Monthly Archives: January 2019

How aspirin may benefit some people with head and neck cancer

Source: www.medicalnewstoday.com
Author: Catharine Paddock PhD, fact checked by Paula Field

Recent research has tied regular use of nonsteroidal anti-inflammatory drugs, such as aspirin, to longer survival in some people with head and neck cancer.

The researchers propose that there should now be a clinical trial to test the effectiveness and safety of nonsteroidal anti-inflammatory drugs (NSAIDs) for this purpose. They suggest that the effect that they observed is likely due to the NSAIDs reducing prostaglandin E2, a molecule that promotes inflammation. A paper on their findings now features in the Journal of Experimental Medicine.

Head and neck cancers are cancers in which tumors develop in the nose, sinuses, larynx, throat, and mouth. In most cases, the tumors arise in the flat thin squamous cells that form the tissue lining of surfaces. For this reason, they bear the name head and neck squamous cell carcinomas (HNSCCs).

In the United States, people with HNSCCs account for around 4 percent of all those with cancer. These types of cancer also tend to have a lower rate of survival compared with many other types. The main risk factors for HNSCC are tobacco use, heavy use of alcohol, sun exposure, and infection with the human papillomavirus (HPV).

Aspirin and HNSCC
Previous research has suggested that taking aspirin regularly can reduce the risk of developing HNSCCs. However, the recent study is the first to link the use of aspirin and other NSAIDs to longer survival in some people who already have HNSCC.

It found that, among people with HNSCC and alterations in the PIK3CA gene, those who regularly used NSAIDs had a longer overall survival rate than those who did not. Regular use of NSAIDs appeared to make no difference to survival in people with HNSCC who did not have any PIK3CA gene alterations.

The researchers defined regular use of NSAIDs as using them at least twice a week for 6 months or longer.

“The present study,” says senior study author Prof. Jennifer R. Grandis M.D., who works in the Department of Otolaryngology at the University of California, San Francisco, “is the first to demonstrate that regular NSAID usage confers a significant clinical advantage in patients with PIK3CA-altered HNSCC.”

PIK3CA and cancer
The PIK3CA gene contains DNA code for the “catalytic subunit” of the signaling enzyme PI3K. The catalytic subunit is the trigger for the enzyme, which activates various signaling reactions in cells. Signals from PI3K are essential for cell survival and activities, such as growth, division, movement, material transport, and protein production. Around 35 percent of people with HNSCC have tumors that harbor “activating mutations” of PIK3CA note the authors.

Colorectal cancer studies have also revealed links between regular NSAID use and improved survival in people who have altered PIK3CA genes. However, they did not explain the underlying mechanism.

Prof. Grandis and colleagues examined medical records and tumor tissue samples belonging to 266 people with HNSCC. The tissue samples came from tumors that surgeons had removed. In most cases, the individuals then received treatment with chemotherapy, or radiotherapy, or both.

Overall survival rose from 45-78 percent
The investigators used the tissue samples to determine which people had altered PIK3CA genes. They then correlated these results against patterns of NSAID use from the medical records.

The analysis revealed that that overall survival increased from 45 to 78 percent in those who regularly took NSAIDs and whose tumors showed that they had an altered PIK3CA gene.

The researchers tested for two types of PIK3CA alterations: mutations and amplifications. They found that the type of alteration did not change the benefit to overall survival. Mutations are alterations in the “spelling” of DNA code, whereas amplification is when DNA sequences repeat. Amplification can lead to increased production of proteins.

The team then tested the effect of NSAIDs on a mouse model. They injected mice with cancer cells containing an altered PIK3CA gene. The mice that received NSAIDs grew much smaller tumors.

NSAIDs block prostaglandin E2 production
Further examination of the mice led the team to suggest that the NSAIDs reduced tumor growth by blocking prostaglandin E2 production.

Prostaglandin E2 has come up in studies of other cancers that have raised the possibility that a PI3K signaling pathway triggers this inflammation-promoting molecule.

The new findings suggest that the benefit of NSAIDs on survival might extend to other types of cancer where there is an altered PIK3CA gene. The discovery about NSAIDs blocking prostaglandin E2 in mice might explain the drugs’ mechanism of action in people with colorectal cancer and altered PIK3CA genes.

Prof, Grandis concludes that they could not make any “specific recommendations” about the use of NSAIDs because of lack of consistency in the dosage, timing, and type of NSAIDs covered by their study.

“But the magnitude of the apparent advantage, especially given the marked morbidity and mortality of this disease, warrants further study in a prospective, randomized clinical trial.”

January, 2019|Oral Cancer News|

Tumor Mutational Burden Predicts Who Will Respond to Immunotherapy

The advent of immunotherapy has significantly shifted the treatment paradigm and prognosis for multiple advanced-stage cancers. In cancers like metastatic melanoma and non–small cell lung cancer (NSCLC), the treatment class has greatly improved survival rates.

However, not all patients respond to the treatments, highlighting the need for predictive biomarkers to determine which patients will benefit. Early reports and small cohorts have suggested high tumor mutational burden being associated with improved clinical response, and now a large study has confirmed the hypothesis.

“Given the potential toxicities of immunotherapy and the highly variable response to immune checkpoint inhibitors, as well as the significant economic cost of these agents, there is an urgent need for biomarkers that can predict immunotherapy response,” explained the researchers of the study.

Looking at data from more than 1000 patients with stage IV or metastatic disease for which immune checkpoint inhibitors are approved, including NSCLC, melanoma, renal cell carcinoma, bladder cancer, and head and neck cancer, researchers found that higher somatic tumor mutational burden is associated with improved overall survival.

Patients were treated with atezolizumab, avelumab, durvalumab, ipilimumab, nivolumab, pembrolizumab, or tremelimumab. Tumor mutational burden was calculated by normalizing the number of somatic nonsynonymous mutations to the total number of megabases sequenced, and noting that mutational load varies across tumor types, the researchers defined tumor mutational burden within each cancer type.

The authors found that, across all cancers, more mutations translated into improved overall survival. The authors noted that the association remained even when removing NSCLC and melanoma from the analysis.

“Although the effect for some individual cancers did not reach statistical significance, possibly because of smaller sample size, the numerical trend of better overall survival was observed in nearly all cancer types, with glioma the clearest exception,” the authors wrote. These findings mirror real-world evidence, which has shown gliomas to be immunosuppressive and remain difficult to treat.

Of note, what constituted as high tumor mutational burden varied greatly by cancer type, which suggests that there is likely not a viable universal number that could define high tumor mutational burden and be predictive of response to immune checkpoint inhibitors across all cancers. While breast cancers and renal cell carcinomas only need 6 mutations per 1 million DNA to predictably respond well to immune checkpoint inhibitors, melanomas need 30.7 and colorectal cancers need 52.2.

According to the researchers, this can likely be explained by distinct tumor microenvironments as well as other factors that have shown to independently predict response, including clonality, immune infiltration, and immune cell exclusion.

Reference:

Samstein R, Lee C, Shoushtari A, et al. Tumor mutational load predicts survival after immunotherapy across multiple cancer types [publihsed online January 14, 2019]. Nature. doi: 10.1038/s41588-018-0312-8.

January, 2019|Oral Cancer News|

Researchers Uncover Major Clue In Predicting Response To Immunotherapy

Researchers at Memorial Sloan Kettering Cancer Center in New York have discovered that cancer cells with high numbers of faults in their DNA are more likely to respond to immune checkpoint inhibitors (ICI), a major class of immunotherapy drugs, which includes Keytruda.

The study, published today in Nature Genetics adds important pieces to the puzzle as to why some cancer patients respond to immunotherapy whereas others do not. The researchers measured ‘tumor mutation burden (TMB)’, essentially counting how many DNA faults a tumor contains by looking for errors in the DNA sequence.

“People assume that TMB is important in predicting response to immunotherapy in all cancers, but up until now, all we’ve had is data from small studies and clinical trials on mostly lung cancers and melanoma,” said Luc Morris, MD, surgical oncologist at Memorial Sloan Kettering Cancer Center and one of the lead authors of the paper.

The researchers studied the DNA of 1,662 patients with advanced cancer (classified as stage IV or metastatic disease) treated with one or more of several FDA-approved ICI drugs and DNA from 5,371 patients with advanced cancer who had not had ICI. They used a tool called MSK-IMPACT, which looks at just 3% of the coding-regions in DNA, but is correlated to the number of mutations in the genome.

“Is TMB associated with likelihood that immunotherapy has benefit? Is this true in all cancers? We wanted to find out whether TMB had broad applicability,” said Morris.

The researchers found that if they took the 20% of cancers in their data with the most mutations, these people responded better to ICI than those with lower numbers of mutations in their tumors.

However, this correlation did not hold true for all tumors, for example, in people with a type of brain cancer called glioma, those with TMB in the top 20% did no better on ICI than those with lower TMB. Also in breast cancer there was no conclusive evidence that a higher TMB predicted response to ICI, although the study included relatively few breast cancer patients as ICI is not currently widely used for the disease.

Researchers don’t exactly know why high numbers of mutations make cancers more susceptible to immunotherapy, but they do have a very plausible theory. They think that the more mutated a cell is, the more likely it is to produce incorrect, mangled proteins. These displayed on the cell surface are called neoantigens and they are so far from what would be considered normal, the immune system identifies them as foreign and attacks the cells.

This is not a unique study in concept, with previous research on a smaller number of cancers of specific types, notably lung and melanoma, indicating that TMB is likely predictive of immunotherapy response. However, it is the largest and most comprehensive study to date, providing the most persuasive evidence that this is true for a greater number of cancer types.

“Only in lung cancer is TMB being used in a clinical trial. Hopefully this data will give us permission to include it in future clinical trials on other cancer types,” said Morris.

However, some patients with high TMB don’t respond to ICI at all, so there is still work to be done to figure out why high TMB is not a universal predictor of response to ICI.

“TMB by itself is not going to give you a high confidence in predicting whether a patient is going to respond to immunotherapy or not. It is one biomarker for response, but a number of other factors are important. I would not suggest you take the data from this paper and apply it to a patient in the clinic,” said Morris.

January, 2019|Oral Cancer News|

New app gives throat cancer patients their voice back

Source: www.straitstimes.com
Author: staff

Throat cancer patient Vlastimil Gular can say what he wants in his own voice thanks to technology that uses past recordings of his voice to create synthetic speech that can be played on his mobile phone via an app. Photo: AFP

Vlastimil Gular’s life took an unwelcome turn a year ago: minor surgery on his vocal cords revealed throat cancer, which led to the loss of his larynx and with it, his voice.

But the 51-year-old father of four is still chatting away using his own voice rather than the tinny timbre of a robot, thanks to an innovative app developed by two Czech universities.

“I find this very useful,” Mr Gular told AFP, using the app to type in what he wanted to say, in his own voice, via a mobile phone.

“I’m not very good at using the voice prosthesis,” he added, pointing at the hole the size of a large coin in his throat.

This small silicon device implanted in the throat allows people to speak by pressing the hole with their fingers to regulate airflow through the prosthesis and so create sound.

But Mr Gular prefers the new hi-tech voice app.

It was developed for patients set to lose their voice due to a laryngectomy, or removal of the larynx, a typical procedure for advanced stages of throat cancer.

The joint project of the University of West Bohemia in Pilsen, Prague’s Charles University and two private companies – CertiCon and SpeechTech – kicked off nearly two years ago.

The technology uses recordings of a patient’s voice to create synthetic speech that can be played on their mobile phones, tablets or laptops via the app.

Ideally, patients need to record more than 10,000 sentences to provide scientists with enough material to produce their synthetic voice.

“We edit together individual sounds of speech so we need a lot of sentences,” said Dr Jindrich Matousek, an expert on text-to-speech synthesis, speech modelling and acoustics who heads the project at the Pilsen university.

A Matter of Weeks
But there are drawbacks: Patients facing laryngectomies usually have little time or energy to do the recordings in the wake of a diagnosis that requires swift treatment.

“It’s usually a matter of weeks,” said Dr Barbora Repova, a doctor at the Motol University Hospital, working on the project for Charles University.

“The patients also have to tackle issues like their economic situation, their lives are turned upside down, and the last thing they want to do is to make the recording,” she told AFP.

To address these difficulties, scientists came up with a more streamlined method for the app, which is supported by the Technology Agency of the Czech Republic.

Working with fewer sentences – ideally 3,500 but as few as 300 – this method uses advanced statistical models such as artificial neural networks.

“You use speech models with certain parameters to generate synthesised speech,” said Dr Matousek.

“Having more data is still better, but you can achieve decent quality with less data of a given voice.”

The sentences are carefully selected and individual sounds have to be recorded several times, as they are pronounced differently next to different sounds or at the beginning and end of a word or sentence, he added.

So far, the Pilsen university has recorded 10 to 15 patients, according to Dr Matousek.

Besides Czech, the Pilsen scientists have also created synthesised speech samples in English, Russian and Slovak.

Baby Dinosaurs
Mr Gular – an upholsterer who lost his job due to his handicap – managed to record 477 sentences over the three weeks between his diagnosis and the operation.

But he was stressed and less than satisfied with the quality of his voice.

“Throat cancer patients often suffer from some form of dysphonia (hoarseness) before the surgery, so in combination with a limited speech sample, it makes the voice sound unnatural,” said Dr Repova.

In a studio at the Pilsen university meanwhile, entrepreneur Jana Huttova is recording outlandish phrases.

The 34-year-old mother of three faces the risk of losing her voice to minor throat surgery – an operation on her parathyroid gland.

“The Chechens have always preferred a dagger-like Kalashnikov,” she says, reading from the text before her.

“I have small kids and I want them to hear my own voice, not a robot,” Ms Huttova said.

Then she moved on to her next sentence: “We were attacked by a tyrannosaur’s baby dinosaurs.”

Connected to the Brain
Dr Matousek believes that in the future, patients will be able to use the app to record their voice at home using a specialised website to guide them through the process.

And he hopes that one day it will go even further.

“The ultimate vision is a miniature device connected to the brain, to the nerves linked to speech – then patients could control the device with their thoughts,” he said.

This kind of advanced solution is a very long way off, said Dr Repova.

“But look at cochlear implants – 40 years ago when they started, we had no idea how it would develop, how widely they would end up being used,” she said, referring to the inner-ear implants used to tackle severe deafness.

“A happy end would be a device implanted in the throat that could talk with the patient’s own voice,” she told AFP.

“It’s realistic: it may not come in a year or even in 10 years, but it’s realistic and we’re on the way.”

January, 2019|Oral Cancer News|

Living well with a feeding tube

Source: health.usnews.com
Author: Lisa Esposito, Staff Writer

Nearyly 450,000 Americans with swallowing or digestive problems manage tube feedings – also called home enteral nutrition – on their own. Some have temporary feeding tubes, while others leave the hospital with feeding tubes surgically placed for the foreseeable future.

Veteran users or “tubies” accept long-term feeding tubes as the best or only way to nourish themselves. Many resume school, work and social lives that were once threatened by severe weight loss and malnutrition. For them, getting a feeding tube means getting their active lives back.

Feeding Tube Benefits
Feeding tubes can prevent weight loss, boost energy and bolster your immune system. They also offer important health benefits for people coping with the following health issues:

Tube feeding for chronic swallowing challenges. For people with chronic health conditions that can cause swallowing difficulties, it helps keep them well-nourished. Neurologic conditions such as Parkinson’s disease, stroke or amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease) can impair nerves, affecting swallowing ability.

Tube feeding for oral and throat cancer. Inability to swallow food because of cancer of the mouth or throat is a major contributor to people receiving one, says Lisa Epp, a registered dietitian nutritionist with Mayo Clinic in Rochester, Minnesota.

Tube feeding for nutrition during recovery. A patient who has a short-term eating problem likely to eventually resolve, such as someone recovering from a surgery, brain injury or stroke, may benefit from having one.

Tube feeding for gastric problems. Gastric problems in which the stomach doesn’t empty well or a part of the intestine doesn’t work are the third major cause for feeding tubes, Epp says. Less commonly, trauma and paralysis impair the ability to swallow.

Tube feeding for kids with impaired eating ability. In kids, genetic and other disorders that affect their development can compromise their ability to swallow and eat. Premature infants, toddlers diagnosed with failure to thrive and kids with congenital heart defects, cerebral palsy, cystic fibrosis, GI tract malformations or gastroesophageal reflux disease (GERD) may be candidates for feeding tubes.

When children are barely able to eat because of chronic illness, feeding tubes must be considered, Epp says. If children can’t have needed surgery or chemotherapy because their bodies are weakened by malnutrition, parents have to make that difficult choice.

“Getting better nutrition is going to help them be stronger, increase their immune system and help children grow to their potential, whatever that potential can be,” Epp says. As for adult patients, she adds, “The No. 1 thing I hear when people come back at six-week and three-month visits is, ‘Why didn’t I do this sooner?'”

Maintaining a healthy body weight while tube feeding. Even though they can eat a certain amount of food, some people with gastric conditions can’t take in enough to maintain their health.

“An important consideration is if a patient is continuing to lose weight,” says Arlene Escuro, a dietitian and nutrition therapy specialist at the Center for Human Nutrition in the Digestive Disease and Surgery Institute at Cleveland Clinic. “The key is if they have a functional GI tract. We do have patients with a GI dysfunction (who are) able to take some food by mouth, but it’s not sufficient to sustain their nutrition, so they will need to continue on with the home tube-feeding regimen.”

Types of feeding tubes
Feeding tubes can be temporary or longstanding. Nasal tubes and gastric tubes are the two main types.

A nasal tube, which is usually temporary, is nonsurgical. Nasogastric tubes enter the body through one nostril and run down into the stomach. Another nasal tube, called a nasoduodenal tube, goes into the small intestine, or duodenum. A nasojejunal feeding tube goes into a farther part of the small intestine, the jejunum.

A gastrostomy tube, or G-tube, is often the choice for people who need longer-term feeding tubes. Surgeons use an endoscope to place the G-tube directly into the stomach. The surgery creates a stoma, a visible opening that connects to the feeding tube outside the body. The feeding tube allows people to take specialized liquid nutrition directly into their stomach.

Gastrostomy tubes are often referred to simply as PEGs. Specifically, PEG means percutaneous endoscopic gastrostomy. The visible portion of the feeding tube is permanently attached. However, people can transition to other options.

With buttons or low-profile feeding tubes, there’s no long outer tube attached to the stomach. Instead, users attach extension sets only when needed for feedings, water or medication. The button closure lies nearly flat against the stomach.

However, buttons aren’t the best option for everyone, Epp says. For instance, people who stay on a pump with continuous feeding throughout the day often prefer a tube, which can feel more secure.

Patients and families need to be fully informed of risks as well as benefits before a feeding tube is placed. Doctors evaluate a patient’s medical history to assess his or her individual risk and determine if there are any contraindications, or reasons against, having this procedure.

A variety of intestinal and esophageal conditions, a history of gastric bleeding, previous abdominal surgery and intractable diabetes are among the possible contraindications for G-tube feedings, according to comprehensive, evidence-based guidelines developed by the Cystic Fibrosis Foundation.

Mechanical risks involve tube malfunctions. For example, the tube can get blocked so feeding can’t get through, or it may become dislodged or fall out. It must then be replaced in a hospital.

Skin problems include redness and irritation around a patient’s stoma because of moisture build-up from the stomach or feeding leakage. “There’s also a risk of infection through the stoma site where (users) had a gastrostomy tube, a PEG tube, placed,” Escuro says.

Gastric side effects can develop as well. “GI complications could be diarrhea, constipation or under-hydration,” Escuro says. “Our goal when we have these patients, as we transition them from hospital to home, is to prevent readmissions and tube-feeding related complications.”

Tube Feeding Schedules
Feeding schedules range from episodic feedings at standard mealtimes to continuous feeding regimens.

“We make the regimen very individualized, as much as possible, so it will not interfere with patients’ lives,” Escuro says. Bolus or syringe feedings are larger feedings spread throughout the day like regular meals. It takes about 15 to 20 minutes to administer the formula, Escuro says, usually taken three to four times a day. “Basically, it’s like eating breakfast, lunch, dinner and a snack.”

Other patients go home with a pump for 24-hour feedings. “The reason for the pump feeding is that the feeding tube is placed in their small bowel,” Escuro says. “We don’t really recommend doing bolus feedings in the small intestine, just because it’s such a small reservoir, where most people will not tolerate bolus feedings.”

Pump feedings can be gradually spaced out for some people. “If they go home on continuous feeding when they’re hooked up to a feeding pump, we try to cycle their feedings, eventually.” Escuro says. “So from 24 hours we will gradually cycle them to 20 hours to 18, 16 and to 12 hours or so. If it’s in the stomach, we can transition a patient to bolus feedings.”

Eventually, some patients are weaned off feeding tubes altogether.

Managing a Feeding Tube
Learning how to manage and become comfortable with home tube feeding ideally starts before patients leave the hospital.

At Cleveland Clinic, patients and family caregivers start home enteral feeding education, which includes hands-on practice, before discharge. After discharge, Escuro says, patients with PEGs receive care from a home health nurse to check the stoma site and make sure it’s healing properly. In addition, a home care dietitian follows up to make sure patients are doing well.

Still, for a patient coming home with a tube placed in his or her stomach, the responsibility can seem overwhelming. Through practice, they master the following steps to successfully manage the feeding tube:

  • Prepare the tube feeding
  • Gather supplies
  • Position for feeding
  • Check residual contents
  • Run continuous/cyclic tube feeding
  • Infuse a bolus tube feeding
  • Clean skin around tube site
  • Clean tube feeding equipment
  • Troubleshoot or report problems

Not Best for Everyone
A feeding tube is not always the right choice. For example, people with severe Alzheimer’s disease in later stages often have trouble eating and drinking. However, a feeding tube might not be for the best, according to Choosing Wisely, an initiative focused on avoiding unnecessary medical tests, treatments and procedures.

A frail older adult with Alzheimer’s could be at greater risk of complications such as pneumonia or pressure sores on the skin. They may lose the human contact of being fed by hand as well as the sensation of tasting food.

“Don’t recommend percutaneous feeding tubes (PEGs) in patients with advanced dementia – instead, offer oral assisted feeding,” tops a list of recommendations for physicians regarding quality of life for older adults from the American Geriatrics Society.

<u>Feeding Tube Food</u>
Commercial tube-feeding formulas are available to meet users’ individual nutritional needs. However, just as consumers of traditional food want more natural, less-processed options including plenty of fruits and vegetables, a similar movement is afoot among feeding tube users.

Blenderized whole foods, either made at home or commercially, are choices for patients who feel they can tolerate them better or who simply want to eat what others do. “It’s basically joining the family during mealtime and getting the same food, but it’s just blenderized,” Escuro says.

Expense is an issue. Users must work with insurers to cover ongoing costs of feeding supplies, particularly the food itself. While insurance usually covers the surgical placement, people pay at least a portion for tube-feeding formulas out of pocket.

<u>Resources for People With Feeding Tubes</u>
In addition to turning to their health care teams, people on home enteral nutritional can go online for expertise, advice and peer support.

The Feeding Tube Awareness Foundation is a nonprofit group whose mission is to support parents of children who are tube-fed.

January, 2019|Oral Cancer News|

CDC: Top HPV-Associated Cancer Is Now Oropharyngeal

Date: 08/23/18
Source: medscape.com
Author: Nick Mulcahy

Oropharyngeal squamous cell carcinoma (SCC) is now the most common HPV-associated cancer in the United States, according to a new report from the Centers for Disease Control and Prevention (CDC) that covers the years 1999 to 2015.

During that period, cervical cancer dropped from being the top HPV-associated cancer and oropharyngeal SCC took its place.

The transition happened because cervical carcinoma incidence rates decreased 1.6% per year, and oropharyngeal SCC incidence rates increased 2.7% per year among men and 0.8% per year among women.

In 2015, there were a total of 11,788 cervical cancers compared with 18,917 oropharyngeal SCCs.

The decline in cervical cancer is a “continued trend since the 1950s as a result of cancer screening,” write the report authors, led by Elizabeth Van Dyne, MD, MPH, an epidemic intelligence service officer at the CDC.

The uptick in oropharyngeal SCC could be due in part to “changing sexual behaviors,” including unprotected oral sex, especially among white men, who report having the highest number of sexual partners and performing oral sex at a younger age compared with other racial/ethnic groups, the authors say.

Oropharyngeal SCCs include those at the base of tongue, pharyngeal tonsils, anterior and posterior tonsillar pillars, glos­sotonsillar sulci, anterior surface of soft palate and uvula, and lateral and posterior pharyngeal walls.

The new report was published August 24 in the Morbidity and Mortality Weekly Report.

The study authors defined HPV-associated cancer as “an invasive malignancy in which HPV DNA was frequently found in special studies.” In other words, the new study data reveal the total number of certain cancers that are associated with — but not necessarily caused by — HPV.

A total of 30,115 new cases of HPV-associated cancers were reported in 1999 and 43,371 in 2015.

Overall, the rate of HPV-associated cancers dropped among women (change, –0.4%) during the study period and rose among men (change, 2.4%).

The CDC analyzed data from their National Program of Cancer Registries and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) program for all years from 1999 to 2015. “These data cover approximately 97.8% of the US population,” say the authors.

However, these two population-based cancer registries have a limitation: They tally invasive cancers but not the HPV status of cancers.

The authors point out HPV causes cervical cancer and “some oropharyngeal, vulvar, vaginal, penile, and anal cancers.”

Table. Annual Change in Type of Cancer From 1999 to 2015

Cancer Type Average Annual Change (%)
Cervical –1.6
Vaginal –0.6
Oropharyngeal in men 2.7
Oropharyngeal in women 0.8
Anal in men 2.1
Anal in women 2.9
Vulvar 1.3

Penile cancer rates remained stable during the study period.

The study authors say that the public health implication of the study is that HPV vaccination “can prevent infection with the HPV types most strongly associated with cancer.”

January, 2019|Oral Cancer News|

Five Things To Look Out For In Cancer Research In 2019

Date: 12/28/18
Source: Forbes.com
Author: Victoria Forster

2018 was a remarkable year for cancer research, with great strides made in diagnosing and treating various types of cancer as well as important breakthroughs looking at the health of cancer survivors. What can we expect to see from cancer research in 2019? As a cancer research scientist, here are the top five topics that I’ll be looking out for.

1. Immunotherapy. Who will respond, who won’t respond and why?

Immunotherapy is now seemingly everywhere, with several therapies approved for various cancer types, including CAR T-cells and immune checkpoint inhibitors and several more in development such as tumor infiltrating lymphocyte (TIL) therapy. TILs successfully cleared all tumors from a woman with metastatic breast cancer, in a research breakthrough which was one of the most reported in 2018.

Over 2,500 trials are now registered worldwide, but as the use of immunotherapy grows, there are still major questions to be answered. One particularly important to the use of immune-checkpoint blocking drugs such as those which target PD-1 or CTLA-4 is ‘why do some patients respond whereas others do not?’ Several research teams worldwide are currently grappling with this question, which is unlikely to have a single, clear answer, but I expect to see much more research published on this in 2019, which will hopefully start to benefit patients by identifying who will and won’t respond to these expensive drugs.

2. Liquid biopsy tests. More clarity on precisely what they do and more evidence that they do it accurately.

The liquid biopsy industry has exploded in 2018, perhaps unsurprising given the market is expected to be worth over $2 billion annually by 2022. The promise is that eventually, we should be able to diagnose cancer with a simple blood test, earlier, more cheaply and even more accurately than we currently do and even use these tests to monitor response to cancer treatment and when and if a tumor returns.  As a cancer research scientist, the number of research papers, presentations at top conferences and news releases by the dozens of companies currently developing these technologies can make it a little overwhelming to figure out what is going on.

In 2018, two of the top liquid biopsy tests on the market had their efficacy called into question with researchers from Johns Hopkins suggesting that the two competing tests gave different results with the same patient samples. A claim which was then challenged by representatives from both companies.

Liquid biopsy tests undoubtedly have huge potential and may indeed live up to their hype, but currently, the field is a little messy and difficult to understand for scientists, patients and oncologists who are not specialists. The American Society for Clinical Oncology (ASCO) issued a statement in March of this year essentially concluding that for most liquid biopsy tests there is currently not enough evidence to recommend their use in either the diagnosis or monitoring of cancer. Hopefully, 2019 brings greater clarity about how these tests can fit into the diagnosis and care of people with cancer and ASCO will be able to review their stance accordingly.

3. More focus on the side-effects of cancer treatment.

As a cancer survivor myself and an advocate for more research into what happens to cancer survivors past the ‘all clear,’ 2018 has been a remarkable year for research into the numerous and often disabling side-effects cancer survivors experience. For decades, cancer research has understandably been mainly focused on making sure as many people survive the disease as possible, but now with millions of cancer survivors in the world, a new research field looking at what actually happens to cancer survivors as a result of their treatments is growing at considerable speed.

From a study which hopes to have found a solution to male infertility after childhood cancer treatment to work showing that some women with early-stage breast cancer can have less radiotherapy without compromising their chance of survival, 2018 was a good year for cancer survivorship research. The highlight, in my opinion, was work from Stanford University scientists that may have figured out why ‘chemo brain’ happens, one of the most commonly-reported side-effects that cancer survivors experience. Even better, the scientists suggest that it may be treatable.

4. Cancer and the microbiome.

The microbiome has been one of the most talked about topics in medicine in 2018 and shows no sign of slowing down. Amidst the predictable flurry of supplements, fad-diets and blog posts giving scientifically-questionable advice telling you how to cherish and nurture your own gut flora, plenty of solid, evidence-backed research has been published showing that the microbiome is potentially involved in multiple sclerosis, inflammatory bowel disease and even Alzheimer’s disease. But what about cancer?

There are already several studies published showing that the microbiome can influence the response to chemotherapy drugs and even in some cases cause the production of toxic breakdown products of the drug. Earlier this month, work published in Nature Communications showed how a particular bacterial strain common in the human microbiome could influence the immune system to drive the progression of a currently incurable type of blood cancer called multiple myeloma. The study raised the possibility that targeting these bacteria with drugs could halt or slow the disease.

5. Organoids, the new secret weapon in personalized cancer medicine.

Back in November 2017, I wrote about how organoids, tiny lab-grown organs made from patient tissue samples would revolutionize the treatment of cancer by allowing researchers to test drugs on patient tumors before deciding which to give the patient. Several pharmaceutical and biotechnology companies have large-scale programs to commercially develop these technologies for using organoids in drug screening for patients and the increasing accessibility of organoid growing kits from companies which supply academic and hospital research laboratories mean research papers are coming out thick and fast.

But, organoids are by no means a perfect way to test new drugs yet. For example, it is easy and quick to make organoids from certain tumor types-such as colorectal, but very difficult from others such as brain tumors. Organoids grown in the lab also don’t have a blood supply, nor are they connected to other body systems which may influence the response of a patient to anti-cancer drugs. But researchers are making progress in organoid development all of the time, figuring out better ways to make and culture them so they more accurately reflect the tumor they were originally made from.  Expect to see them playing an increasing role in designing personalized medicine approaches for cancer patients as well as being involved in more lab-based cancer breakthroughs.

January, 2019|Oral Cancer News|

Hospitals required to post all prices online beginning January 1

Date: 12/26/18
Source: KATV
Author: Associated Press

 

Medicare will require hospitals to post their standard prices online and make electronic medical records more readily available to patients, officials said Tuesday.

The program is also starting a comprehensive review of how it will pay for costly new forms of immunotherapy to battle cancer.

Seema Verma, head of the Centers for Medicare and Medicaid Services, said the new requirement for online prices reflects the Trump administration’s ongoing efforts to encourage patients to become better-educated decision makers in their own care.

“We are just beginning on price transparency,” said Verma. “We know that hospitals have this information and we’re asking them to post what they have online.”

Hospitals are required to disclose prices publicly, but the latest change would put that information online in machine-readable format that can be easily processed by computers. It may still prove to be confusing to consumers, since standard rates are like list prices and don’t reflect what insurers and government programs pay.

Patients concerned about their potential out-of-pocket costs from a hospitalization would still be advised to consult with their insurer. Most insurance plans nowadays have an annual limit on how much patients must pay in copays and deductibles — although traditional Medicare does not.

Likewise, many health care providers already make computerized records available to patients, but starting in 2021 Medicare would base part of a hospital’s payments on how good a job they do.

Using electronic medical records remains a cumbersome task, and the Trump administration has invited technology companies to design secure apps that would let patients access their records from all their providers instead of having to go to different portals.

Verma also announced Medicare is starting a comprehensive review of how it will pay for a costly new form of immunotherapy called CAR-T. It’s gene therapy that turbocharges a patient’s own immune system cells to attack cancer.

Immune system T cells are filtered from the patient’s own blood and reprogrammed to target and kill cancer cells that had managed to evade them. Hundreds of millions of copies of the revved-up cells are then returned to the patient’s blood to take on the cancer.

Though only a couple of such treatments have been approved for blood cancers, the cost can exceed $370,000 per patient.

“It’s a new area for the agency,” said Verma. “We haven’t seen drugs priced at this level and we’re having to think about our strategy.”

January, 2019|Oral Cancer News|