Providence performs first ‘Jaw in a Day’ surgery in Oregon

Author: Brittany Falkers

The innovative procedure for patients with oral cancers offers a faster recovery and better cosmetic results.

Click here to watch


Terry Sambrailo is strolling into the new year with a new perspective on her health.

“The worst is all over now, it’s behind me,” she said.

Sambrailo lives in Idaho but is staying with friends in Hillsboro while she recovers from a first-in-Oregon procedure for oral, head and neck cancer patients.

“I think it’s wonderful and I’m just fortunate that I was a good candidate for it,” Sambrailo said. The 74-year-old was diagnosed with cancer in her left jaw last year. It started with a toothache.

“And then another toothache and that’s when we finally did the biopsy and we found out it was more than just tooth. It was the cancer in the bone,” she said.

She found a team of specialists and surgeons working through Providence Cancer Institute in Portland with an innovative new procedure called “Jaw in a Day.”

“It took a heck of a team to do it,” Sambrailo said.

Leading that team were Providence head and neck oncologic and microvascular reconstructive surgeons Ashish Patel, M.D., D.D.S., and Baber Khatib, M.D., D.D.S., F.A.C.S.

“I think for lack of a better medical word, it is really cool,” Dr. Khatib said. “The technology behind this is phenomenal.”

A diagnosis of oral, head or neck cancer can mean a series of surgeries to remove the tumor, rebuild the jaw and teeth and then implant new teeth. That can take one to two years.

During the process, the patient has no teeth for six months to a year. Not only does this severely affect their ability to talk and chew, but also their mental health and ability to interact with others.

“One of the devastating things with oral cancer is that – not only does it require this large removal of the area of the cancer, but this can affect the way patients look, speak, interact with people afterwards, and this is a lifelong, what used to be a disfiguring type of surgery,” Dr. Khatib said.

The “Jaw in a Day” procedure can accomplish what used to take about a year in a single day. The patient undergoes a complex procedure that removes the tumor, rebuilds the jaw using the patient’s fibula (calf bone) and implants new teeth within hours.

“I was able to use these cutting guides on the fibula, cut it into a shape that looked pretty natural to what her original jaw looked like and then put in these dental implants all at the time of the surgery,” Dr. Khatib said. “Being able to give them teeth does more than just give them a smile, which is a pretty significant thing in itself, but it offers them an ability to chew, to swallow and articulate so much better.”

Providence has used this procedure before on non-cancerous tumors, but now it is available for patients like Sambrailo. She was the first patient on the West Coast to receive it for her cancer treatment.

She’s still recovering and will need restorative dentistry in the months ahead but is excited about her prognosis.

“Your body, at 74, doesn’t turn around real fast,” Sambrailo said. “But I probably saved nine months to a year, rather than having it the old way.”

Learn more about oral, head and neck cancers and the latest treatments at Providence here:

2020-12-31T07:48:53-07:00December, 2020|Oral Cancer News|

Is poor survivorship care driving high second-cancer risk?

Author: Kristin Jenkins

In the United States, men and women who survive adult-onset cancers for at least 5 years are at significantly increased risk of developing and dying from new primary cancers, particularly those driven by smoking and obesity, a new study shows.

“This was disturbing but at the same time provides tremendous opportunities for cancer prevention and control, not only to mitigate the subsequent cancer risk but also to minimize comorbidities,” lead author Hyuna Sung, PhD, of the American Cancer Society in Atlanta, Georgia, told Medscape Medical News.

“The importance of smoking cessation, weight control, physical activity, and other factors consonant with adoption of a healthy lifestyle should be consistently emphasized to cancer survivors,” Sung said.

Results from a retrospective analysis of the most recent Surveillance, Epidemiology, and End Results (SEER) data from a cohort of 1.5 million survivors of first primary cancers (FPCs) show that male survivors — excluding those with prostate cancer — had a 45% higher risk of dying from any subsequent primary cancer (SPC) compared with men in the general population without a history of cancer.

Female survivors had a 33% higher risk of any SPC-related mortality, the study authors report in the Journal of the American Medical Association.

A significant proportion of the total incidence and mortality from SPCs was made up of smoking- or obesity-associated SPCs, the analysis shows.

“The risks of smoking-related SPCs were commonly elevated following many types of smoking-related FPCs, suggesting the role of smoking as a shared risk factor,” the researchers say.

Overall, four common smoking-related SPCs — lung, urinary bladder, oral cavity/pharynx, and esophagus — accounted for 26% to 45% of the total SPC incidence and mortality. Lung cancer alone accounted for 33% of the SPC-associated mortality in men and 31% of the mortality in women.

As previously reported by Medscape Medical News, second lung cancers occurring up to a decade after the first are on the rise, supporting long-term surveillance in survivors.

The current study also shows that in both men and women, four common obesity-related cancers — colorectal, pancreatic, uterine and liver — comprised 22% to 26% of the total SPC mortality.

“Survivorship care guidelines recommending health promotion need wider dissemination and implementation in oncology and primary care,” the study authors write about recommendations from the cancer society.

The investigators point out that in spite of evidence that a body mass index beyond the range of normal in survivors of breast and colorectal cancer increased risk of second obesity-associated cancers, many patients say they have never discussed with a doctor how to modify their lifestyle for a healthy body weight.

In 2018, the National Cancer Institute (NCI) reported that 67% of US cancer survivors were overweight or obese, Sung and colleagues note.

In an accompanying editorial, Patricia Ganz, MD, and Jacqueline Casillas, MD, of the David Geffen School of Medicine at UCLA, Los Angeles, California, agreed that the current study findings indicate “research and implementation of evidence-based interventions to promote smoking cessation and energy balance are a priority.”

The editorialists also point to issues of poor communication in clinical practice. “Among patients who survive a primary cancer, concern about recurrence, especially metastatic disease, is extremely common; however, information about future risk for subsequent primary cancers is seldom communicated to these patients, leading to missed opportunities to prevent or detect SPCs at an early stage.”

Close collaboration with primary care physicians during the early follow-up period is “a must,” Ganz told Medscape Medical News.

Oncologists should start the discussion right after initial treatment, when survivors are looking for ways they can prevent cancer recurrence or the development of new cancer, Ganz suggests.

“The ones I worry about the most are the young adults who could really benefit from the prevention outlook that primary care clinicians espouse,” she says, citing a 2016 study.

“If they continue to smoke or gain weight, that increases their risk of SPCs but also of comorbid chronic conditions…so it’s very important for them to get into the hands of a primary care physician. This issue is in the primary care provider court.”

Reorganization of Care and Payment Needed
For the study, Sung and colleagues analyzed data from 12 SEERS registries of FPC survivors diagnosed between 1992 and 2011. All patients had survived 5 years or more after initial diagnosis and had been followed to the end of 2017. Mean follow-up was 7.3 years.

The incidence and mortality of SPCs per 10,000 person-years were expressed as a standardized incidence ratio (SIR) and standardized mortality ratio (SMR) compared with expected risk in the general population.

A total of 30 FPC types were identified, including 12 smoking-related cancers and 12 obesity-related cancers.

In men, the highest risk of developing and dying from any SPC was estimated among survivors of laryngeal cancer (SIR 1.75) and gallbladder cancer (SMR 3.82), and among female survivors of laryngeal cancer (SIR 2.48; SMR 4.56).

Compared with men in the general population without a history of cancer, male survivors had an overall risk of developing any SPC that was significantly higher for 18 of the 30 FPC types. Male survivors also had an overall mortality risk for any SPC that was significantly higher for 27 of 30 FPC types.

This increased risk pattern looked much the same in female survivors when compared with women in the general population without cancer. The overall risk of developing and dying from any SPCs was significantly higher in female survivors for 21 and 28 of 31 FPC types, respectively.

The most common SPCs — after lung cancer — included colorectal cancer (8.8% of male survivors); pancreatic cancer (8.5% of male and 9.4% of female survivors); non-Hodgkin lymphoma (6% of male survivors); and breast cancer (5.8% of female survivors).

The study also shows that the risk for alcohol- and infection-related cancers was significantly higher following a diagnosis of most alcohol- and infection-related cancers.

These findings also have implications for reducing the economic burden of care, Sung and colleagues say.

“With the growing number of long-term survivors, the costs of treating patients with multiple primary cancers will increase, amplifying financial burden for cancer survivors and their families, particularly among elderly persons who may be living on fixed incomes. This consideration also has implications for the Medicare program, the primary payer for the population aged 65 years and older, as well as other health care payers,” the authors write, citing related financial research.

When it comes to improving outcomes for cancer survivors, “SPCs are just the tip of the iceberg,” Ganz warns. We will need some reorganization of healthcare delivery and payment schemes to make it happen, I think.”

She notes that recommendations for long-term survivorship care after cancer treatment were summarized following the 2017 National Cancer Policy Forum Workshop. Since then, “there has not been much movement,” Ganz says.

Current NCI-funded studies of innovative survivorship care planning and implementation are important, but results will not be forthcoming for at least 5 more years, she points out. “We really need more immediate efforts to transform care delivery.”

This study was funded by the American Cancer Society. Sung, study coauthors, and editorialists Ganz and Casillas have disclosed no relevant financial relationships.

JAMA. Published online December 22, 2020. Full text

2020-12-30T11:53:06-07:00December, 2020|Oral Cancer News|

Study reveals low risk of COVID-19 infection among patients undergoing head and neck cancer surgery

Author: news release

A recent international observational study provides important data on the safety of head and neck cancer surgery during the COVID-19 pandemic. The findings are published early online in CANCER, a peer-reviewed journal of the American Cancer Society. The study is part of the COVIDSurg Collaborative, an initiative to describe surgical practices during the early period of the pandemic, when many hospitals had limited capacity and when it was unclear whether it was safer to delay or continue in-hospital cancer treatments.

“The problems were particularly acute in head and neck cancer surgery because for many cases, cure is dependent on surgery, but there was great concern about spreading infection from aerosol-generating procedures in the airway,” said corresponding author Richard J. Shaw, MD, FDS, FRCS, of The University of Liverpool Cancer Research Centre, in the U.K.

Professor Shaw and his colleagues in the COVIDSurg Collaborative examined information on 1,137 patients with head and neck cancer undergoing potentially curative surgery in 26 countries. The most common sites were the oral cavity (38 percent) and the thyroid (21 percent). The death rate within 30 days after surgery was 1.2 percent, a rate that would be normally expected in this patient population, without a pandemic. Also, 29 (3 percent) patients tested positive for COVID-19 within 30 days of surgery; of these 13 (44.8 percent) developed severe respiratory complications and three (10.9 percent) died. According to Professor Shaw, clinicians now know that these risks can be minimized with precautions such as staff testing, infection control measures, and vaccination.

Patients were more likely to test positive for COVID-19 when they lived in communities with high levels of COVID-19, when they had oral tumors, and when they received a tracheostomy (an opening created in the neck to facilitate placing a tube into the windpipe).

“The early consensus was that head and neck surgery was very risky for patients, particularly less fit or elderly patients, or those who required complex procedures or reconstructive surgery,” Professor Shaw said. “Our data are reassuring in this regard, showing that there is no additional risk of COVID-19 for these groups.”

The investigators noted that insights from the study are especially important now, as many regions are experiencing a second wave of COVID-19 spread. “Data from the COVIDSurg Collaborative have clarified the measures required to make cancer surgery safe, and critically, to inform priorities for both patients and healthcare systems,” said Professor Shaw. “For patients with head and neck cancer, the tumors present a much greater threat to life than the risk of developing COVID-19, assuming precautions are taken.”

2020-12-21T21:32:31-07:00December, 2020|Oral Cancer News|

Agusta University Speech Therapy program helps cancer patients with speech and swallowing problems

Author: Jozsef Papp, Augusta Chronicle

After getting surgery in April for cancer of the oral cavity, Lenny Schaeffer was having problems opening his mouth wide enough to eat anything larger than a grape.

He went through the whole process: surgery, chemotherapy and radiation therapy. During that process, he lost his ability to open his mouth, and it even affected his speech.

An oncologist and his radiation therapist informed him of a new program, speech therapy, at the Georgia Cancer Center at Augusta University that could help him.

“What the speech therapy program did is basically give me exercises to do to increase the flexibility that I have in my mouth,” he said. “It allows me to eat better, more kinds of food and also improve speech.”

Dr. Sarah Smith, a speech pathologist at the Georgia Cancer Center, said the program is aimed at helping cancer patients like Schaeffer, patients who have cancer of the neck and mouth area and are suffering from exposure to radiation during their treatment. As a National Cancer Center Network Facility, the center was called to have a multidisciplinary approach to treating cancer, Smith said.

Smith was moved to the cancer center in the summer, mainly to keep cancer patients from walking from the center to the hospital because of COVID-19.

“Treating head and neck cancer is very different than treating other types of disabilities,” she said. “When cancer patients come to the cancer center, we offer a variety of providers, right on site, versus trying to drive all over Augusta and figure out how to get a hold of a dietitian or an occupational therapist that understands cancer or speech therapist that understands cancer.”

Smith said they try to engage patients before surgery or treatment so patients can understand what’s going to happen and have peace of mind knowing help is available. She said radiation in the neck and head area can get rid of the cancer, but a lot of patients don’t realize it can cause speech problems and difficulty swallowing.

“Somebody can survive cancer, but that doesn’t mean they’re going to be in the same condition as before the disease. The treatment options all have negative consequences, so we want to be there to restore quality of life,” Smith said. “The goal is that we would see them before they start treatment to discuss what the treatment is going to do to their speech and their swallowing.”

Smith said the reality is that the speech therapy program needs to be rigorous because treating cancer is rigorous. The program requires a lot of work from the patient’s side to combat radiation and all the changes that come from surgery.

Over the past four months, Schaeffer had three sessions with Smith.. He said he was given exercises that have allowed him to eat better and more kinds of food, and his speech has improved.

“After doing the exercises that were given to me, now I can open my mouth to a normal amount so I can pretty much eat any food that I want to, at this time,” he said. “It just helps me speak better because of the enhanced range of motion.”

Schaeffer said he has been very impressed with the program. He said Smith shows that she cares about her patients and is eager to help any of them achieve the results they want.

He encourages those who might have similar programs to learn about the program and get the help they need, just like he did.

“I would recommend anybody that has a need for speech therapy to contact the program at the Georgia Cancer Center and at least do a consult of what may available to them,” he said.

2020-12-20T20:37:18-07:00December, 2020|Oral Cancer News|

UK Innovators target nanoparticles at inoperable cancers

Author: from Medicines Discovery Catapult

At a point of critical clinical need for improved treatments for pancreatic and head and neck cancers, a partnership of healthcare innovators set out to revolutionise radiotherapy for inoperable, and the most difficult to treat tumours.

With the aim of achieving a higher quality of life for those with unfavourable prognoses, this project, funded by Innovate UK, the UK’s innovation agency, brings together partners with a wealth of experience and specialist know-how in the areas of nanoparticle development, drug delivery and bioimaging.

The pioneering work being conducted will target cancerous cells more selectively, enabling a reduced dose of radiation, which would lower the toxic effects a patient receives as a result.

This targeted approach will employ Xerion Healthcare’s non-toxic radiosensitiser – this heightens the cells’ sensitivity to radiotherapy, increasing the likelihood of successful treatment while reducing the often devastating side effects.

To ensure the nanoparticles carrying the therapeutic agent reaches deep inside the tumour, Active Needle Technology’s unique delivery system conveys the treatment to the cancerous cells with the assistance of ultrasonic vibrations, which not only allow accurate placement, but also enables an optimal distribution throughout the tumour and limits damage of healthy cells in the process.

Medicines Discovery Catapult’s (MDC) advanced pre-clinical imaging suite and state-of-the-art expertise in complex medicines validation will undertake in-life imaging of the nanoparticle distribution, allowing the partners to validate its biodistribution in tumour and across other tissues and organs.

Ian Quirk, CEO of Active Needle Technology said:

“For patients suffering from a range of late stage cancers, treatment options can be limited. The effectivity and accuracy of Active Needles delivery of Xerion Healthcare’s ground-breaking new anti-cancer treatment is poised to revolutionise radiotherapy, and offer the hope of recovery for vast numbers of patients. We’re delighted to be working with Medicines Discovery Catapult to take the technology one step closer to the clinic.”

Dr Gareth Wakefield, Chief Technology Officer from Xerion Healthcare said:

“Effective direct tumoural delivery of anti-cancer agents is a key stepping stone to getting our nanoparticle products into clinical trials and into treatment programs for patients with inoperable tumours. Partnering with Active Needles unique ultrasonic delivery system and MDC’s real time imaging allows us to optimise the delivery system for maximum efficacy.

“Late presenting inoperable tumours require very high dose radiotherapy for successful treatment. This can often have very severe side effects or simply not be possible due to nearby sensitive organs. This project gives us a way to boost the effectiveness of the treatment without increasing the whole body dose.”

Professor Peter Simpson, Chief Scientific Officer at Medicines Discovery Catapult (MDC) said:

“MDC is pleased to be providing our state of the art imaging facilities and complex medicines expertise in this exciting collaboration with Active Needle Technology and Xerion Healthcare – to assess the biodistribution and efficacy of this nanoparticle approach.

“Complex medicines have the potential to address patients’ problems which conventionally administered small molecules and monoclonal antibodies cannot. This project is a very encouraging example of exploring how using an advanced drug delivery technology could improve drug biodistribution, and so improve the targeting and efficacy of potentially toxic therapeutics.”

Although great progress has been made in the treatment of some common cancers, there remain many indications where there has been little improvement in care over decades. Pancreatic cancer is on course to become the second leading cause of cancer mortality by 2030 with head and neck cancer currently seeing a 50% mortality rate. It has never been more timely or pertinent for research in this space to be undertaken.

2020-12-19T08:18:56-07:00December, 2020|Oral Cancer News|

Addenbrooke’s to use Microsoft’s AI tool to speed up cancer treatment

Author: staff

Microsoft said that Addenbrooke’s Hospital in Cambridge, UK, will use its artificial intelligence (AI) technology powered InnerEye tool for speeding up cancer treatment.

Developed at its Cambridge Research Lab, the InnerEye project helps in developing AI models that leverage the hospital’s own data to automatically show tumours and healthy organs on patient scans. These are then checked and confirmed by a clinical oncologist prior to giving treatment to the patient, said Microsoft.

According to the tech major, the process will reduce the otherwise lengthy treatment planning stage, which is crucial for head and neck cancers, which can multiply quickly if left untreated. Microsoft claims that InnerEye can help execute contouring process in complex cases 13 times faster than the current approach.

Addenbrooke’s Hospital oncologist and InnerEye co-lead Dr Raj Jena said: “The results from InnerEye are a game-changer. To be diagnosed with a tumour of any kind is an incredibly traumatic experience for patients.

“So as clinicians we want to start radiotherapy promptly to improve survival rates and reduce anxiety. Using machine learning tools can save time for busy clinicians and help get our patients into treatment as quickly as possible.”

Run by Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s is a teaching hospital, research centre, and also a designated academic health science centre.

Addenbrooke’s Hospital and Microsoft are said to have been collaborating over the last eight years to develop and pilot InnerEye. The hospital will become the first NHS facility to have introduced a deep-learning solution trained on its own data, once the AI tool is deployed.

Microsoft said that to make sure that all hospitals can use the InnerEye Deep Learning Toolkit, the company has made it available freely as opensource software. However, clinical use of machine learning models is subject to approval from relevant regulators.

Microsoft Research Cambridge principal research manager Javier Alvarez-Valle said: “AI models trained with InnerEye are changing the way cancer is treated, speeding up the process to give patients greater peace of mind and empowering clinical oncologists with an AI assistant.

“The AI works in the background, so clinical oncologists just open up the scans on their computer and they can see what their AI model has highlighted. The clinical oncologist then decides what to do with that information.

“AI models trained with InnerEye will be hosted in Microsoft’s Azure cloud, so all the data is securely held in the UK and only available to the medical staff who need to use it.”

2020-12-12T10:01:59-07:00December, 2020|Oral Cancer News|

First patient participates in immunotherapy trial despite COVID-19 pandemic

Author: UC-San Diego, Reviewed by Emily Henderson, B.Sc

Since 2016, Bernard Thurman has undergone traditional treatments, experimental therapies and surgeries to counter the cancer within him, but nothing has successfully eradicated the disease. Earlier this year, the oncologists in Los Angeles who were treating him referred Thurman to a personalized cancer therapy trial being developed at Moores Cancer Center at UC San Diego Health.

“Truly, I am running out of options, as far as treatment goes,” said Thurman, whose cancer developed in his tonsils and has since spread to his lungs.

“The latest immunotherapies, both the FDA-approved and the experimental, were proving ineffective. Obviously, it was time to go in a different direction.”

Thurman met with Ezra Cohen, MD, associate director for translational science at Moores Cancer Center, in mid-March to discuss an investigational cell therapy that uses a patient’s own immune cells — specifically tumor infiltrating lymphocytes (TIL) — to seek and destroy their own unique cancer cells.

Days after this meeting, COVID-19 swept the country, forcing hospitals to rethink which procedures could continue and which would need to be paused. Because the TIL trial requires that patients be hospitalized, it was put on hold. Thurman was disappointed.

“Don’t let the pandemic make you decide to put off cancer treatment,” said Thurman. “You may or may not get COVID, but cancer will kill you if you don’t treat it. So, don’t delay it.”

Knowing the urgency of treatment, Cohen, a head and neck oncologist, suggested an alternative trial.

“We treated Mr. Thurman on an initial clinical trial with a different type of immunotherapy, an antibody, and he did fairly well at the beginning,” said Cohen. “But, again his cancer began to grow and, unfortunately, progressed.”

While the COVID-19 pandemic continues to sicken people worldwide, UC San Diego Health has resumed previously paused medical services. This allowed Cohen, and colleagues Gregory Daniels, MD, PhD, and Aaron Miller, MD, PhD, to reinitiate the Phase I TIL trial.

After seeing that Thurman’s cancer was unabated on the immunotherapy trial, he was enrolled as the first patient and received a personalized TIL therapy on Tuesday.

“Treating our first patient with his own cells generated at UC San Diego marks a milestone following years of preparation leveraging the core strengths of the cancer center — patient care, research and collaboration,” said Daniels, an oncologist specializing in skin and head and neck cancers and protocol principal investigator for the TIL trial.

TIL therapy has been around for decades, with some success in treating melanoma — the most serious form of skin cancer.

Together, UC San Diego and La Jolla Institute for Immunology (LJI) researchers are taking TIL therapy a step further by selecting the T-cells that are most likely to be responsive against an individual’s cancer. They are also expanding the therapy to treat melanoma and head and neck cancers.

“Cell therapy has been proven effective for a number of different patients, but we want to improve upon it,” said Miller, a medical oncologist. “We want to make it more effective, less toxic and more applicable to a broader population of cancer patients.”

Engineering Thurman’s TIL therapy involved a weeks-long, personalized process that began with Thurman undergoing a tumor biopsy at Jacobs Medical Center at UC San Diego Health in October.

Tissues samples were then sent to LJI where a team led by Stephen Schoenberger, PhD, and Bjoern Peters, PhD, developed a novel technology platform to identify mutations recognized by the patient’s own immune system. Early funding support from the Immunotherapy Foundation created the infrastructure to develop the process, which was first used to develop a personalized cancer vaccine trial in 2018.

An algorithm is used to isolate tumor-infiltrating lymphocytes, a type of T-cell, with the strongest response against Thurman’s cancer mutations.

“We are taking the patient’s tumor, sequencing the protein coding portion of the genome, finding out which mutations can be recognized by the patient’s immune system, and then looking for the TIL fragments that contain those T-cells,” said Schoenberger, an adjunct professor of medicine at UC San Diego School of Medicine. “If we can identify which TIL can recognize the mutations that are selectively expressed in the tumor, selectively grow those and reinfuse them to the patient, we will hopefully have a more potent and more effective therapy. That’s our advance.”

Once the T-cells that appeared to be initiating the strongest immune system response to Thurman’s cancer are identified, a team led by Dan Kaufman, MD, PhD, at the Advanced Cell Therapy Laboratory at UC San Diego multiply the specified T-cells by the billions.

The cells are autologous: They are the patient’s own cells, simply lab-grown.

At Jacobs Medical Center, Thurman underwent an infusion of these engineered cells and a high-dose interleukin-2, a biologic therapy used to boost T-cell response in cancer therapy. Ideally, within weeks, the TIL therapy will shrink tumors.

“All of us involved in this research project want one thing, and one thing only, and that is for patients to get better and to offer new effective therapies to patients with cancer,” said Schoenberger.

Thurman wants that too. He is optimistic, but also understands that he is the first patient to receive this experimental, personalized cancer therapy. He thinks others should enroll in clinical trials too.

“Clinical trials are a lifeline. Give it a shot. You may literally have nothing to lose,” said Thurman. “It may be beneficial, personally. It may not. But it will further research for other patients down the road and hopefully help others in the future.”

2020-12-12T09:56:17-07:00December, 2020|Oral Cancer News|

Deep learning models for image-guided RT in head and neck and prostate cancers

Author: Lisa Kuhns

Machine learning models achieve clinically acceptable accuracy in image segmentation tasks in radiotherapy planning and reduce overall contouring time for head and neck and prostate cancers, according to a recent study in JAMA Network Open (2020;3[11]:e2027426. doi:10.1001/jamanetworkopen.2020.27426)

Personalized radiotherapy planning requires large time commitments for oncologists and processes often vary among experts and institutions.

Authors aimed to explore clinically acceptable autocontouring solutions that can be integrated into clinical practice and used in different radiotherapy areas.

Researchers evaluated multicenter imaging data set made up of 519 pelvic and 242 head and neck computer tomography scans from 8 clinical sites. Patients in the study were diagnosed with either prostate or head and neck cancer. The models were trained to automatically delineate organs at risk and evaluated internal and external datasets. Models were compared against expert annotations in an interobserver variability (IOV) study.

For 13 of the 15 structures, the models performed within the bounds of expert IOV. For internal vs external data sets, the models achieved mean [SD] Dice scores for left femur at 98.52% and 98.04% (P = .04), respectively.

“In this study, the models achieved levels of clinical accuracy within expert IOV while reducing manual contouring time and performing consistently well across previously unseen heterogeneous data sets,” concluded the study authors. “With the availability of open-source libraries and reliable performance, this creates significant opportunities for the transformation of radiation treatment planning.”—Lisa Kuhns

2020-12-11T09:20:35-07:00December, 2020|Oral Cancer News|

Personalized vaccines: the new frontier in cancer treatment

Author: Udbhav Venkataraman

Exciting results from a new clinical study showed that a personalized vaccine combined with an immunotherapy drug had a promising response rate in patients with advanced incurable head and neck cancer.

Dr. Julie Bauman, chief of Hematology and Oncology at the University of Arizona College of Medicine — Tucson, led a phase one clinical trial with the pharmaceutical company, Moderna, to test the combined use of personalized vaccines created from tumor DNA with the immunotherapy drug pembrolizumab.

Of the 10 patients involved in the study, five of the them responded to the treatment, meaning 30% of the cancer mass had decreased. Furthermore, two of the patients completely responded, meaning that cancer could not be detected.

Molly Cassidy is one of those two patients. What was initially determined to be a stress-related ear-ache turned out to be an aggressive case of squamous cell carcinoma, a form of head and neck cancer.

Head and neck cancers impact the linings of the mouth and throat. Risk factors for this disease include alcohol consumption, smoking and other environmental carcinogens that we are all exposed to. It can also be caused by human papillomavirus (HPV).

Cassidy did not fit this profile at all.

“I’m HPV-negative. I didn’t drink. I didn’t smoke. I’m a woman. I was the first person in my family to have cancer. I was 35 when I got my diagnosis,” Cassidy said. “I was also in really good health … To hear that I had cancer was really surprising.”

With an initial prognosis that the cancer was curable, Cassidy underwent a standard but invasive surgery followed by a grueling series of radiation and chemotherapy sessions over the next few months.

Just a week after completing Cassidy’s initial treatment plan, the cancer returned aggressively. She had several tumors in her neck and they were spreading to her lungs. Her prognosis became bleaker.

“Having such a quick recurrence was not a good sign … they put me on a palliative plan and I was told I need to get my affairs in order,” Cassidy said. “I wasn’t expected to live for more than a year.”

Cassidy now had advanced incurable head and neck cancer which occurs when an initial cancer treatment fails and the cancer returns. This combined with the fact that she was HPV negative made her eligible for Bauman’s clinical study.

One of the recent frontiers of cancer research has been immunotherapy — harnessing our immune systems to fight cancer. Our immune system is able to detect and attack foreign invaders in our bodies, including cancer cells. However, these cells develop ways to hide from the immune system.

Immunotherapy can involve using medication to activate and train the immune system to recognize and eliminate these cancer cells. When this treatment is effective, the response can be long-lived.

“I can give you chemo and drive you to a complete response, but as soon as chemo is not there, the cells that are left become resistant and grow back,” Bauman said. “Immunotherapy leaves behind an army of T-cells that if the cancer rears its ugly head again, will presumably kill it.”

According to Bauman, the current U.S. Food and Drug Administration-approved therapies are non-specific. These therapies generally activate the T-cells of the immune system which recognize foreign invaders. This method means that T-cells that recognize cancer cells would be activated. This method of therapy however has a low effectiveness rate.

“In head and neck cancer, this class of therapy is successful 10-15%of the time … We want that to be more often,” Bauman added.

Furthermore, there can be auto-immune side effects because T-cells that recognize our own healthy tissues may start attacking those very tissues.

This is where new and fascinating technology comes into the picture: personalized vaccines. This approach is a specific approach, where T-cells are activated based on the mutations of the patient’s cancer.

After taking a sample of cancer cells from the patient, those cells’ DNA is sequenced. Using a computational algorithm, the cancer DNA is compared to the patient’s healthy DNA to find the specific mutations present in that patient’s cancer. From all those mutations, Moderna is able to synthesize a messenger RNA vaccine, which can be used to train the appropriate T-cells to recognize abnormal proteins from these cancer cells.

A helpful video about the process can be found at the UA Health Sciences website. The clinical trial consisted of using both this personalized vaccine approach with the FDA approved T-cell activator pembrolizumab.

“The trial is the combination of using those mutations almost like a trojan horse … educating the immune system to see those mutated proteins at the same time as we give the unbridled T-cell activator,” Bauman said. “We’re awakening T-cells, but we’re saying this is the particular class of T-cells that we are calling.”

For the trial, each patient was given two doses of pembrolizumab over six weeks. During this time, the vaccine was developed by Moderna. After the vaccines were created, the patients received one dose of their vaccine every three weeks for nine weeks along with the pembrolizumab, and the cancer was monitored using a CAT scan.

And the results show that the vaccines are safe. This seems really promising and exciting to pursue.

“Although it is only 10 patients, and we have to not only overpromise … it is a really strong signal to expand the study and to see if we continue to see what we saw with these 10 patients,” Bauman said.

“When I was going into treatment, I was really ill and the treatments themselves were pretty hard on me. Cancer treatment is no walk in the park,” Cassidy said. “But once I got through the treatment’s initial side effects, I started to notice an increase in my energy and I wasn’t in as much pain.”

Having completely responded to her treatment, Cassidy is now able to live a normal life. She has spoken with various dentists and used her platform to help educate people about the prevalence and signs of oral cancers and the importance of understanding what the inside of our mouths are supposed to look like.

“It also brought forth what are the most important things for me — my son and husband and the importance of slowing down and enjoying my time with my family,” Cassidy said.

There are many new things that Bauman is looking into researching further. As they expand the trial to 40 participants for the next phase of trials, she is exploring how to optimize the vaccine.

“If we can selectively educate the immune system … we can have a therapy that is active, could drive a permanent response and not be toxic or harsh on the rest of the body,” Bauman said.

Bauman also mentioned that this optimization might mean potentially experimenting with a different drug than pembrolizumab for treatment, although this is a great start. They have also taken samples of the T-cells from the patients to see which types of mutations the T-cells respond best to.

“People who have advanced in cancer … have extraordinary suffering because cancer is uncontrolled in this area where things are critical to our humanity, like talking and breathing and eating and kissing and smiling. To be able to reverse that suffering and offer that hope is uniquely gratifying,” Bauman said.

2020-12-09T06:51:37-07:00December, 2020|Oral Cancer News|
Go to Top