Monthly Archives: July 2019

Psychological impact of head and neck cancers

Author: Emma Morriss

Bristol-Myers Squibb (BMS), in partnership with patient groups The Swallows and the Mouth Cancer Foundation, have announced the results from a patient survey into the psychological impact of head and neck cancers. The research explored the long-term burden of treatment on head and neck cancer patients.

After undergoing treatment for head and neck cancer, which can include surgery, chemotherapy or radiotherapy, many patients report an ongoing impact on their day-to-day life. However, 55% of the 118 patients surveyed indicated they did not receive the right level of information in preparation for the complications encountered from treatment.

There are around 11,900 new head and neck cancer cases in the UK every year and the incidence of head and neck cancer has increased by 32% since the early 1990s.

Following treatment, the survey showed 56% of patients had problems with simple things like swallowing, often experiencing severe pain, while two-thirds of patients experienced changes in their voice or speech. The survey also showed self-reported change from pre- to post- treatment in vital areas including a drop in the ability to communicate (37%), memory loss (21%), and trouble sleeping (20%).

As well as physical symptoms, treatment can have severe implications on mental health too. 52% of patients reported feelings of anxiety before treatment, which only reduced to 48% following treatment. However, emotional and psychological support was only offered to 46% of patients.

A majority of patients did receive access to a clinical nurse specialist, however there was still 23% who were not offered this service. Clinical nurse specialists use their skills and expertise in cancer care to provide physical and emotional support, coordinate care services and inform and advise patients on clinical as well as practical issues, which have been shown to lead to more positive patient outcomes.

“These results show the impact treatment may have on head and neck cancer patients. The continued problems and symptoms experienced by patients after treatment significantly impacts patients’ daily life. We also know physical disfigurement can increase social anxiety. It is important that we raise the awareness of this and work together to provide solutions to improve and support patient outcomes.” said Mouth Cancer Foundation, Clinical Ambassador, Mr Mahesh Kumar.

“With the incidence of head and neck cancers increasing, it is vital we understand what we can do to help patients. We are so pleased to have worked in collaboration with BMS and the Mouth Cancer Foundation to help raise awareness of this disease and understand where patients might need more help to reduce the impact on their lives. We know head and neck cancers, and the associated complications, do not get a lot of attention so it’s crucial for awareness days such as World Head and Neck Cancer Day to be used to shine a light on the disease. By doing so, it will help to improve detection, treatment and outcomes for patients.” commented Chris Curtis, Chairman of The Swallows.

Aggressive radiotherapy dose de-escalation confers benefits in HPV-associated oropharyngeal squamous cell carcinoma

Aggressively de-escalated adjuvant radiotherapy for patients with HPV-associated oropharynx squamous cell carcinoma produced local tumor control rates comparable to those of historical controls, according to results of a single-arm phase 2 study published in Journal of Clinical Oncology.

The de-escalated treatment also was associated with decreased toxicity and slight improvement in swallowing function.

“HPV-associated oropharyngeal squamous cell carcinoma represents a demographically and biologically distinct disease compared with historical head and neck squamous cell carcinomas,” Daniel J. Ma, MD, radiation oncologist at Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Patients are more likely to be younger and nonsmokers and have fewer medical comorbidities. Furthermore, in vitro and in vivo experiments have demonstrated that these tumors are more sensitive to radiotherapy and chemotherapy compared with historical head and neck squamous cell carcinomas.”

The current standard treatment for HPV-associated oropharyngeal squamous cell carcinoma is 7 weeks of radiotherapy at 70 Gy in combination with cisplatin or surgery followed by a 6-week regimen of adjuvant radiotherapy at 60 Gy to 66 Gy with or without cisplatin.

However, these approaches result in significant toxicities.

The two-cohort study by Ma and colleagues included 79 patients (mean age, 58.7 years; 89.9% men) with p16-positive oropharyngeal squamous cell carcinoma who had a smoking history of 10 years or less and negative margins.

Patients in cohort A (n = 36) received 30 Gy delivered in 1.5-Gy fractions twice daily for 2 weeks in combination with 15 mg/m2 docetaxel once per week. Cohort B (n = 43), which included patients with extranodal extension, received the same treatment plus a simultaneous boost to nodal levels with extranodal extension to 36 Gy delivered twice-daily in 1.8 Gy fractions.

Locoregional tumor control at 2 years served as the study’s primary endpoint. Two-year PFS, OS, toxicity, swallow function and patient-reported quality of life served as secondary endpoints.

Median follow-up was 35.7 months (range, 25.2-61.8).

Results showed 2-year rates of 96.2% for locoregional tumor control (100% cohort A vs. 93% cohort B), 91.1% for PFS and 98.7% for OS, outcomes comparable to those observed with standard adjuvant treatment.

One patient in cohort A and nine patients in cohort B experienced disease recurrence.

Rates of grade 3 of higher toxicities were 2.5% before radiotherapy de-escalation and 0% at 1 year and 2 years after de-escalation.

Researchers observed a slight improvement in swallowing function from before radiotherapy to 1 year after completion of treatment.

July, 2019|Oral Cancer News|

UB center helps bring local dental products to market

Author: Marcene Robinson

Stocked on the shelves of Western New York pharmacies is a bottle of dry mouth spray Lubricity, a product developed and manufactured locally by You First Services, Inc. with the support of the University at Buffalo Center for Dental Studies.

Through the partnership, the UB Center for Dental Studies verified the effectiveness of Lubricity through clinical trials, helping bring the product to market and contribute to the growth of You First Services as a budding employer in the region.

Since its establishment in 1988, the UB Center for Dental Studies has built an extensive history of performing scientific and clinical studies for new products by major companies around the world, including Johnson & Johnson and Colgate-Palmolive.

However, the center also works with local manufacturers, providing access to cutting-edge technology, state-of-the-art facilities and guidance from experienced researchers. Since its inception, the center has completed more than $15 million in research projects with contracts ranging from $10,000 to $450,000.

“Ease of accessibility to university scholars is one of the major benefits of having a research university like UB in our community, said Sebastian Ciancio, DDS, director of the Center for Dental Studies and Distinguished Service Professor in the UB School of Dental Medicine.

“Our Center for Dental Studies has helped manufacturers bring a number of useful products to the marketplace to improve oral health of consumers.”

Approved by the U.S. Food and Drug Administration in 2018, Lubricity, works as a saliva substitute for those who suffer from dry mouth. A side effect of more than 500 medications, dry mouth doubles the rate of dental decay compared to people without the condition, and increases the risk of pathogenic and fungal infections, says Ciancio.

The mouth spray, which contains hyaluronic acid, commonly known as “nature’s lubricant,” says Ciancio, is the commercialization of research concepts developed by late UB Distinguished Professor Robert Baier.

Lubricity, which can also be found online at Walmart, Walgreens and Amazon, and in independent pharmacies and hospitals pharmacies, is the flagship product and one of the early successes of You First Services. Formed in 2013, the company has grown from a fledgling startup housed in the UB Technology Incubator at Baird Research Park to a multimillion-dollar manufacturer of oral health care and sterilization products.

The company has received multiple peer-reviewed grants for programs in its disinfection and sterilization and infectious diseases control divisions, and earned the 2018 Bright Buffalo Niagara Industry Partner Award.

In addition to retaining space at Baird Research Park, in 2017, You First Services constructed a $2.6 million pharmaceutical manufacturing facility in Buffalo with the goal of creating 28 full-time jobs in the region.

The company also employs 12 UB alumni, and has provided paid internships to nearly a dozen UB students from fields that include engineering, biological sciences, business, communications and architecture.

“We are very proud of our long-standing relationship and for the incredible quality of the research programs here at the University at Buffalo, said Satish Sharma, MD, executive chairman and chief executive officer of You First Services Group of Companies and research associate professor of urology in the Jacobs School of Medicine and Biomedical Sciences at UB.

“The Center for Dental Studies’ scientific performance in terms of productivity, impact and excellence has remained outstanding. We at YFS will continue to work together with the University at Buffalo to continue to develop our programs to make a significant impact on the overall economy of the state and region.”

The UB Center for Dental Studies recently performed clinical trials for You First Services’ second product MetaQil, a mouth rinse that treats dysgeusia, a metallic taste disorder that occurs due to a number of causes, including damage to oral tissues by chemotherapy. The condition causes patients to experience a loss of taste or an overwhelming metallic taste.

The center performed a clinical trial of more than 50 local participants, who were treated with either MetaQil or a placebo. The study found that nearly 85% of participants reported a significant reduction in metallic taste while using the product.

MetaQil is available in local pharmacies and online.

The Center for Dental Studies and You First Services will continue to explore opportunities for research collaboration and clinical trials. To learn more about the UB Center for Dental Studies, visit the center’s website.

Examining the potential of preoperative CT lymphography with ICG in oral cancer

Author: Leah Lawrence

The majority of patients with localized squamous cell carcinoma of the tongue had at least one sentinel lymph node (SLN) successfully identified and removed using preoperative computed tomography (CT) lymphography and intraoperative indocyanine green (ICG) fluorescence, according to a small study published in JAMA Otolaryngology-Head & Neck Surgery.

According to Kohei Honda, MD, of Hiigata University Graduate School of Medical and Dental Sciences, in Akita, Japan, and colleagues, this combined method “has the potential to provide clear visualization with high sensitivity, even if the SLN is located close to the primary injection site”.

Traditionally, SLN detection is performed using preoperative lymphoscintigraphy with radioisotopes and intraoperative γ-probe detection with or without blue dye mapping. However, the use of radioisotopes has its disadvantages, including exposure to radiation, high cost, and masking of SLN because of shine-through radioactivity when close to the injection site.

Honda and colleagues tested the usefulness of SLN biopsy with preoperative CT lymphography and intraoperative ICG. The study included 18 patients with previously untreated cN0 tongue cancer. All patients underwent CT lymphography prior to SLN biopsy. During biopsy, a minimum skin incision was made according to a predetermined location of SLN and SLN were excised under ICG guidance.

Of the 18 patients, SLN could be mapped using preoperative CT lymphography in 16 patients (89%), in whom at least one SLN was identified and removed using intraoperative ICG.

Metastases to SLN were found in 5 of the 16 patients (31%). There were two patients with T1N0 and three with advanced T2N0.

Of the 30 SLNs removed, 80% were identified by preoperative CT lymphography and intraoperative ICG methods, 17% by ICG methods alone, and 3% by CT lymphography alone.

“In a previous study, we performed preoperative SLN mapping using CT lymphography and an intraoperative blue dye method for early tongue cancer. The identification ratio in finding the SLN using the intraoperative blue dye method was 67%,” the researchers wrote. “We could therefore improve the intraoperative detection rate from 67% to 100% using ICG instead of blue dye.”

Furthermore, a method free of radioisotopes could offer patients a lower cost, freedom from radiation, and no need for facility approval.

In an editorial published with the study, Remco de Bree, MD, PhD, Jan Willem Dankbaar, MD, PhD, and Bart de Keizer, MD, PhD, of University Medical Center, Utrecht, Netherlands, wrote that although this new technique seems promising, more studies are needed to improve its accuracy and to evaluate its usefulness.

“Use of CT lymphography may have a future in lymphatic drainage mapping of localized oral cancer and might become a high-resolution alternative for standard lymphoscintigraphy using radioisotopes if specific nuclear medicine facilities are not available, use of radioisotopes is not wanted or needed, or the shine-through phenomenon must be avoided,” they wrote. “However, intraoperative localization of the SLNs by matching CT lymphography with other nonradioactive techniques, such as ICG fluorescence imaging is challenging.”

Precision Medicine Is Crushing Once-Untreatable Cancers

Source: Newsweek
Date: June 16th, 2019
Author: David H. freedman


For tens of thousands of patients, precision medicine is rewriting their cancer stories.

Linda Boyed, for example, an energetic 52-year-old occupational therapist, was thrilled to be on vacation with her family in Hawaii, hitting the beaches and taking long walks. But she couldn’t shake a constant feeling of fatigue. By the time she returned home, near Columbus, Ohio, her skin had yellowed. Her doctor passed her to an oncologist, who delivered the bad news: Cancer of the bile ducts in her liver had already spread too far for chemotherapy or surgery to do any good. He offered to help keep her comfortable for her final few months.

Boyed’s husband refused to accept that prognosis. He found a doctor at Ohio State’s cancer center who was running studies of experimental drugs for gastrointestinal cancers. Boyed signed herself up. Genetic tests on her tumors revealed a mutation in a gene called FGFR (short for “fibroblast growth factor receptor”), which was likely spurring the cancer’s growth. The doctor gave her an experimental drug, called BGJ398, to inhibit the action of the FGFR mutation. Boyed’s symptoms cleared up, the tumors stopped growing, and she regained the weight she had lost.

That was three years ago.

These days Boyed gets downright bubbly when she tells the story. “I basically lead a normal life now,” she says. “I just watched my son graduate from high school. I think I actually did more in the past year than I did before the cancer.”

Stories like Boyed’s are playing out across the U.S., as new cancer drugs emerge from labs and enter trials. The days when cancer patients received one-size-fits-all regimens of chemotherapy and radiation may soon be a thing of the past. Instead, doctors are taking a far more nuanced view of what drugs and treatments will work on which patients and on what different kinds of cancers. The idea of this so-called precision medicine, or personalized medicine, is that ultimately doctors will use genetic tests—of both the patient and the cancer tumor—to determine the exact drugs or treatments that have the best chance of working.

Although precision-medicine techniques are now being trained on many diseases, their impact is being felt most strongly in cancer treatment. Researchers are building a growing list of genes and genetic mutations that show up in tumors and matching them to drugs that can stop them. The cancer genes that drugs can target now number in the dozens, and researchers are hot on the trail of hundreds more. For some cancers once considered virtual death sentences, the outlook is already much improved: About half of lung-cancer patients respond well to one of the new gene-matched therapies, and in half of those cases, the cancer doesn’t come back. FGFR inhibitors, the drug that saved Boyed, have shown promise not only in bile duct cancer but also for some types of bladder, lung, breast and uterine cancers. “We have six trials open now for FGFR inhibitor drugs alone,” says Sameek Roychowdhury, the oncologist who saved Boyed’s life. “By the end of this year there should be 20.”

After decades of fits and starts in the field of cancer research, the progress made in precision medicine is welcome news indeed. But make no mistake: There is no “cure.” Medicine is not even close to bringing cancer to its knees. For patients diagnosed with advanced cancers—those that have already metastasized, or spread—only one in 10 turn out to have genes currently known to make the cancer susceptible to a new drug. “Our goal is to give 100 percent of patients a new therapy based on genomic testing,” says Roychowdhury. “But today we don’t know how to provide a special treatment for the results of nine of 10 genomic tests we do.”

Most patients don’t even get that one-in-ten chance. Many doctors still lack expertise in the area and fail to administer the genetic tests that could open the door to a precision medicine treatment. Expense is also an obstacle: Insurance companies don’t reimburse adequately for the tests. For these reasons, only 10 percent of cancer patients undergo genetic testing. Precision medicine is helping, at best, only a few percent of the nearly 2 million people who are diagnosed with cancer in the U.S. each year, and the fraction is much smaller among the 17 million cancer patients worldwide.

To increase the number of patients eligible for treatment, doctors are turning to artificial intelligence for help. Genetic testing is churning out so much data that even an army of Ph.Ds couldn’t make sense of it all. Artificial intelligence turns that volume of data from a liability to an advantage. Scientists are now delegating the task of finding the weaknesses in cancer tumors to “deep learning” software that can churn through millions of genetic test results and patient outcomes to find new relationships between tumor genes, cancer growth and specific drugs.

Teasing Out Patterns

To increase the odds that a cancer patient who walks through their doors is given a treatment option, City of Hope National Medical Center outside of Los Angeles plans within two years to be the first major hospital in the U.S. to do genomic testing on the tumors of every single one of its 9,000 cancer patients a year. “Tumors that look identical under the microscope look vastly different under from a genomic point of view,” says Michael Caligiuri, a physician and president of City of Hope National Medical Center outside of Los Angeles. “They need to be treated differently.”

As other hospitals follow suit, they will generate a vast volume of data—grist for the AI mill. The 20,000 genes of a typical human genome include three billion DNA nucleotides, or bits of information, any of which can be mutated, repeated or moved in any number of ways to cause cancer. Each of the human body’s billions of cells has its own copy of the genome, subject to its own mutations.

But DNA is only part of the picture: Whereas DNA is a blueprint, the real work in our cells is carried out by proteins—complex molecules that control almost everything in our biology. Proteins govern both the growth of a cancer tumor and the work of the immune system in fighting it. There are as many as 6 million basic proteins and variations on them, and researchers are now measuring thousands of them directly in cancer-tissue samples and feeding that information to the deep-learning programs.

“Drugs don’t target genes, they target proteins,” says David Spetzler, chief scientific officer of Caris Life Sciences in Irving, Texas. “That’s where we’re seeing the most progress in understanding cancer, and it’s what’s going to be the most useful information we gather in the next five years.” Says Jeffrey Balser, a physician who heads the Vanderbilt University Medical Center: “That’s a lot of incredibly deep knowledge coming to the table.”

Deep-learning algorithms don’t work the way scientists do—they never “understand” the biology behind the cancer they’re analyzing. Instead, they digest reams of information from tissue samples of patients that had certain kinds of cancer, and correlate that information with the ultimate fate of those patients—who responded to which treatments and who didn’t. It’s a kind of hit-or-miss association exercise, but one that’s conducted thousands of times, using vast amounts of data. Computers can tease out patterns in the data that a human could never see—linking, say, the presence of the FGFR gene to a particular cancer of the bile duct.

Spetzler’s company, for instance, is working to crunch protein-fortified data with deep-learning software. To wring useful insights out of the data from 170,000 cancer patients that Caris has access to, the company enlists hundreds of different deep-learning algorithms. The programs essentially compete with one another to find patterns in the data that indicate which drugs will work best with which patients. “Different algorithms will miss different patients, but together they can do a better job,” says Spetzler.

AI is helping provide yet another critical set of clues to how to match patients to new drugs by learning to read slides of tissue samples taken in biopsies. Those slides have always been read under a microscope by pathologists, who come up with a cancer diagnosis based on the cells’ appearance. So-called “machine learning” programs are starting to step in. An Israeli company called Nucleai has trained its software with 20 million digitized biopsy slides to recognize cancer, and it already performs with 97 percent accuracy.

Diagnosing cancer is just the start, says Nucleai CEO Avi Veidman. The goal now is to use AI to extract more information from slides than pathologists can—information that can help match patients to new drugs. “Most of the information in that tissue isn’t being used when doctors or software are trying to predict the treatments that will work,” says Veidman, who spent two decades with Israel’s intelligence forces developing AI software to recognize missile bases and terrorist activity in satellite images before turning his attention to cancer three years ago. “AI can analyze the different types of features in the image much more efficiently and find hidden patterns.” He notes, for example, that subtle signs of the battle between the patient’s cancer cells and immune-system cells can be spotted by the software, and those signs can provide essential clues to whether or not the cancer might be vulnerable to one of several new immunotherapy drugs—that is, drugs that work not by fighting the cancer directly, but by boosting a patient’s immune system so it can attack the tumor.

South-Korean firm Lunit has developed AI software that can analyze pathology slides to predict, for example, which patients will respond to a relatively new type of cancer drug called checkpoint inhibitors, which can prevent cancer cells from blocking a patient’s immune cells. Lunit claims that the software is 50 percent more accurate than tests that use genetic data alone. “That’s going way beyond what human eyes can do,” says CEO and physician Beomseok Brandon Suh. “The software is finding patterns that are too complex for people to recognize, but that have biological meaning.”

Similar advances are taking place with AI-based systems that are reading X-rays, MRIs and other image data. “There are already algorithms that are as good at reading a mammogram as a highly trained radiologist, or at recognizing skin cancer as a dermatologist,” says Chi Young Ok, a pathologist at the MD Anderson Cancer Center in Houston. “The progress is astounding.” Eventually those images, too, are likely to help AI systems go beyond diagnosing cancer to spotting hints of the vulnerability of a patient’s unique cancer.

Data Dilemma

Deep-learning algorithms look at more data and analyze it more thoroughly than machine learning programs do. They are a bit like Seymour, the ravenous plant in Little Shop of Horrors, whose appetite never stopped growing. Although researchers and clinicians now have access to databases that contain information from as many as 250,000 cancer patients, it’s not nearly enough.

Thousands of different mutations in a patient’s genome can shape the development of cancers and determine which treatments are effective. Each cancer cell is a moving target, continually developing new mutations that can help it evade immune cells and survive powerful cancer drugs. Since AI software needs thousands of examples of a particular pattern before it can begin to recognize it, and since a particular pattern of mutations may come up in only a few thousand patients altogether, the software may well need access to the data of millions of patients to make faster progress. “We can make predictions now about how tumors will evolve and what treatments will work, but right now a significant fraction of those predictions are wrong,” says UCLA’s Paul Boutros, a physician who heads up cancer data science for the UCLA Jonsson Comprehensive Cancer Center.

A number of collaborations—with names like the International Cancer Genome Consortium, the Oncology Research Information Exchange Network, and the Actionable Genome Consortium—have sprung up among research centers and hospitals to share patient data. Gathered with patients’ permission and with personally identifiable information stripped out, that data could eventually help researchers reach the needed critical mass of information. “We need to get to the point where all these different data networks are tied together into a network of networks,” says City of Hope’s Caligiuri. Clinicians need access to that data, too, to find patients like the ones they’re treating to see what might work. “We should be able to go to a computer, type in information about a patient’s cancer, and up will pop 50 cases around the world that are similar at the molecular level,” he says.

Easing the Bottleneck

Medicine is of no use if patients don’t have access to it. To get new drugs out faster, researchers are using AI to speed the process of drug development. One of the biggest causes of delay in testing new drugs is recruiting enough patients for a trial. Researchers not only need a group to try the new drug, but another “control” group to get the standard treatment, for purposes of comparison. Even when a new precision drug is promising, it can take years to run the trials that demonstrate the drug actually works for an identifiable group of patients.

To speed things along, researchers are starting to use high-powered statistics and computer models to avoid having to recruit a control group at all. Instead, they use a mashup of data from past studies to predict how a real control group would fare. “The results you get from a synthetic control arm are as reliable as if you had actually enrolled control-group patients in the trial with the same physicians and protocols,” says Glen de Vries, president of Medidata Solutions, which has designed the statistical tools.

That won’t be enough to ease the trial bottleneck for clinicians and researchers hoping to come up with precision treatments for the deadliest, most aggressive cancers. For instance, glioblastoma, the brain cancer, has the lowest median survival time from diagnosis—15 months—of any major cancer. It’s challenging enough to design a drug that can make it through the blood-brain barrier to get at a glioblastoma tumor. The disease works so quickly that there’s barely time to give an experimental drug a chance to show whether or not it is effective.

To give more experimental precision drugs a better shot at glioblastomas, the newly created Ivy Brain Tumor Center at the Barrow Neurological Institute in Phoenix has developed “accelerated trials” for its brain-cancer patients. A newly diagnosed patient is first given a dose of an experimental precision drug. The dose is too small to harm the patient (in case it turns out to be toxic, always a risk with new drugs) but big enough to reach the tumor. After surgery, doctors test the tumor to see if the drug had any effect. If it did, the patient continues with an increased dose. If not, the patient and doctor find out in time to take another course of treatment. “Speed is the key to finding drugs that work,” says Ivy director Nader Sanai. The approach has already turned up a personalized treatment that in one patient’s case beat back a form of brain cancer called malignant meningioma.

While all these approaches together are likely to bring us closer to the day when most cancers succumb to precision treatments, no one thinks that day will be here soon. Still, the move to personalized treatments is benefitting almost all cancer patients by sparing them the ordeal of a treatment that has little chance of working. “If you can look at a genomic or other test and know ahead of time whether or not a patient’s tumor will respond to a treatment, then even if only one out of 100 patients responds you’ve saved 99 patients from unnecessary complications and expense,” says Stanley Robboy, vice-chair for diagnostic pathology at the Duke University Cancer Center. “These drugs can cost $100,000, and can bankrupt families.”

Even that modest benefit, however, is being denied to most advanced cancer patients today. Health insurance companies frequently balk at paying for the genetic tests, which can cost as much as $10,000. “Medicare and some companies are starting to provide some coverage,” says Roychowdhury. “But it’s an arduous process to get reimbursed for the testing, and it’s hard to get the cutting-edge tests covered at all.” That’s one reason most of the top cancer centers in the country don’t routinely provide the testing to all their patients, even though virtually all experts agree that should be the standard of care everywhere for cancer.

When a patient does get a tumor tested and the test shows a match to a promising precision drug, insurers often refuse to pay for the drug too, says Roychowdhury. The insurers cover only drugs that have already gotten FDA approval as a standard treatment, after a long period of trials. FGFR inhibitors of the sort that rescued Linda Boyed and many others are still usually not reimbursable. Patients who become part of formal drug trial, as Boyed did, usually get the drug for free. But in some cases patients with the most advanced cancers—the ones who need experimental drugs the most—are excluded from trials. Drug companies and even academic researchers often want to avoid including very sick patients out of fear they’ll skew the results toward failure.

Payment isn’t the only obstacle to treatment. About 85 percent of U.S. cancer patients get treated at a community hospital, where they see an oncologist who treats many different types of cancers. Those generalists are typically not up on the latest tests and treatments, says Caligiuri. The hospitals who employ them don’t expect them to go through the time and expense of figuring it out. While highly regarded cancer centers place as many as a quarter of their patients on newer precision drugs, the percentage at most community hospitals is nearly zero.

What should patients do? “The first and most important thing I would say to anyone who has just received a diagnosis of cancer is that you need to get a second opinion from an oncologist who is a specialist in your type of cancer before you start any treatment,” says Caligiuri. “If your first treatment isn’t the optimal one, the tumor develops multiple resistances not only to that treatment but to other treatments that might have worked if you got them first.” When asked about other treatment options, community oncologists often insist that patients are best off starting treatment first. Some play on patients’ fears that even a short delay might hurt their chances of recovery—when in fact, it might save their lives.

Vanderbilt’s cancer center is trying to fix this problem by boosting the participation of community-hospital oncologists in precision-medicine initiatives. Its My Cancer Genome website helps doctors and patients find out what new treatments and trials might be available for any particular cancer—the site lists 4,000 trials. “It pains me when patients come to us and they’ve already been given a treatment that wasn’t going to help them,” says Vanderbilt’s Balser. “At that point the patient is behind the eight ball, and all we can do is try to pick up the pieces.” Like many other top cancer centers, Vanderbilt is also creating affiliations with community hospitals in its region to support those hospitals in gaining access to precision-medicine expertise, genetic testing and trials of the newest drugs. Vanderbilt already has forged such ties to nearly 70 hospitals in five states.

A growing roster of precision-medicine approaches will also help in preventing cancers from taking hold in the first place. Some imaging techniques, such as PET scans, are approaching the needed sensitivity and resolution to pick up a cluster of newly formed cancer cells so tiny that it can be blasted away on the spot with a beam of focused radiation. Such treatments would be convenient and come with fewer complications.

And why wait until someone gets cancer to look at genetic information? If everyone routinely got genetic screening to see which cancers they’re at high risk for, tests like PET scans, which can cost $7,000 or more, could be given selectively. Unfortunately, genetic screening itself is currently either too expensive or, in the case of consumer-focused genetic-testing companies like 23andMe, too unrefined to justify being rolled out to the entire population. But researchers and biotech companies are working on cutting the costs and raising the accuracy of genetic tests. “If we can know the cancer you’re at risk for, the right image every three years can change your life,” says Caligiuri.

Of course, it would be good to know that if a cancer does slip through, precision medicine will have just the right drug for it. That way cancer patients will have more to look forward to than just being made comfortable in their final days—the fate that was Linda Boyed’s, until it wasn’t.

July, 2019|Oral Cancer News|

New guidelines for patients suffering from mucositis or oral ulcerations from head and neck cancer treatment

Author: press release

MedX Health Corp. announces it will initiate a targeted marketing campaign following an announcement by a worldwide coalition of researchers and clinicians who have agreed that light therapy is among the most effective interventions for the prevention of oral mucositis and painful ulcers in the mouth and throat resulting from cancer therapy. The Company said this represents a significant sales opportunity in Canada and the United States for MedX’s photobiomodulation therapy devices.

The new guidelines from the Multinational Association of Supportive Care in Cancer (“MASCC”) and International Society of Oral Oncology (“ISOO”), recently published in the journal Supportive Care in Cancer, present a significant upgrade in care guidelines for adult cancer patients worldwide ( More than 70,000 head and neck cancers are diagnosed annually in Canada and the United States, and it is documented that 100% of patients undergoing radiation therapy for these cancers will develop mucositis, which patients report as the worst side effect of their cancer treatment. Pain from the condition can slow or delay cancer treatment, and in severe cases require hospitalization.

“Cancer patients can now benefit from this non-invasive, non-pharmacological treatment for a common, debilitating side effect of treatment,” said Dr. Praveen Arany, DDS, PhD, the current President of the World Association for Photobiomodulation Therapy (W.A.L.T.), a co-corresponding author on the MASCC/ISOO paper and assistant professor of oral biology and biomedical engineering at the University at Buffalo School of Dental Medicine. “Recent advancements in our understanding of mechanisms of low dose light treatments, or Photobiomodulation (“PBM”) therapy, are enabling rigorous validation of clinical protocols. MASCC/ISOO’s new guidelines are a major milestone for the PBM field and we are confident it will set a clear path for several exciting clinical applications for PBM therapy.”

“With these new guidelines we expect our devices will help dramatically reduce mucositis,” noted Scott Spearn, CEO of MedX. “Our laser/light products have been on the market for other indications and are FDA cleared and Health Canada licensed for PBM therapy and are already being used in a number of mucositis treatment studies in Canada and the US. We expect sales of our PBM therapy products to accelerate over the next year with a sales and marketing campaign focused in this particular segment being rolled out across North America.“

MedX has been collaborating with cancer specialists using its products with their patients, including Ryan Tapping of Ottawa, who was diagnosed with throat cancer in December 2018 and underwent radiation and chemotherapy in early 2019. “I began using MedX’s HOME™ unit during my 3rd week of a 7-week radiation treatment program. I continued treatments once or twice daily until 7 weeks post radiation. I believe that the MedX unit I used for twelve weeks helped heal my mouth and throat to a point where I could successfully swallow again sooner than if I had not used the device. It helped contribute to the return of more normal saliva and all mouth functioning related to chewing and swallowing.”

They turn to Facebook and YouTube to find a cure for cancer — and get sucked into a world of bogus medicine

Source: The Washington Post
Date: June 25th, 2019
Author: Abby Ohlheiser

Mari pressed kale leaves through the juicer, preparing the smoothie that she believed had saved her life.

“I’m a cancer-killer, girl,” Mari told her niece, who stood next to her in the kitchen. The pair were filming themselves for a YouTube video.

Mari said she was in remission from a dangerous form of cancer, and the video was meant as a testimony to what she believed was the power of the “lemon ginger blast.” In went some cucumber, some apple, some bok choy, a whole habanero pepper.

While she pressed, she preached.

“I’m telling you, it’s anti-cancer,” Mari said. “It’ll kill your cancer cells.”

The video, first uploaded in 2016, remains on YouTube, but there’s an “important update” attached to the video’s description. It was written by Liz, the niece, a year later.

Mari’s cancer had returned, the note said, and she had died.

When Mari’s cancer came back, Liz wrote, her aunt opted to do chemotherapy. Her smoothie recipe remains online, with 506,000 views and counting. “I will not take down her videos,” wrote Liz, who declined to comment for this story, in the description of a follow-up video, “as they continue to help people.”

I found Mari’s videos without looking for them last fall, when a search for a smoothie recipe opened up an algorithmic tunnel to videos that claimed to know the secret to curing cancer. These tunnels, forged by Google searches and Facebook recommendations, connect relatively staid health and nutrition advice to fringe theories, false claims and miracle juices.

But the web of false, misleading and potentially dangerous cancer “cures” and conspiracy theories isn’t just there for those who stumble into it accidentally.More often it ensnares people who are reeling from bad news and groping for answers.

“People with a new cancer diagnosis are often feeling vulnerable and scared,” said Renee DiResta, a researcher who studies disinformation. The treatments for cancer, especially chemotherapy — which targets cancerous cells but can also kill or damage healthy ones — can come with significant, unpleasant side effects. Facing the horrors of such a diagnosis and treatment, some people start searching for information and community online.

What they find can be quite disturbing to medical professionals: home remedies that purport to cure diseases with baking soda, frankincense, silver particles.

Google and Facebook have promised to crack down on health misinformation in recent months, as links between anti-vaccine conspiracy theories and measles outbreaks in the United States become major news. But bogus health information cannot be eradicated from the Web with a shock of chlorine. Health conspiracy theories and false cures have polluted social media for years, abetted by companies that have been more focused on building out the plumbing than keeping the pipes clean of misinformation.

YouTube is trying to plug the holes that lead to videos like the Coldwell interview. When I ran the “cure for cancer” search again, in May, YouTube’s search results were a completely different story. The baking soda and Coldwell videos are still online, but no longer appear among the top pages of results. Instead, most of the top results came from major cancer research centers.

I asked YouTube about the change, which occurred just before we reached out to the company for comment on this story. I was told YouTube has started to treat search results for different types of topics differently: When its algorithms decide a search query is related to news or information-gathering on a topic like cancer, they will attempt to populate the results with more authoritative sources. The company said it is working with experts on certain health-related topics to improve results.

Even as YouTube patches “cure for cancer,” medical misinformation remains available and popular in other ways. People who are susceptible to cancer misinformation aren’t just typing keywords into YouTube. They’re also turning to fellow travelers who followed the same algorithmic tunnels to the same wells, where community members who have never met in person swap folk remedies and discuss the untrustworthiness of cancer doctors and pharmaceutical companies.

It’s tempting to think of medical misinformation as a technological problem in need of a technological solution, but that’s only part of it. The social media age has made humans part of the infrastructure of the Internet. And when it comes to medical information, it’s not just algorithms that direct online seekers who are trying to figure out how to cope with a bad diagnosis. It’s also other people.

For those facing a battle with a terrifying illness, hopeful anecdotes can be powerful. Anecdotes can turn seekers into believers, who can turn other seekers into believers. And on Facebook, those anecdotes continue to attract large audiences.

Even as Facebook works to limit the reach of anti-vaccine chatter, other medical misinformation is thriving — including bogus cancer cures. The boundaries between false medical beliefs are permeable: If you believe baking soda can cure cancer, you might also believe that the measles vaccine causes autism. (It doesn’t.) Behind each “alternative” theory of cures and causes lurks a deep suspicion of doctors, drug sellers and especially chemotherapy.

On Facebook, I easily found groups devoted to sharing “natural” cures for cancer, where people who have cancer diagnoses, or care for someone who does, asked other group members for ideas for how to cure it. “Cancer Cures & Natural Healing Research Group” has just under 100,000 members. I joined the closed group in February, identifying myself as a Washington Post journalist to the administrators.

The administrator for that group initially agreed to speak with me in private messages. But then I was blocked from the group and the administrator’s personal Facebook page. (The administrator did not return a follow-up email seeking comment.)

Facebook’s algorithms then began suggesting other groups I might like to join: “Alternative Cancer Treatments” (7,000 members), “Colloidal Silver Success Stories” (9,000 members) and “Natural healing + foods” (more than 100,000 members). I requested access to some of those groups, too, and several admitted me. People in the groups would ask one another for cancer-fighting advice. Some would be told to use baking soda or frankincense.

Rather than remove the groups, Facebook’s strategy to limit health misinformation centers on making it harder to join them unknowingly. Facebook said in an emailed statement that it “will alert group members by showing Related Articles” for any post already deemed false by Facebook’s third-partyfact-checkers, for instance.

Facebook is in the process of experimenting with how to address health misinformation beyond vaccines.One possibility might be alerting users who are invited to join a groupthat ithascirculated debunked hoaxes.

To this point, it’s been up to users to steer their peers toward or away from bad health advice. In one Facebook group, in February, a parent asked for advice on how to cure a child’s strep throat without antibiotics. The responses were split; some told the parent not to mess around and go to the doctor for antibiotics; others recommended colloidal silver and hydrogen peroxide. The National Capital Poison Center notes thateven food-grade hydrogen peroxide “should never be taken internally” unless extremely diluted, and that its use as an alternative therapy is “not based on scientific evidence.”

The world of alternative medicine seekers has its own celebrities. The names are like pass phrases. Post a question about natural cancer treatments in the right Facebook group, and you’ll get the names of supposed success stories that the pharmaceutical industry doesn’t want you to know about, and the instruction to “do your own research” into their stories.

“CHRIS BEAT CANCER! Look it up,” one Facebook user advised on a discussion thread.

So I did. The first Google result, when I ran the search in mid-May, was Chris Wark’s website, where Wark sells access to his method for $147. Below that, Google also suggested a few specific videos from Wark, promoting his “cancer fighting salad” and a lecture on how he beat cancer with “diet.”

Joanna Tackett, a spokeswoman for Wark, said in an email that Wark is not a doctor and does not provide medical advice, and that he has given free access to the paid program to hundreds of thousands of people.

Misinformation experts worry about “data voids,” created by the way information gets indexed online. If the only people discussing and looking up a particular term or phrase are those advocating a certain view, people searching that phrase would be shown information that supports that view.

“You can easily dominate search results for a term when you’ve created the term and only in-groups use it,” DiResta said. As social media companies identify and crack down on one search term, she said, 20 more might be rising in interest to take its place.

A Google spokesman said the company has worked to improve the accuracy of results for general health-related queries, but for very specific searches, such as “Chris beat cancer,” the system is designed to return “results from a diverse range of sources to help you form your own opinion — some of these provide information about the book, while others provide critiques.”

Google users searching for cancer information more generally might end up being served ads that promote dubious treatments, even if those sources don’t show up in the search results. In a search for “cure for cancer,” in May under incognito mode, the first result was an ad: “Stage four cancer survivor | thanks to natural cancer cures.” The ad promoted a cancer clinic in Mexico that appears to use unconventional treatments. Another Google spokesman said that ads promoting miracle cures are against the company’s rules, and that “if we find ads that violate our policies we remove them.”The ad was removed after I flagged it in an email.

For some searches, the results will be a tug-of-war between the believers and debunkers. Searching “Chris beat cancer” did not reveal a total data void. Google did show me two results challenging Wark’s claims about beating cancer with a healthy diet — but only after links to his YouTube channel, his website, the salad video, the lecture and Wark’s book. (When I ran the search later, after asking Google about the results, the challenges appeared a bit more prominently.)

One of the challengers is David Gorski, a surgical oncologist at Wayne State University School of Medicine who runs a blog, called Science-Based Medicine, devoted to medical bunk.

Gorski dove down the cancer conspiracy theory tunnels a decade ago, armed with science and determined to stanch as much misinformation as he could. Back then, he said, “all there really was were websites, blogs and discussion boards that were privately maintained. Their reach was nowhere near what Facebook came to be.”

Now, Gorski faces not only a more forceful tide of misinformation, but also intense blowback from those who have responded to his work. Accusations of wrongdoing from holistic healing sites and a wave of negative ratings on his profile have tainted the results of Google searches for his name.

Gorski’s debunking of Wark’s story was simple. Wark, who says he had surgery for his Stage 3 colon cancer but refused chemotherapy after, had a 64 percent chance of surviving five years with surgery alone, Gorski said. To get that figure, the oncologist used a tool called Adjuvant Online, which helps doctors assess the risks and benefits of potential therapies designed to prevent the recurrence of cancer after it is treated. The database used clinical trial data from a wide range of studies.

“Attempts to discredit me because I had surgery give far too much weight to my personal story, and miss the larger message. . . . People have healed all types and stages of cancer holistically (against the odds),” Wark said in a statement. “As a patient advocate, I am highly critical of the cancer industry and pharmaceutical industry,” he added, before saying that “I do not tell patients not to do the treatment.”

Surgery was the recommended primary treatment for Wark’s cancer, Gorski said. Chemotherapy is a secondary measure, meant to help prevent the cancer from coming back. Wark’s decision to forgo the post-surgery chemo was a risk, but by then the odds were in his favor.

After I was kicked out of the “Cancer Cures and Natural Healing Research Group,” I joined the similarly named “Natural Healing & Cancer Cures Research Group,” a closed Facebook group with more than 40,000 members. (Again I identified myself as a journalist while joining the group.)

That’s where I saw a post by Beth Anne Rekowski, who said her sister was sick with Stage 3 lung cancer.

“She and I both agree,” Rekowski wrote, “NO chemo or radiation.”

I called Rekowski to find out why.

Cancer has haunted Rekowski for much of her adult life. She wanted to be a nurse, but when her young son got cancer, she dropped out of nursing school. When he died in 1992, at age 4, Rekowski felt like she had died with him. Grief became activism, and she started raising money for charities that helped pay for cancer research. Later, her brother-in-law and her father were diagnosed. They died, too.

Rekowski had health issues of her own, and on the advice of a friend, she visited two naturopathic doctors. When their practices closed (Rekowski blames Big Pharma), she started seeking out remedies online. She found Facebook groups full of them.

“I used Facebook health groups just full-speed ahead,” Rekowski told me in a March phone interview from her mother’s home, where she is a full-time caretaker, “and I couldn’t believe what resources were on there. People, you know, to help other people because they’ve been there.” The Facebook groups were Rekowski’s lifeline.

She came to believe that chemotherapy, not cancer, had killed her son, father and brother-in-law. “Talk about parental guilt and remorse,” Rekowski told me.

Now, every sick relative is a chance for redemption. She advised her sister against chemotherapy or radiation to treat her lung cancer. Rekowski wanted her to use “naturals” and “immunotherapy” instead. And so she turned to her lifeline: the other members of the Natural Healing & Cancer Cures Research Group.

“If you can please give me a list,” she wrote in a post on the Facebook group, “in order of urgency and priority, of what you feel is imperative for nutrition, immune boosting, cancer killing, and whatever else you feel my sister needs.”

The responses flooded in by the dozens.

Salt water baths. 4 times a day.

B17 vitamin. . .CBD Oil full spectrum.

Add Wheatgrass juice to your sister’s diet.

Rekowski’s sister trusted her doctors: She did chemotherapy. Then she got an infection in her lungs, according to Rekowski, and in March her doctors said it was time to enter hospice. But Rekowski still had hope. She said she convinced her sister to wait on hospice, and went to a health food store that evening and bought a small fortune’s worth of essential oils.

She believed she could heal her sister’s lungs with fenugreek, licorice root, peppermint oil and oregano oil. Once her sister’s lungs were better, Rekowski believed, she could get to work curing her cancer.

In May, Rekowski wanted me to know that she believed her sister was a miracle. Once the infection had subsided, she texted to say the doctors had offered to start her sister on chemotherapy again. “My sister declined,” she wrote, and decided to continue with “natural supplements and natural oils.”

When Rekowski and I talked about health, it sometimes felt like we were talking about faith. The story she tells about her sister’s illness is meant as a parable about how chemotherapy can kill. She saw me, and the readers of this article, as potential converts.

I told Rekowski that I believed the groups she depended on exploited people’s desire for hope in the face of a bleak prognosis. When there are no options left, it’s powerful to find a community that tells you otherwise, even if those options turn out to be ineffective or even harmful.

But each time I challenged her with a counterpoint, Rekowski waved it away. The government was covering up evidence that supported her views, she told me. The treatments she found on Facebook worked for her, she believed, and that was all the proof she needed.

As a surgical oncologist, Gorski sees the effect that medical misinformation can have on the body. A couple of times a year, he says, he’ll treat “patients with neglected cancers, who try to treat their cancers naturally” before turning to medicine. The tumors have become “nasty ulcerating masses.” Even for patients with terminal diagnoses, traditional medicine can offer palliative care that can manage the pain and may be covered by health insurance.

After years of allowing health misinformation to spread, social media companies are beginning to treat the problem the best they can. They didn’t create cancer conspiracy theories, but experts like Gorski have observed how they made the problem worse. “It’s just way more concentrated and effective,” he said. “You go on Facebook and type in ‘alternative cancer cures’ and you’ll find stuff real fast.”

July, 2019|Oral Cancer News|

Updated HPV vaccine recommendations follow big HPV infection drops shown in new study

Author: Tara Haelle

A vial of the human papillomavirus (HPV) vaccine Gardasil. (AP Photo/Charles Rex Arbogast)

Adults up to age 45 are now recommended to discuss with their doctors getting the human papillomavirus (HPV) vaccine, which prevents 3% of all cancer in women and 2% of all cancer in men—an estimated 34,000 cancers a year in the U.S. Following confirmation from the director of the Centers for Disease Control and Prevention (CDC), the recommendations also extend the age in men from age 21 to age 26, the same as in women.

The decision from the CDC’s Advisory Committee on Immunization Practices (ACIP) July 26 came the same day The Lancet published the largest study to date on the vaccine’s effectiveness. The meta-analysis of 65 studies found drops of 31%-83% of HPV infections and genital warts in men and women, depending on age and diagnosis.

HPV is responsible for nearly all cervical cancer, over 90% of anal cancer, 70% of oral, throat and neck cancers and over 60% of penile cancer. Though HPV is primarily transmitted through sexual contact, non-sexual transmission occurs as well.

Previously, the HPV vaccine had been recommended for females and males in a series of two doses up to age 14 or three doses up to age 26 in women and age 21 in men. Men ages 22-26 could also get the vaccine.

ACIP’s unanimous vote to extend the recommendation to age 26 in men corresponds to evidence showing the vaccine’s substantial benefits for men. In fact, research shows men to be up to six times more likely than women to develop an oral infection with the highest risk strain of HPV.

ACIP’s 10-4 vote regarding adults ages 27-45 who haven’t received the HPV vaccine emphasizes shared decision-making with their providers. The HPV vaccine is not licensed by the FDA for adults older than 45 since data on its effectiveness does not exist for this age group.

The “decision from ACIP emphasizes what the data has shown—that the HPV vaccine is safe and effective for use in patients ages 27 to 45, and that use of the vaccine in this age group should be the result of shared decision-making between patients and their trusted physicians,” Christopher M. Zahn, M.D., vice president of Practice Activities at the American College of Obstetricians and Gynecologists (ACOG) said in a statement.

“Obstetrician-gynecologists are encouraged to discuss with their patients ages 27 to 45 the potential benefits of HPV vaccination, addressing the reduced efficacy compared to vaccination within the younger target age range as well as the reduced risk of high-grade disease and cervical cancer,” Zahn said, adding getting the vaccine at the recommended age of 11-12 years offers the most benefit.

“Women’s decisions will also likely consider their individual circumstances, preferences, and concerns, and the role of the obstetrician-gynecologist is to provide unbiased information in a balanced, thorough way in order to aid that decision-making,” he said.

New research finds big drops in HPV-related infections

The new study found that HPV infections with strains 16 and 18 dropped 83% among girls ages 13-19 and by 66% among women ages 20-24 up to eight years after vaccination.

The HPV 16 and 18 strains in Gardasil cause 70 percent of all cervical, vaginal, vulvar and anal cancers. Gardasil 9 also protects against HPV 6 and 11, which cause 90% of genital warts, and against five other strains (31, 33, 45, 52, and 58). Together, the strains in Gardasil 9 represent 90% of HPV-related cancers.

HPV infections caused by HPV 21, 33 and 45 cut in half (54%) among vaccinated girls ages 15-19, according to the new research. Similarly, genital warts diagnoses fell by 67% in these girls and by 48% in boys of the same age. Older men (up to 24) and women (up to 29) also saw declines in genital warts by 31%-54%.

Rates of grade 2 cervical neoplasia, a precursor to cancer, also dropped by half (51%) in screened girls 15-19 and by 31% in women 20-24 years.

Cervical cancer can take up to 20 years to develop, so the vaccine, first approved in 2006, has not been available long enough for a sizable evidence base showing a reduction in cancer incidence. Dramatic declines in HPV infection rates, however, are expected to translate to similar declines in HPV-caused cancer rates, and immunity from the vaccine is long-lasting.

Multiple large reviews of the HPV vaccine have found it to be among the safest vaccines available. While the actual shot itself can be particularly painful, the only regularly reported side effects are pain, redness and soreness at the injection site and, in some teens, temporary fainting, which is common with many vaccines in adolescents. Among 13,000 people in the clinical trials for Gardasil 9, five people also reported fever, allergy to the vaccine, asthmatic crisis, headache and tonsillitis, though not all of these were determined to be caused by the vaccine.

The most effective way to reduce cervical cancer has been and remains regular screenings. However, screenings only detect early development of abnormal tissue that could become cancerous whereas the HPV vaccine prevents the viral infections that leads to those tissue abnormalities in the first place.

Since there is no current way to screen for throat/mouth/neck or anal cancer in women or men (or penile cancer in men), the HPV vaccine remains the only way to prevent those cancers.