Treatment paradigms are shifting for locally advanced HPV-positive head and neck cancers

Source: Authors: Kaveh Zakeri, MD, MAS, Nancy Y. Lee, MD The standard of care for patients with locally advanced head and neck squamous cell carcinomas does not substantially differ according to human papillomavirus (HPV) status in the National Comprehensive Cancer Network guidelines.1 Resectable tumors can be treated with surgery followed by adjuvant therapy. Alternatively, definitive chemoradiation therapy with cisplatin is the other dominant treatment paradigm. Incidence of HPV-associated oropharyngeal squamous cell carcinoma has increased rapidly and is associated with higher overall survival (OS) compared with cancers caused by smoking and alcohol.2,3 Given the unique biology of HPV-associated oropharyngeal disease, a separate staging system was developed for these tumors.4 HPV-associated oropharyngeal cancers are more radiosensitive and chemosensitive than cancers caused by smoking and alcohol, yet the traditional treatment paradigms—including high doses of radiation and chemotherapy—were developed prior to the epidemic of HPV-associated disease. De-escalation of therapy has been proposed for HPV-associated oropharyngeal cancer based on data demonstrating high OS and progression-free survival (PFS).5 De-escalation of therapy has been investigated for both definitive surgical and chemoradiation therapy paradigms. Most de-escalated approaches focus on selecting patients according to clinical features, such as disease stage and smoking status, whereas personalized de-escalation reduces treatment intensity for patients according to treatment response. Transoral Robotic Surgery Followed by Adjuvant Radiotherapy Transoral robotic surgery (TORS) is a minimally invasive approach that reduces morbidity compared with traditional, open surgery for patients with oropharyngeal cancers. TORS is a standard of care option for patients with resectable tonsil or base [...]

2021-11-23T08:16:08-07:00November, 2021|Oral Cancer News|

Oral cancer and COVID-19

Source: Author: Seb Evans The Dental Defence Society explain how COVID-19 has impacted the detection of oral cancer and what dental teams should do to improve outcomes. Referrals for oral cancer have fallen dramatically since the start of the pandemic. This is raising fears that many cases have gone undiagnosed because of disruption to routine dental care. Missed opportunities for early detection mean it is likely that thousands of patients will eventually present with late-stage disease and poor prognosis. They will also require aggressive and complex treatments that diminish their quality of life. As well as adding to the burden on the healthcare system. Now more than ever, dental teams must prioritise the prevention, early detection and rapid referral of oral cancer. They will play a vital role in mitigating the ongoing impact of the pandemic on outcomes for this cancer through performing examinations at every opportunity, recognising when a patient presents with signs and symptoms, and raising awareness. Increasing burden of oral cancer in the UK The most recent figures on mouth cancer in the UK align with the global trend. They shows an alarming rise in incidence and mortality. The State of Mouth Cancer UK Report 2020/21 reports that last year 8,722 people were diagnosed with mouth cancer. And an estimated 2,702 people died from the disease. That’s up 58% and 48%, respectively, from a decade ago. Early detection and rapid referral for treatment makes a huge difference for patients with oral cancer. It boosts survival from [...]

2021-11-21T09:53:43-07:00November, 2021|Oral Cancer News|

Detecting suspicious lesions: what do I say next?

Source: Author: Philip Lewis Dental team members are amazing. They put patients at their ease and provide treatment for their dental issues. They improve smiles, boost self-confidence and they save lives. Yes, you read that right. There aren’t many opportunities for dental team members to be lifesavers. Detecting mouth cancer at an early stage is one of them. It’s an initiative for the whole dental team. Both clinical and non-clinical team members have a vital part to play. From a receptionist noticing changes in a patient’s voice, a practice manager spotting a swelling they haven’t seen before to a clinician picking up on a soft-tissue abnormality, we all get the chance to be pivotal in protecting a patient’s wellbeing. Risk factors We know there are risk factors we should be aware of: the use of tobacco in any form, regular use of alcohol, especially spirits, social deprivation with its associated problems of nutrition and vitamin deficiency. It is understood that increasing age is a factor and that men are more likely than women to get the disease. We appreciate the significant effects of infection that certain strains of HPV have had recently but realise how important it is to examine all adults. Many sufferers have no identifiable risk factors. During the clinical examination, we’ll be looking for anything unusual, including: Red, white or mixed patches Ulcers that don’t heal within a maximum of three weeks Swellings Changes to normal appearance or texture and lumps in the face or neck [...]

2021-11-19T07:02:03-07:00November, 2021|Oral Cancer News|

Improving the management of HNSCC: next steps

Source: Author: Victoria Meucci Villaflor, MD, Cesar Perez, MD Dr Cesar Perez reacts to the utilization of next-generation sequencing in head and neck squamous cell carcinoma and highlights future areas of study. Video of interview here. Victoria Meucci Villaflor, MD: With solid tumor oncology moving more toward precision medicine or personalized medicine, where do you think head and neck cancer is going? Cesar Perez, MD: The data that we discussed from the RUN-HN trial have shown us that there’s a role for personalized medicine in head and neck cancer. We’ve seen more value in sequencing for this population that we weren’t finding much before, besides checking for PD-L1 by immunohistochemistry. Next-generation sequencing probably has a new role in this disease. I hope that this is just the tip of the iceberg of what we can accomplish by doing sequencing on our patients with head and neck cancer. Victoria Meucci Villaflor, MD: Dr Perez, are you using next-generation sequencing on all of your patients with head and neck cancer? Cesar Perez, MD: Yes. Until recently, we weren’t finding that much value in doing next-generation sequencing in patients with head and neck squamous cell carcinoma. But based on all the trials in clinical development, I’m now doing next-generation sequencing on every patient in the metastatic and recurrent setting to find those patients with a high TMB [tumor mutational burden], for example, who might not have good PD-L1. But I’m mainly doing it for clinical trial purposes, so we can then try [...]

2021-11-18T08:38:14-07:00November, 2021|Oral Cancer News|

Two markers help predict head and neck cancer prognosis

Source: Author: news release, University of Michigan Health Rogel Cancer Center A new study from the University of Michigan Health Rogel Cancer Center finds circulating tumor DNA, or ctDNA, levels can predict as early as two weeks after starting treatment which patients are likely to have good outcomes. At the same time, specialized MRI and PET scans two weeks after starting chemoradiation also correlated with outcomes. “Rates of throat cancer have steadily increased in recent years, driven by HPV infections, fueling the need for biomarkers to help guide treatment decisions, especially for locally advanced disease,” said senior study author J. Chad Brenner, Ph.D., associate professor of otolaryngology at Michigan Medicine. “Quantitative imaging of metabolism, local blood volume density and cell density from PET and MRI scans have shown both prognostic value in predicting treatment outcome as well as utility in selecting patients for additional focal radiation treatment,” said study author Yue Cao, Ph.D., professor of radiation oncology and radiology at Michigan Medicine. The researchers conducted a randomized trial of patients with stage 3 oropharyngeal squamous cell carcinoma. In total, 93 patients had imaging and 34 also had blood tests before starting chemoradiation and again at two, four and seven weeks after treatment. The study found that HPV ctDNA clearance at two weeks, but not at four weeks, predicted outcomes. The metabolism, local blood density and cell density before radiation therapy or at two weeks after starting treatment predicted outcomes as well. These early predictor biomarkers could help determine which [...]

2021-11-17T07:43:52-07:00November, 2021|Oral Cancer News|

Most men benefit from initial and catch-up cancer prevention vaccination

Source: Author: Don Ward Hackett The Lancet Infectious Disease published the results from an extensive cancer prevention phase 3 study on November 12, 2021, supporting quadrivalent HPV vaccination in men, including catch-up vaccinations. The Gardasil quadrivalent human papillomavirus (HPV) vaccine was shown to prevent infections and lesions related to HPV6, 11, 16, and 18 in men aged 16–26 years. The researchers assessed the incidences of external genital warts related to HPV6 or 11 and external genital lesions and anal dysplasia associated with HPV6, 11, 16, or 18, over ten years of follow-up. The 3-year Base Study was an international, double-blind, randomized, placebo-controlled trial done at 71 sites in 18 countries. The Vaccination Period for the Base Study encompassed Day 1 through Month 7, during which time participants received qHPV vaccination at Day 1, Month 2, and Month 6. Follow-up for the Base Study encompassed Month 7 through Month 36. And the 7-year, open-label, long-term follow-up extension study was done at 46 centers in 16 countries. Between August 2010 and April 2017, 1,803 participants were enrolled in the long-term follow-up study, of whom 936 (827 heterosexual men and 109 MSM) were included in the early vaccination group and 867 (739 heterosexual men and 128 MSM) were included in the catch-up vaccination group. In early vaccine group participants during long-term follow-up compared with the placebo group in the Base Study, the incidence per 10 000 person-years of external genital warts related to HPV6 or 11 was 0·0 (95% CI 0·0–8·7) versus 137·3 [...]

2021-11-16T08:57:09-07:00November, 2021|Oral Cancer News|

FDA grants priority review to first-line Toripalimab regimen in advanced nasopharyngeal carcinoma

Source: Author: Hayley Virgil A priority review was granted to toripalimab by the FDA for 2 indications in patients with advanced nasopharyngeal carcinoma. A biologics license application (BLA) for the combination of toripalimab (Tuoyi) plus gemcitabine and cisplatin for patients with advanced recurrent or metastatic nasopharyngeal carcinoma was accepted by the FDA and granted priority review, according to a press release from developer Junshi Biosciences.1 The BLA also covered the use of toripalimab monotherapy for the treatment of recurrent or metastatic disease following a platinum-containing regimen in the second line and beyond. The application for the anti–PD-1 monoclonal antibody is supported by findings from both the phase 2 POLARIS-02 trial (NCT02915432), which assessed toripalimab in previously treated and recurrent or metastatic nasopharyngeal carcinoma, and the phase 3 JUPITER-02 trial (NCT03581786), examining gemcitabine and cisplatin with or without toripalimab in recurrent of metastatic nasopharyngeal carcinoma.2,3 POLARIS-02 revealed durable clinical responses in those treated with toripalimab and JUPITER-02 identified notable improvements in progression-free survival (PFS). The Prescription Drug User Fee Act action date is currently set for April 2022. “We are excited by the continued progress of toripalimab toward a first marketing authorization outside of China,” Patricia Keegan, chief medical officer at Junshi Biosciences, said in a press release. “With the earlier approval in China, toripalimab became the world’s first immune checkpoint inhibitor for the treatment of nasopharyngeal carcinoma, bringing a novel therapy to a disease that has long lacked new drug development. We will cooperate closely with our partner, Coherus, [...]

2021-11-04T10:38:02-07:00November, 2021|Oral Cancer News|

Lung cancer screening for head and neck survivors?

Source: Author: Mike Bassett, Staff Writer, MedPage Today Head and neck cancer survivors are at an especially high risk for second primary lung cancers, a secondary analysis of the National Lung Screening Trial (NLST) suggested. After adjustment for various factors including pack-years of smoking, lung cancer incidence among NLST participants with a history of head and neck cancer was more than doubled compared to those without such a history, at 2,080 versus 609 cases per 100,000 person-years (adjusted rate ratio [RR] 2.54, 95% CI 1.63-3.95), reported John D. Cramer, MD, of Karmanos Cancer Institute in Detroit, and colleagues. According to the findings in JAMA Otolaryngology-Head & Neck Surgery, a non-significant trend toward improved overall survival was observed among those with a history of head and neck cancer who underwent low-dose CT (LDCT) in the trial rather than chest radiography (HR 0.79, 95% CI 0.42-1.52). As was a trend toward better detection of secondary lung cancer detection in those assigned to LDCT (RR 1.55, 95% CI 0.59-3.63). "The wide CIs, presumably due to the small sample size and number of outcome events, prevent definitive conclusions," noted Cramer and colleagues. Still, they argued, "these results support routine annual low-dose CT chest screening for lung cancer in HNC [head and neck cancer] survivors with prior significant tobacco use who are fit enough to undergo treatment with curative intent." In a commentary accompanying the study, Sean T. Massa, MD, of Louis University Hospital in St. Louis, and colleagues, also noted the small sample [...]

2021-11-01T15:16:43-07:00November, 2021|Oral Cancer News|

NHS blood test trial to detect 50 types of cancer starts in Black Country

Source: Author: staff The world’s largest trial of a revolutionary new blood test which detects 50 types of cancer has started in Walsall, with thousands of residents invited to take part. The potentially lifesaving GalleriTM test can detect more than 50 types of cancer before symptoms appear. The test is being piloted by the NHS in a programme across eight areas of the country, and Walsall is the first location in the West Midlands to take part. Thousands of letters have been sent to selected residents aged 50 to 77, inviting them to participate in the trial and attend the mobile clinic on Sainsbury’s car park on Reedswood Way. The clinic, which opened this week, will be there until December before moving on to more locations in the West Midlands. Appointments are still available and people are being urged to come forward if they have received a letter before the mobile clinic moves on to Redditch. Among those taking part in the trial is 76-year-old Bill Anslow from Willenhall. He said: "I’ve come as my family has been deeply impacted by cancer. My mum died of cancer five years ago and my wife Kathleen was diagnosed with stomach and oesophageal cancer and died earlier this year." "It’s a horrible, horrible disease and it’s terrifying to think about the effects cancer has on people. What my wife went through was terrible and I wouldn’t want that for anyone." "As soon as I received my letter, I got in touch straight [...]

2021-11-01T14:57:51-07:00November, 2021|Oral Cancer News|
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