UB awarded $1.5 million to reprogram white blood cells in fight against oral cancer

Source: Science Magazine
Date: March 25th, 2021

BUFFALO, N.Y. – The University at Buffalo has received a $1.5 million grant from the United States Department of Defense to develop new therapies that help reduce chronic inflammation and immunosuppression in oral cancers.

Through the three-year grant, the research will center on a type of white blood cell called a macrophage that – after migrating to oral tumors – triggers uncontrolled inflammation, which suppresses the body’s immune response and lowers the effectiveness of anticancer therapies.

The researchers aim to reprogram the macrophages by targeting genes that regulate inflammation. By lowering inflammation, oral cancers will become more sensitive to new and traditional chemotherapies.

If successful, the findings could help increase survivorship of oral cancers, which claim the life of roughly half of all oral cancer patients within five years, according to Keith Kirkwood, DDS, PhD, principal investigator, Centennial Endowed Chair and professor of oral biology in the UB School of Dental Medicine.

“A change in behavior in the white blood cells within the tumor itself removes the ‘brakes’ in the system, causing more oral cancer growth,” says Kirkwood, also associate dean for innovation and technology transfer in the UB School of Dental Medicine. “We propose to reprogram the white blood cells to regain control of the brakes.”

Additional investigators from Roswell Park Comprehensive Cancer Center include Wesley Hicks Jr., MD, DDS, chair of the Department of Head and Neck/Plastic and Reconstructive Surgery; William Magner, PhD, scientist in the Department of Immunology; and Scott Abrams, PhD, professor in the Department of Immunology.

The research will focus on oral squamous cell carcinoma, the most common type of oral cancer. Found in the lips, mouth or throat, oral cancers can affect the ability to eat and speak, and may cause permanent disfigurement of the face.

Veterans are two times more likely to develop head and neck cancers than non-veterans, says Kirkwood. The increased risk may be attributed to higher rates of alcohol and tobacco use among veterans, he says. Nearly 75% of oral cancers are caused by either alcohol or tobacco use, according to outside research.

Deactivating cancer cell gene boosts immunotherapy for head and neck cancers

Source: newsroom.ucla.edu
Author: Brianna Aldrich

By targeting an enzyme that plays a key role in head and neck cancer cells, researchers from the UCLA School of Dentistry were able to significantly slow the growth and spread of tumors in mice and enhance the effectiveness of an immunotherapy to which these types of cancers often become resistant.

Their findings, published online in the journal Molecular Cell, could help researchers develop more refined approaches to combating highly invasive head and neck squamous cell cancers, which primarily affect the mouth, nose and throat.

Immunotherapy, which is used as a clinical treatment for various cancers, harnesses the body’s natural defenses to combat disease. Yet some cancers, including head and neck squamous cell carcinomas, don’t respond as well to the therapy as others do. The prognosis for these head and neck cancers is poor, with a high five-year mortality rate, and there is an urgent need for effective treatments.

The UCLA research team, led by distinguished professor Dr. Cun-Yu Wang, chair of oral biology at the dentistry school, demonstrated that by targeting a vulnerability in the cellular process of tumor duplication and immunity, they could affect tumor cells’ response to immunotherapy.

The enzyme they focused on, KDM4A, is what is known as an epigenetic factor — a molecule that regulates gene expression, silencing some genes in cells and activating others. In squamous cell head and neck cancers, overexpression of KDM4A promotes gene expression associated with cancer cell replication and spread.

It is well known that tumor cells can spread undetected by the immune system and, without surveillance, can metastasize to lymph nodes or other parts of the body. In this instance, tumor cells that develop in the epithelial layer that lines the structures of the head and neck can turn into head and neck squamous cell carcinoma when unchecked.

Cancer cell replication occurs through the abnormal spread and activation of signaling pathways for cancer cells, and the researchers asked the question: If we can disrupt these processes and identify a vulnerability, can we change the body’s response to fighting cancer cells and its response to outside immunotherapy?

“We know that the KDM4A gene plays a critical role in cancer cell replication and spread, so we focused our study on removing this gene to see if we would get an opposite response,” said Wang, the study’s corresponding author and a member of the UCLA Jonsson Comprehensive Cancer Center.

By removing the KDM4A gene in their mouse models, the researchers witnessed a notable decrease in squamous cell carcinomas and far less metastasis of cancer to the lymph nodes — a precursor to the spread of the disease throughout the body. Surprisingly, they also discovered that the KDM4A’s removal also led to the recruitment and activation of the body’s infection-fighting T cells, which killed cancer cells and stimulated inherent tumor immunity.

They then sought to uncover why the squamous carcinoma cells had such a poor response to immunotherapy treatment. In another set of mouse models, they again removed KDM4A and introduced a PD-1 blockade, which signals immunotherapy drugs to attack cancer cells. The combination of immunotherapy and KDM4A removal further decreased squamous cell cancer growth and lymph node metastasis.

Next, the researchers tested whether a small-molecule inhibitor of KDM4A could improve the efficacy of the original PD-1 blockade–based immunotherapy. They found that the inhibitor also significantly helped remove cancer stem cells, which are associated with cancer relapse.

The findings hold promise for the development of more specific inhibitors for KDM4A and more effective cancer immunotherapies.

“I am continuously impressed by Dr. Cun-Yu Wang and his team for breaking through barriers in our understanding of cancer-causing cellular processes,” said Dr. Paul Krebsbach, dean and professor at the UCLA School of Dentistry. “The results of this study have major implications for the development of more effective, life-saving cancer therapies.”

The work was supported by grants from the National Institute of Dental and Craniofacial Research, which is part of the National Institutes of Health.

Dr. Wang is the Dr. No-Hee Park Professor of Dentistry at UCLA, a professor at the UCLA Samueli School of Engineering and a member of Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA.

Additional authors include Wuchang Zhang, Wei Liu, Lingfei Jia, Demeng Chen and Dr. Insoon Chang, all of the Laboratory of Molecular Signaling at the UCLA School of Dentistry and members of the Jonsson Comprehensive Cancer Center, and Dr. Michael Lake and Laurent Bentolila, both of the California NanoSystems Institute at UCLA.

Deal-making in head and neck cancer to start yielding dividends for patients

Source: www.thepharmaletter.com
Author: staff

A frenzy of deal-making activity in head and neck cancer is bringing late-stage clinical candidates into view, according to GlobalData.

Intelligence from the data and analytics provider shows that there have been some 340 licensing agreements since 2004 in head and neck cancer, amounting to an approximate total value of $35 billion.

Aarohi Rede, oncology analyst at GlobalData, said: “The past few years have seen several licensing deals globally for clinical development in head and neck cancer. Merck KGaA’s collaboration with Debiopharm has the potential to transform the current treatment paradigm for head and neck squamous cell carcinoma (HNSCC) by combining xevinapant, a new molecular entity, with Merck KGaA’s strong commercialization capabilities.”

Of the total licensing agreements signed, the highest recorded licensing agreements took place in North America, followed by Asia-Pacific, while the lowest recorded number of deals belonged to South and Central America.

Dr Rede added: “Head and neck cancer is largely a chemotherapy-dominated market, but the past few years have seen effective use of Keytruda (pembrolizumab) and Bristol Myers Squibb’s Opdivo (nivolumab) in the recurrent or metastatic settings. The current clinical development pipeline has around 20 late-stage agents in the immuno-modulating therapy or cell inhibitor classes, thus revealing a robust late-stage pipeline that is highly conducive to future partnerships for licensing and commercialization, and is expected to contribute to significant market growth over the next ten years.”

Many of these licensing deals involve strategic partnerships between Asia-Pacific, namely Chinese manufacturers, and US pharmaceuticals for joint clinical and commercial development of oncology assets, with the purpose of gaining market access in the USA.

“While the currently marketed agents are patent protected, the introduction of drugs through these alliances poses competition for some of the premium-priced therapies, both from a market share and price perspective,” Dr Rede said.

“While licensing agreements have been one of the key business development tactics in oncology, venture financing ($8.6 billion valuation), asset transactions ($4 billion valuation), and contract service agreements ($30 million valuation) are some of the other investment approaches considered in recent years to advance drug development science in the head and neck space by way of investment capitalism.”

On treating advanced head and neck cancer without cisplatin – an oncology grand rounds discussion

Source: www.medpagetoday.com
Author: Mark L. Fuerst

An oncology grand rounds discussion with Sachin Jhawar, MD.

Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous set of diseases with different features and treatment recommendations. Physicians face challenges in initial treatment decision-making and response assessments, including the changing role of surgery, the incorporation of human papilloma and Epstein Barr virus status, as well as the potential for treatment de-escalation using patient-related and tumor-related factors.

A recent “Oncology Grand Rounds” article in the Journal of Clinical Oncology provides an overview of treating advanced HNSCC when cisplatin is not an option, including concurrent chemotherapy, cetuximab, targeted therapy, and immunotherapy.

In the following interview, the paper’s lead author, Sachin Jhawar, MD, of Ohio State University Comprehensive Cancer Center in Columbus, reviews the main issues.

What is the focus of the article?
We focused on patients with locally advanced disease who would be receiving definitive non-surgical treatment when possible treatment with concurrent cisplatin, delivered either every 3 weeks or weekly, is always the preferred treatment.

We specifically wanted to delve into the subset of patients who we would not recommend to receive cisplatin because of age or comorbidities. This could be concurrent chemotherapy (carboplatin/paclitaxel), concurrent cetuximab, and altered or standard fractionation radiation schedules without systemic therapy, as well as when to consider immunotherapy and palliative radiation for those with recurrent or metastatic disease.

There is also a great deal of institutional preference involved. At our institution, we prefer concurrent carboplatin/paclitaxel in patients who cannot receive cisplatin. Generally, we reserve definitive radiation alone options for patients who are completely ineligible for any systemic therapy.

If definitive therapy would be considered too difficult, or for those who have metastatic disease, still other palliative regimens are available.

When should clinicians consider nivolumab or pembrolizumab?
At this time, immuno-oncology agents such as nivolumab or pembrolizumab are approved and used regularly only in the recurrent or metastatic setting. Even in the recurrent setting, they are generally considered only if surgery or re-irradiation therapy is not an option.

These novel agents should only be considered earlier in a patient’s treatment course in place of more traditional systemic options via a clinical trial.

What are the potential benefits of the combined use of immunotherapy, chemotherapy, and vaccines?
The potential benefits of combination strategies using checkpoint inhibitors and other immuno-oncology treatments, including vaccines, in combination with more traditional therapies including surgery, radiation, and chemotherapy are still being worked out. It is likely that we will first see applications of these newer therapies in the recurrent and metastatic setting, but they may be incorporated earlier into patient care as more data about safety and efficacy emerges.

We have seen regular use of immuno-oncology treatments in other disease sites, and these therapies are being introduced earlier in the treatment course for patients. I would expect a similar pattern to emerge for HNSCC, although we will need to wait for phase III randomized controlled trial data for these immunotherapies to be ready for prime time.

It should be noted, however, that given the heterogeneity of HNSCC, there are certain scenarios in which we are working towards de-escalation of therapy, and addition of more therapies may not be needed.

In the patients with HPV-positive oropharyngeal squamous cell carcinoma and less than 10 pack-year smoking histories, the cure rates are more than 90% with current standard-of-care treatment. We are now working towards de-escalating therapy. It is not clear what role, if any, immuno-oncology will play in these already favorable situations.

What about the potential synergy of molecular targeted agents with radiation?
There are multiple potential targets that could lead to synergy with radiation. Cetuximab actually acts on one of these targets, the epidermal growth factor receptor. Other potential targets that are being studied for combinations with radiation include cell signaling pathways (mTOR, AKT), cancer metabolism, tumor hypoxia, and DNA repair pathways (PARP, ATR).

There are other studies that have been completed or are ongoing that use agents to improve radioprotection of normal tissues. To date, none of these targeted agents are being regularly used on their own or in combination in the care of patients outside of clinical trials.

What improvements with new targeted therapies and immunotherapies do you foresee?
As our understanding of the molecular mechanisms of carcinogenesis, aberrant cancer signaling pathways, and the tumor microenvironment improves, I expect that the number of targets and, therefore, the number of molecular targeted agents will grow. This will lead to a large increase in the number of clinical trials and expansion of our armamentarium against HNSCC.

Similarly, as our understanding of the interplay between cancer and the immune system and mechanism of immune escape improves, I suspect we will be able to improve response rates from immuno-oncology drugs. Currently, only 10% to 20% of patients respond to immuno-oncology treatments, leaving a great deal of room for improvement.

Taken together, this will allow for more individualized, patient-specific care and afford the ability to test novel combinations to improve cure rates. Simultaneously, this will decrease toxicity by choosing the right treatment for the right patient, rather than having a one-size-fits-all approach to therapy.

What’s the take-home message for practicing oncologists?
There is a great deal of change forthcoming in the treatment of HNSCC, but at this time standard-of-care therapy still consists of some combination of traditional cancer therapies, including radiation, surgery, and chemotherapy.

Read the study here and expert commentary about the clinical implications here.

A new type of recyclable: Finding new uses for established drugs

Source: www.eurekalert.org
Author: news release

Researchers from Tokyo Medical and Dental University (TMDU) uncover potential novel therapeutic strategies for oral and esophageal carcinomas

Discovering and treating tumors before they spread throughout the body is key for cancer patients to achieve positive outcomes. When tumor cells spread, which is known as metastasis, they can take over other organs and lead to death. Oral and esophageal carcinomas, or mouth and throat cancers, frequently metastasize to the lymph nodes. Unfortunately, there are currently no therapies that are specific to treating these particular cancers. Now, researchers at Tokyo Medical and Dental University (TMDU) identified several drugs that can possibly be used to treat oral and esophageal carcinomas.

In an article published in Molecular Cancer Research, a group of researchers from TMDU found that combining two drugs, pitavastatin and capmatinib, inhibited the viability of oral cancer cells in culture, as well as the growth of tumors in a mouse model.

Although esophageal carcinoma is the sixth most deadly cancer worldwide and is relatively well understood at the molecular level, the research has not been translated into specific therapeutic development. Because of this urgent need, the TMDU group became interested in drug repurposing, where a drug that has been approved for a certain disease can be used to effectively treat an additional indication. This concept significantly speeds up the drug discovery and development process, increasing the number of patients that can benefit from an established therapeutic.

“Drug repurposing can be extremely helpful for discovering efficacious treatments for diseases lacking approved therapies,” says lead author of the study Tomoki Muramatsu “We began this process for oral and esophageal carcinomas by screening an FDA-approved drug library.”

The researchers performed the drug screening on a highly metastatic oral cancer cell line. Overall, the drug pitavastatin reduced the growth of these cells most significantly. Through molecular analysis, they determined that pitavastatin acted by inhibiting a cellular pathway called MET signaling. Because of this, the researchers added in a second MET inhibitor drug, known as capmatinib.

“Combining pitavastatin with capmatinib resulted in an even greater reduction in cancer cell growth,” describes senior author Johji Inazawa. “Capmatinib by itself had no effect on the cancer cells, but it synergized with pitavastatin.”

The researchers then injected these cells into mice to generate tumors and observed a similar effect with the pitavastatin and capmatinib combination.

“Our results in the mouse model corroborated our in vitro findings,” says Muramatsu. “The data suggest that MET signaling may be a valuable therapeutic target in these tumors.”

The study also identified a potential biomarker for these particular cancers – a gene called GGPS1. Expression levels of this gene may correlate with patient responsiveness to pitavastatin. This work provides knowledge that may be vital for identifying therapeutics for these devastating diseases.

The article, “Suppression of MET signaling mediated by pitavastatin and capmatinib inhibits oral and esophageal cancer cell growth,” was published in Molecular Cancer Research at DOI: 10.1158/1541-7786.MCR-20-0688.

First UK clinical trial in proton beam therapy

Source: www.icr.ac.uk
Author: staff

Image: The Proton Beam Scanner. Credit: The Royal Christie NHS Foundation Trust

The first proton beam therapy clinical trial in the UK, co-led by The Institute of Cancer Research, London, is now taking place at The Christie NHS Foundation Trust in Manchester. The trial will determine whether the use of proton beam therapy reduces long-term side effects and improves quality of life for patients treated with radiotherapy for throat cancer.

The study, funded by Cancer Research UK with support from The Taylor Family Foundation started last year and, despite the Covid-19 pandemic, is recruiting ahead of target, with 37 patients so far taking part. In total 183 people will take part in the study, about two thirds will receive proton beam therapy, and a third will receive standard radiotherapy.

State of the art proton beam therapy
Currently all patients allocated proton treatment within the trial, which is called TORPEdO, receive this at the state of the art NHS proton beam therapy centre at The Christie in Manchester, which opened in 2018. Another centre is currently being built at University College London Hospitals.

A combination of chemotherapy and radiotherapy is usually effective in curing head and neck cancers, but radiotherapy can damage the healthy surrounding tissue. This can result in severe long-term side effects including dry mouth, loss of taste, difficulty chewing and swallowing and problems with hearing. Some patients might need to use a feeding tube for the rest of their lives.

Precisely target tumours
Proton beam therapy uses charged particles instead of X-rays and can target tumours more precisely, causing less damage to surrounding tissues.

A year after treatment, patients will be asked about their quality of life and doctors will assess the impact of any side-effects, and whether they still need to use a feeding tube a year after treatment, or have lost a significant amount of weight.

First proton beam therapy trial in the UK
Dr David Thomson, consultant clinical oncologist at The Christie and chief investigator on the trial, said:

“It’s very exciting and a privilege to conduct the first proton beam therapy trial in the UK here in Manchester. In what is a true team effort, the amount of support from colleagues across the country has been fantastic. There’s a real need to develop treatments which cause less side effects and improve long-term quality of life for patients with head and neck cancer. Proton beam therapy may do this, by reducing the damage to healthy surrounding tissues, so it was an obvious patient group to research first.

“Currently the proton beam therapy unit at The Christie is mainly used for children and young adults. We would like to make the facility available for other groups of adult patients who may benefit most from it too. The first step is to determine whether proton beam therapy improves side effects and quality of life for patients with throat cancer.”

Potentially transformative for patients
Professor Emma Hall, Deputy Director of the Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, who co-leads the study, said:

“Radiotherapy is a highly effective treatment involved in around 40 per cent of cancer cures, but it can cause side effects where radiation affects nearby tissues, and this can be a particular problem for patients with throat cancers. Proton beam therapy has the potential to target tumours more precisely, with less spillover of radiation into the neighbouring healthy tissue.

“We think that for patients with throat cancer, proton beam therapy could be transformative – minimising side effects, improving recovery and sparing some people the long-term impacts of treatment, such as the need to use a feeding tube. This trial is an important first step in understanding if proton beam therapy can deliver on its promise, and if so who stands to benefit most.”

The researchers will also study which patients benefit most from proton beam therapy to help them determine who to offer the treatment to in the future in terms of who is most likely to see long-term improvements.

Around 11,700 people are diagnosed with head and neck cancer every year in the UK, and more than 8 in 10 patients suffering from throat cancer – such as tonsil and base of tongue cancer – receive radiotherapy as part of their treatment.

‘An incredible achievement’
Michelle Mitchell, chief executive of Cancer Research UK, said:

“It’s fantastic to hear that despite the challenges that this pandemic has thrown at us, patients with head and neck cancer have been able to access cutting-edge treatments like proton beam therapy. Many patients used to have to travel abroad to receive this type of treatment, so to be pioneering its use for adults in the UK is an incredible achievement.

“Cancer Research UK has a solid history of delivering practice-changing radiotherapy trials, which included making IMRT the gold standard for treating head and neck cancers. But there is always room for improvement, and we hope that proton beam therapy will be the next step in transforming the lives of people with neck and head cancer.”

Neville Shepherd from The Taylor Family Foundation said:

“We are delighted to see the trial proceed against the headwinds of Covid-19. It’s wonderful to know a cohort of 24 patients are already receiving proton beam therapy treatment for their throat cancer. We thank all involved for dealing with the challenges of set up and delivery of the trial in these extraordinary times.”

Which COVID-19 vaccine is best for cancer patients?

Source: www.mdanderson.org/
Author: Cynthia DeMarco

With three COVID-19 vaccines now authorized for emergency use by the Food and Drug Administration (FDA), you might be wondering which vaccine is best for current and former cancer patients. After reviewing all available data, MD Anderson medical experts agree that all three vaccines are safe and recommended for cancer patients.

So, should you take Johnson & Johnson’s Janssen COVID-19 vaccine (J&J), which requires only one dose, if that’s what’s available? Or should you wait for one of the Pfizer or Moderna vaccines, which both require two doses, spaced 21 and 28 days apart, respectively?

According to our experts, the answer is clear: “Don’t pass up an opportunity to get the vaccine, no matter which one it is,” says Anita Ying, M.D., vice president of Ambulatory Medical Operations. “The best COVID-19 vaccine to get is the first one available to you.”

Timing matters for cancer patients getting a COVID-19 vaccine
Ying’s advice is particularly true for cancer patients, since some may be immunocompromised, making them both more vulnerable to severe infections and more likely to need hospitalization should they contract COVID-19.

“The sooner you can start building resistance to the novel coronavirus, the sooner you’ll have at least some protection against it,” notes infectious diseases specialist David Tweardy, M.D. “And that benefits everyone.”

For patients in active treatment, a COVID-19 vaccine will likely be more effective when coordinated with their treatment schedules. Those who have recently had surgery should wait two weeks before receiving one. And those enrolled in clinical trials, or who are receiving chemotherapy, CAR T cell therapy, immunotherapy or stem cell transplants should consult their care teams for additional guidance on timing.

Other timing considerations apply for those who’ve received a different vaccine recently, who’ve received monoclonal antibody therapy or convalescent plasma to treat a COVID-19 infection.

Everyone else can receive a COVID-19 vaccine as soon as one becomes available to them.

Benefits of all three vaccines outweigh risks of COVID-19
No matter which COVID-19 vaccine you get, you can rest assured that it is both safe and effective in protecting against severe infections. Vaccines must be at least 50% effective at preventing symptomatic infection in order to be authorized by the Food and Drug Administration.

“The Pfizer and Moderna vaccines are 95% and 94% effective, respectively, at preventing symptomatic infection,” says Tweardy. “The Johnson & Johnson vaccine is 67% effective overall.”

At first glance, that may make the J&J vaccine look slightly less desirable. But both the J&J and the Pfizer vaccines were 100% effective at preventing hospitalizations and death due to COVID-19, and the Moderna vaccine was 89% effective. The J&J vaccine also had the second-highest rates of efficacy at preventing severe infections: 77% after 14 days and 85% after 28 days.

“The overall numbers are different,” notes Tweardy. “There’s no getting around that. But when you consider the fact that different strains of the virus were circulating at the time the Johnson & Johnson one was being tested, it’s really not a fair comparison. What we’re looking for is a vaccine that prevents death and allows patients to survive the infection, and that’s exactly what the Johnson & Johnson one does, just as effectively as the other two.”

One dose or two: choosing the COVID-19 vaccine that’s right for you
Though their methods of accomplishing it differ slightly, all of the current COVID-19 vaccines work by inducing people’s bodies to produce a spike protein dotting the novel coronavirus’ surface. Recipients’ immune systems then recognize the protein as an invader and start generating antibodies against it.

This immune response is what makes vaccine recipients much less likely to develop a COVID-19 infection, should they ever be exposed to it. And that’s why it’s best to be vaccinated as quickly as possible.

Still, there may be some situations in which it makes more sense to opt for the Johnson & Johnson vaccine. For one thing, the J&J vaccine requires only one dose to be effective, while the Pfizer and the Moderna vaccines require two, spaced several weeks apart. That means you could achieve the maximum protection afforded by the J&J vaccine in a much shorter time period.

“The goal is to start building up resistance as quickly as possible,” says Tweardy. “So, the sooner you can launch that process, the better. But if you’re really afraid of needles or unable to commit to receiving a second dose at the recommended time, Johnson & Johnson might be a better option for you, if it’s available.”

When a vaccine opportunity knocks, don’t hesitate
One of the most important things to keep in mind is that supplies of the COVID-19 vaccine are still limited across the country. So, if an opportunity arises to get a COVID-19 vaccine, think very hard before letting it pass you by — especially if the only reason you’d be doing so because it’s not the vaccine you’d prefer most.

“It might be several weeks or months before you get another opportunity,” adds Ying. “And it may or may not be the one you want. So, in my opinion, it’s not worth missing the chance to be vaccinated.”

Stress over medical finances tied to worse outcomes for some cancer patients, study finds

Source: www.beckershospitalreview.com
Author: Erica Carbajal

Head and neck cancer patients who reported high levels of financial worry, or financial toxicity, at the start of treatment were about twice as likely to have worse outcomes, according to research findings published in the April 2021 edition of Oral Oncology.

Researchers from Buffalo, N.Y.-based Roswell Park Comprehensive Cancer Center surveyed 284 patients with head and neck cancers to assess their quality of life before and after treatment. The responses were then evaluated in comparison with patients’ clinical outcomes.

“The association we found was very strong, very concerning,” said Anurag Singh, MD, senior study author. “If you are worried about your finances, your risk of dying is roughly double.”

Researchers performed both multivariable and matched-pair analyses. Results showed those who reported the highest levels of financial toxicity at the start of treatment had worse outcomes in terms of both overall survival and cancer-specific survival.

A matched-pair analysis of 66 patients found those with financial toxicity had worse overall survival outcomes, with a hazard ratio of 2.72 and worse cancer-specific survival, with a hazard ratio of 3.75.

“We want everyone to be aware of these impacts,” Dr. Singh said. “Doctors should consider how financial toxicity may be impacting their patients, and do everything we can to improve our patients’ quality of life, and we want to encourage patients to take advantage of financial counseling and every other resource that can lessen their burden.”

Researchers chose to focus on those with head and neck cancers for this study due to the intense treatment demands, leaving patients of these cancers more likely to experience high levels of financial burden.

One in three patients with rare cancer are initially misdiagnosed – survey

Source: www.dutchnews.nl
Author: staff

One-third of people who contract rare types of cancer are initially given the wrong diagnosis, according to new research. In 10% of cases patients had to wait longer than a year to be referred to a hospital by their local doctor, while 8% were not diagnosed until six months after first seeing a specialist.

‘We understand that general practitioners don’t immediately think of cancer in every case, but where there are persistent symptoms rare cancers should be considered,’ said Ajra Broenland, director of the Dutch Federation of Cancer Patient Organisations (NFK).

The survey of 2,027 patients was carried out for the NFK by research institute Integraal Kankercentrum Nederland.

Around 20,000 people are diagnosed with rare cancers such as vulva, bile duct, and head and neck cancer. The survival rate is around 15% lower than for more common varieties.

Half of the patients who took part in the survey were referred to a hospital within two weeks of visiting their doctor, but in 25% of cases the process took longer than three months and 8% waited for over a year.

One in three people had to wait more than four weeks from their first appointment with a specialist to receive a diagnosis. ‘It is important to detect cancer at the earliest possible stage,’ said Broenland.

Big Tobacco asks regulator to convince people nicotine isn’t that bad

Source: www.smh.com.au
Author: Tiffany Kary

Marlboro cigarettes maker Altria Group wants to enlist an unlikely partner in convincing consumers that nicotine isn’t as bad as they think – its regulator.

The company asked the US Food and Drug Administration to tackle misperceptions about nicotine as part of a proposed $US100 million ($130 million) advertising campaign to reduce the harm caused by tobacco, according to a letter seen by Bloomberg News.

That could be difficult with about three-fourths of US adults incorrectly believing nicotine causes cancer, Altria said in the communication, citing government research. Clearing up the drug’s health risks will be key to the agency reducing smoking because it will help convince cigarette users to switch to non-combustible options for nicotine, the company said.

While there are at least 60 well-established carcinogens in cigarette smoke, it’s been known for years that nicotine isn’t the direct cause of many of smoking’s ills. The drug has even been touted as a way to ease tension and sharpen the mind. But nicotine is the ingredient that addicts people to tobacco products, and it has risks, including possibly making people more susceptible to abusing opioids, according to The National Institute on Drug Abuse, a US government agency.

The FDA “should commit resources and expertise to correct the deeply entrenched public misperceptions regarding the health risks of nicotine,” Paige Magness, Altria’s senior vice president of regulatory affairs, said in the letter dated February 25.

Such a campaign would help the agency by getting more smokers to use non-combustible offerings that “may present lower health risk,” according to the letter.

The FDA declined to comment.

‘Moving beyond smoking’
The stakes are high for Altria. The company still generates 86 per cent of its $US20.8 billion in annual revenue from cigarettes and cigars. With that heavily regulated market slowing, the company’s mantra has become what it calls “moving beyond smoking.” But that transition, which the rest of the tobacco industry has also embraced, could be derailed if there isn’t a regulatory blessing to promote these new product categories.

Altria is asking for help in an environment where marketing any product with tobacco or nicotine has been stymied by regulators. The FDA weighs in on what the company can say about the risk of its products only after scientific evidence is submitted.

The FDA does have the budget and marketing chops to reach the masses through its public education campaigns.

But the agency uses much of those resources on targeting the health risks of products made by the likes of Altria. Its recent “Real Cost” ads say oral tobacco can cause mouth cancer, tooth loss, brown teeth and jaw pain, while “most vapes contain seriously addictive levels of nicotine.”

Watch on YouTube

Altria has said that nicotine products without smoke are potentially less risky. It’s been asking the FDA to regulate with that in mind for more than a decade, according to the letter.

In the US, Altria sells IQOS, a smoke-free product that heats tobacco instead of burning it. The FDA has authorised it to be marketed as having less exposure to harmful chemicals than cigarette smoke, which is short of a full claim that it’s less harmful.

Altria also has a stake in Juul Labs, which makes vape devices that let users inhale nicotine. Anti-tobacco groups and public health agencies, including the FDA, have remained wary of these products, saying that while they don’t have the known carcinogens of cigarette smoke, they may present other health risks that aren’t as well known. More recently, the company began selling an oral pouch that is free from smoke and tobacco with five levels of nicotine strength.

“Nicotine isn’t benign,” said Eric Lindblom, a former senior adviser to the FDA’s Centrr for Tobacco Products, and now a senior scholar at the O’Neill Institute, a health research group at Washington DC’s Georgetown University. Studies show that it can interfere with brain development and birth outcomes, he said. “It’s an agricultural poison in large doses.”

However, pushing the FDA to help change nicotine’s reputation could benefit Altria’s fledgling reduced-risk offerings, according to Lindblom. The agency has suggested that it might lower the level of nicotine that can legally be used in combustible products, which could further taint the drug in the public’s mind.

“They’re a smart company,” Lindblom said. “They want a product line that can survive no matter what the FDA does.”

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