Center (CCC) and UC Cancer Institute, was recently awarded $782,000 from the American Cancer Society to continue his research, which will hopefully assist in use of a certain oral rinse to catch recurrence of these types of cancers in their earliest stages. He originally received a National Cancer Institute K22 award to begin this study. "In 2017, mouth and throat cancer, otherwise known as oral and pharyngeal cancer, accounted for an estimated 49,670 new cancer diagnoses and 9,700 cancer-related deaths in the US, and the outcomes for patients with this cancer is relatively poor. About half of these patients will have cancer recurrence within 2 years of treatment,” Langevin says. "Earlier detection of recurrent tumors is associated with better clinical outcomes, so there is a clear need for new tests that can help facilitate early detection.” Langevin says that researchers in his lab previously identified a biomarker panel made up of 22 regions of DNA; based on the amount of a certain molecule attached to these regions—a process called DNA methylation—scientists could identify the presence of mouth and throat cancer with a high level of accuracy by using noninvasive oral rinse (mouthwash) samples. "With this project, we hope to evaluate the potential of this oral rinse methylation panel as a clinical tool for early detection of cancer recurrence following diagnosis and treatment,” he says. "This will hopefully [...]

Patients with HPV-positive oropharynx cancer should receive chemoradiation

Source: medicalxpress.com Author: provided by European Society for Medical Oncology Patients with human papilloma virus (HPV)-positive throat cancer should receive chemoradiotherapy rather than cetuximab with radiotherapy, according to late-breaking research reported at the ESMO 2018 Congress in Munich. "Many patients have been receiving cetuximab with radiotherapy on the assumption that it was as effective as chemotherapy with radiotherapy and caused less side effects but there has been no head-to-head comparison of the two treatments," said study author Prof Hisham Mehanna, Chair, Head and Neck Surgery, Institute of Cancer and Genomic Sciences, University of Birmingham, UK. Throat cancer is rapidly becoming more common in Western countries. For example in the UK, incidence was unchanged in 1970 to 1995, then doubled in 1996 to 2006, and doubled again in 2006 to 2010.The rise has been attributed to HPV, a sexually transmitted infection. Most throat cancer was previously caused by smoking and alcohol and affected 65-70 year-old working class men. Today HPV is the main cause and patients are around 55, middle class, working, and have young children. HPV-positive throat cancer responds well to a combination of cisplatin chemotherapy and radiotherapy, and patients can survive for 30-40 years, but the treatment causes lifelong side effects including dry mouth, difficulty swallowing, and loss of taste. Patients deemed unable to tolerate chemotherapy, for example because of poor kidney function or older age, receive cetuximab, an epidermal growth factor receptor (EGFR) inhibitor, and radiotherapy. This study compared side effects and survival with the two treatments in [...]

A case for second opinions in cancer care

Source: healthblog.uofmhealth.org Author: Beth Uznis Johnson Jim Sitko expected minor surgery to remove a small lesion that his dentist discovered under his tongue during a routine checkup in July 2017. An oral surgeon near his home in Clarkston, Michigan, took several samples to biopsy, a procedure that left Sitko’s tongue badly damaged. Resulting pain left the patient barely able to swallow for more than a week. And the pathology report revealed devastating news: squamous cell carcinoma of the tongue. Treatment, Sitko was told, would include major surgery to remove a portion of his tongue and rebuild it with veins and tissue from other parts of his body. Rehabilitation would be extensive and might also require radiation therapy once the patient healed. Because he had received successful treatment for prostate cancer six years earlier at the University of Michigan Rogel Cancer Center, Sitko opted to return and meet with surgeon Steven Chinn, M.D., MPH. Sitko’s mouth was still healing from his initial surgery, so Chinn relied on the outside pathology report to prep for the complicated surgery ahead. He ordered additional pathology testing by Rogel Cancer Center head and neck specialists — an essential step to confirm an advanced cancer diagnosis. Meanwhile, the thought of having tongue cancer overwhelmed Sitko. “The complications aside from taking care of the cancer were unbelievable,” the 70-year-old says. “I might have a breathing tube and feeding tube. I took a retreat to my condo in northern Michigan to review 25 pages of paperwork for two [...]

Oral cancer a risk when consuming cannabis, warns orthodontist

Source: www.cbc.ca Author: staff Eating or smoking pot can pose some deadly health risks, according to the president of the Essex County Dental Association. "One of the more common ones that you hear about is oral cancer," said Dr. Mark Parete​, adding cannabis contains known carcinogens, similar to what's found in tobacco. He said the ingestion of tetrahydrocannabinol (THC), marijuana's main psychoactive ingredient, into a person's blood stream weakens their immune system and leaves gums and teeth prone to infection. "Just like nicotine, it actually causes a generalized inflammation which ultimately breaks down collagen and bone — which is the support system of your teeth," said Parete​. Full disclosure between patients and medical professionals is extremely important in treating heath events. Parete​ said people shouldn't be shy of revealing cannabis use to their dentist or orthodontist. "When the patients come in, we always update our medical history ... Inform us if you have any new medications, including using marijuana for recreational or medicinal purposes," he said. Indirect health impacts can occur through cannabis use, Parete​ warns. He said when the "munchies" come calling, cannabis users aren't usually making the best choices in terms of their oral health. "It's probably not your healthy fruits and vegetables. So, if you can, we really advise our patients to swish your mouth some water after eating just to make sure you're flushing any kind of sugars off the teeth to prevent dental cavities."

Why oral cancer threatens men

Source: www.scientificamerican.com Author: Claudia Wallis, Scientific American November 2018 Issue Back in 2006, when the vaccine for human papillomavirus (HPV) was introduced, I rushed to get my teenage daughters immunized. Here, amazingly, was a vaccine that could actually prevent cancer. By blocking HPV infection, it protects girls from the leading cause of cervical malignancies. I didn't give much thought to my son, and neither did the medical establishment. It wasn't until 2011 that health authorities recommended the vaccine for boys. In hindsight, that delay was a mistake, though perfectly understandable: the vaccine was developed with cervical cancer in mind and initially tested only in girls. Today, however, we see a rising tide of cancers in the back of the throat caused by HPV, especially in men, who are three to five times more vulnerable than women. This surge of oropharyngeal cancers, occurring in many developed nations, took doctors by surprise. Oral cancers were expected to decline as a result of the drop in smoking that began in the 1960s. Smoking-related oropharyngeal cancers are, in fact, down. But making up the difference, particularly in men, are those related to HPV, which have more than doubled over the past two decades. With cervical cancer waning (thanks to screening and prevention), this oral disease is now the leading HPV-related cancer in the U.S. Nearly 19,000 cases were reported in 2015, according to a recent report by the Centers for Disease Control and Prevention. Roughly nine out of 10 involve a nasty strain called [...]

Long-term implant failure in patients treated for oral cancer by external radiotherapy: a retrospective monocentric study

Source: Journal of Oral Medicine and oral Surgery, JOMOS Date: October 10th, 2018 Authors: Aline Desoutter, Sophie Deneuve, Sophie-Charlotte Condamin and Anne-Gaëlle Chaux-Bodard Abstract Introduction: The placement of dental implants in irradiated bone has allowed functional rehabilitation for many oral cancer patients. Nonetheless, there is only few data about implant failure in irradiated tissues and their consequences. This retrospective study aims to highlight the rate and circumstances of implant failure. Material and method: Patients treated with external radiotherapy for oral carcinoma and who received dental implants were included. Patients reconstructed with free bone flaps were excluded. Results: Eighteen patients were included. Forty implants were placed between 2004 and 2007, 8 failed, of whom one osteoradionecrosis was observed. Time interval between radiotherapy and implantation was 44.6 (6–182) months. Mean dose was 51.8 (50–66) Gy. Discussion: In the series, the implant failure rate is 20%, which corroborates the literature's data. Failures occur more often for doses over 50 Gy. The placement of dental implant in irradiated bone leads to soft tissue complications but also increases the risk of osteoradionecrosis. The recent reimbursement of dental implants in oral cancer patients by the National Social Health system will probably increase the indications. Multidisciplinary staffs should be aware of benefit/risk ratio for each patient. Introduction Dental implants in patients treated for upper aerodigestive tract (UADT) cancers have facilitated the functional and aesthetic rehabilitation of patients whose postoperative anatomy did not allow for the placement of conventional prostheses. Several studies have been conducted and the success rates have varied [...]

2018-10-16T13:03:44-07:00October, 2018|Oral Cancer News|
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