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Predictors of survival in mucosal melanoma of the head and neck.

Source:MedScape.com Jethanamest D; Vila PM; Sikora AG; Morris LG Department of Otolaryngology-Head and Neck Surgery, New York University School of Medicine, New York, NY, USA. BACKGROUND: The head and neck is the most common site of mucosal melanoma, a cancer with poor prognosis. In contrast to cutaneous melanoma, mucosal melanoma of the head and neck (MMHN) is uncommon, with limited data regarding outcomes and prognostic factors drawn from small, single-institution case series. In order to identify factors predictive of survival, we analyzed MMHN outcomes in a large US cohort. METHODS: MMHN cases (n = 815) diagnosed in the USA between 1973 and 2007 were analyzed in the Surveillance, Epidemiology, and End Results registry, and cause of death was individually determined in 778 (95.5%) cases. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to analyze prognostic variables. RESULTS: Disease-specific survival status was determined in 778 (95.5%) cases. The 5- and 10-year rates of overall survival (OS) were 25.2 and 12.2%; disease-specific survival (DSS), 32.4 and 19.3%. On multivariable analysis, anatomic primary site was an independent predictor of OS and DSS, with tumors in the nasal cavity and oral cavity associated with survival superior to tumors in the nasopharynx and paranasal sinuses. Age > 70 years, tumor size, nodal status, and distant metastasis status were additional independent predictors of poorer survival. CONCLUSIONS: In this large cohort of patients with MMHN, we have identified several novel factors robustly predictive of overall and melanoma-specific survival. This news story was resourced by the Oral Cancer Foundation, and [...]

2011-11-14T18:04:18-07:00November, 2011|Oral Cancer News|
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Implications of the Oropharyngeal Cancer Epidemic

Source: Journal of Clinical Oncology Chaturvedi et al,1 analyzing specimens back to 1984, validate the long-held hypothesis that infection with human papillomavirus (HPV) has increased oropharyngeal squamous cell carcinoma (OPSCC) incidence in the US. They find the incidence of OPSCC in men—who have higher risks of both HPV-positive and HPV-negative OPSCC than women—similar to that of cervical cancer in women. From 1988 to 2004, incidence of HPV-negative OPSCC decreased in parallel with smoking whereas incidence of HPV-positive OPSCC increased at about 7.5% per year, so the percentage of OPSCC that was HPV-positive went from less than 20% to more than 70%. HPV-positive and HPV-negative OPSCC are etiologically and clinically distinct,2,3 with HPV-positive disease having better outcome.4–6 In the current study,1 the hazard ratio of 0.3 for HPV-positive/HPV-negative in survival analysis essentially balances the difference in prevalence so each form of OPSCC now accounts for a similar number of deaths. Notably, the authors found that outcomes for HPV-positive OPSCC have improved over time, whereas outcomes for HPV-negative OPSCC are as dismal as they were 25 years ago. The authors argue convincingly that vaccination to prevent oral HPV infections should be evaluated and that better treatments for both types of OPSCC should be developed. We are unlikely to get a better picture of the recent history of OPSCC in the United States. This study used all available OPSCC specimens from the three Surveillance, Epidemiology, and End Results (SEER) registries that participate in the Residual Tissue Repositories Program, analyzed them in several ways, [...]

2011-11-09T15:24:59-07:00November, 2011|Oral Cancer News|
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FDA Approves Cetuximab for Late-Stage Head and Neck Cancer

Source: The Oncology Report The Food and Drug Administration on Nov. 7 approved cetuximab as an initial treatment of late-stage head and neck cancer in combination with chemotherapy. Cetuximab, marketed as Erbitux by Bristol-Myers Squibb, is an epidermal growth factor receptor (EGFR) antagonist, administered as an intravenous infusion. Previously, it was approved in combination with radiation therapy for the initial treatment of locally or regionally advanced squamous cell carcinoma. It was also approved for use alone in patients with recurrent locoregional disease or metastatic disease whose disease has progressed following platinum-based chemotherapy. The newly approved indication is for the treatment of these recurrent or metastatic patients as an initial therapy in combination with platinum-based therapy with 5-fluorouracil (5-FU), a BMS spokesperson said. (At press time, the company had not yet issued a statement on the approval.) Erbitux was initially approved in 2004 to treat EGFR-positive late-stage colon cancer after patients stopped responding to chemotherapy and was approved in 2006 for the treatment of head and neck cancer. The newly approved indication is for "recurrent locoregional disease or metastatic squamous cell carcinoma of the head and neck in combination with platinum-based therapy with 5-FU," according to the revised label, posted on the FDA Web site. The two previously approved indications for head and neck cancer were for "locally or regionally advanced squamous cell carcinoma of the head and neck in combination with radiation therapy," and for "recurrent or metastatic squamous cell carcinoma of the head and neck progressing after platinum-based therapy. [...]

2011-11-09T11:05:16-07:00November, 2011|Oral Cancer News|
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US FDA approval for expanded use of Erbitux

Source: www.pharmabiz.com Author: staff The US Food and Drug Administration (FDA) has approved Erbitux (cetuximab), in combination with platinum-based chemotherapy with 5-fluorouracil (CT), for the first-line treatment of recurrent locoregional or metastatic squamous cell carcinoma of the head and neck (SCCHN). The approval, which is based on data from the landmark EXTREME (ErbituX in first-line Treatment of REcurrent or MEtastatic head & neck cancer) trial, makes Erbitux plus CT the first treatment regimen approved in 30 years with extended overall survival in patients with recurrent locoregional or metastatic SCCHN. Erbitux (cetuximab) is a monoclonal antibody (IgG1 Mab) designed to inhibit the function of a molecular structure expressed on the surface of normal and tumour cells called the epidermal growth factor receptor (EGFR, HER1, c-ErbB-1). In vitro assays and in vivo animal studies have shown that binding of ERBITU Erbitux GFR blocks phosphorylation and activation of receptor-associated kinases, resulting in induction of apoptosis (cell death), inhibition of cell growth, and decreased matrix metalloproteinase and vascular endothelial growth factor production. In vitro, Erbitux can mediate antibody-dependent cellular cytotoxicity (ADCC) against certain human tumor types. In vitro assays and in vivo animal studies have shown that Erbitux inhibits the growth and survival of tumour cells that express the EGFR. No anti-tumour effects of Erbitux were observed in human tumour xenografts lacking EGFR expression. EXTREME, which was previously published in the New England Journal of Medicine, was a phase III open label, randomized, multi-centre, controlled trial. This study was conducted outside the US by [...]

2011-11-09T06:24:41-07:00November, 2011|Oral Cancer News|
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E-Cigarette Controversy

Source: The New York Times If you want a truly frustrating job in public health, try getting people to stop smoking. Even when researchers combine counseling and encouragement with nicotine patches and gum, few smokers quit. Recently, though, experimenters in Italy had more success by doing less. A team led by Riccardo Polosa of the University of Catania recruited 40 hard-core smokers — ones who had turned down a free spot in a smoking-cessation program — and simply gave them a gadget already available in stores for $50. This electronic cigarette, or e-cigarette, contains a small reservoir of liquid nicotine solution that is vaporized to form an aerosol mist. The user “vapes,” or puffs on the vapor, to get a hit of the addictive nicotine (and the familiar sensation of bringing a cigarette to one’s mouth) without the noxious substances found in cigarette smoke. After six months, more than half the subjects in Dr. Polosa’s experiment had cut their regular cigarette consumption by at least 50 percent. Nearly a quarter had stopped altogether. Though this was just a small pilot study, the results fit with other encouraging evidence and bolster hopes that these e-cigarettes could be the most effective tool yet for reducing the global death toll from smoking. But there’s a powerful group working against this innovation — and it’s not Big Tobacco. It’s a coalition of government officials and antismoking groups who have been warning about the dangers of e-cigarettes and trying to ban their sale. The controversy [...]

2011-11-08T13:22:07-07:00November, 2011|Oral Cancer News|
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FDA Approves Cetuximab for Metastatic Head and Neck Cancer

Source: MedScape News Today The US Food and Drug Administration (FDA) has approved cetuximab (Erbitux, Bristol-Myers Squibb ) for use in combination with chemotherapy for the treatment of metastatic head and neck cancer. Data show that when combined with cisplatin-based chemotherapy, cetuximab improved overall survival, compared with chemotherapy alone. According to the researchers, this is the first time in 3 decades — since cisplatin was first used in head and neck cancer — that any regimen has improved on its success. The improved survival that was seen after cetuximab was added to the regimen (at a median of 2.7 months) is "therefore notable." Cetuximab was approved in the United States in 2004 for the treatment of epidermal growth-factor receptor–positive late-stage colon cancer in patients who no longer responded to chemotherapy. In 2006, it was approved for use in combination with radiation therapy for the treatment of locally or regionally advanced squamous cell carcinoma of the head and neck. This latest approval expands on that to cover metastatic head and neck cancer. The ability of cetuximab "to extend the lives of patients with head and neck cancer is an important tool for oncologists, who often rely on a multitreatment approach for patients," said Richard Pazdur, MD, director of the Office of Hematology and Oncology Drug Products in the FDA's Center for Drug Evaluation and Research, in a statement." Given the aggressive nature of head and neck cancers that cannot be treated with surgery and radiation, it is important that patients have [...]

2011-11-08T12:00:48-07:00November, 2011|Oral Cancer News|
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Why HPV vaccination of boys may be easier

Source: www.npr.org/blogs/health Author: Richard Knox When the Centers for Disease Control and Prevention recommended a half-dozen years ago that preteen girls be vaccinated against human papillomavirus, two things happened. A lot of parents and some conservative groups were jarred by the idea of immunizing young girls against a sexually transmitted virus. And uptake of the vaccine has been poor — only about a third of 13- to 17-year-old girls have gotten the full three-shot series. Now, in the wake of a CDC expert panel's recommendation to extend vaccination to 11- and 12-year-old boys, there's reason to think things might be different this time. "There's been a surprisingly muted reaction," says Dr. Don Dizon, a Brown University oncologist. "We tend to believe that girls are chaste and are going to 'save themselves for marriage.' But, you know, sexual activity is something that's almost expected of boys." Seventeen-year-old Connor Perruccello-McClellan agrees. The idea that teenage girls might have sex is "just a touchy issue, a taboo, I guess," he says. "It's just not as accepted for girls." Perruccello-McClellan, a senior at Providence Country Day School in Rhode Island, is among the 1 percent of U.S. males who have already been vaccinated against HPV. That's because Rhode Island has one of the nation's most aggressive campaigns to vaccinate schoolchildren against nine different infections, including HPV. Still, like most people, he thought HPV vaccine protects only against cervical cancer — a notion that may have abetted the double standard associated with it. Cervical cancer [...]

2011-11-07T14:46:21-07:00November, 2011|Oral Cancer News|
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A spitting image of health

Source: http://www.sciencenews.org Author: Susan Galdos Rinse and spit. Someday soon, doctors may join dentists in issuing these simple instructions. And before leaving the office, you might know whether you’re at risk for oral cancer. Additional tests on that same ptui may reveal whether you show signs of certain other cancers or diseases such as diabetes and Alzheimer’s. Saliva — the frothy fluid that helps clean the mouth, digest food and fight tooth decay — carries many of the same proteins and other molecules found in blood and urine. Scientists have long been interested in mining a person’s mix of these compounds for clues to diagnosing diseases. Three years ago, these efforts got a boost when researchers completed a preliminary master list of the proteins found in spit — 1,166 of them. Since then, scientists have nearly doubled the length of the protein list, while identifying changes in the salivary protein profile that are linked to disease. Other labs are delving into genetic material found in human saliva, looking for variations in gene activity that might signal disease risk. Already, studies show that diseases such as breast cancer, type 2 diabetes and Alzheimer’s leave specific and identifiable signatures in saliva. Such biomarkers have also been found for Sjögren syndrome, an autoimmune condition that affects production of tears and saliva. And proteins known to be related to heart activity, including a handful whose levels are elevated during a heart attack, have also shown up in spittle. Such findings — combined with the [...]

2011-11-06T10:34:31-07:00November, 2011|Oral Cancer News|
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EU grants orphan drug status to BioAlliance Pharma’s clonidine Lauriad

Source: www.pharmabiz.com Author: staff European Commission has granted orphan drug designation to BioAlliance Pharma SA's clonidine Lauriad for prevention of radiotherapy-induced oral mucositis in patients with head and neck cancer. Oral mucositis is a very frequent inflammation of the oral mucosa in head and neck cancer patients treated with radio- and chemotherapy (98,000 new patients estimated per year in Europe). Severe oral mucositis occurs in 60% of these patients and may induce intense oral pain and eating disability requiring artificial nutritional support. In 20 to 30% of cases, patients have to be hospitalized and the disease may result in a modification or a stop of the radiotherapy treatment in more than 10% of them. Radiotherapy-induced oral mucositis has currently no preventive cure. In Europe, the orphan designation is granted for medicinal products in diseases affecting less than 5/10,000 patients. This status permits to benefit from incentives related to the clinical development, thus enabling a faster registration, and an extra protection with a 10- year commercial exclusivity after market authorization. “The European designation for clonidine Lauriad as an orphan drug is key in shortening its development timeline, optimizing costs and reinforcing its future market access. Clonidine Lauriad, currently in Phase II clinical trial, is the second product from our “Orphan Oncology Products” portfolio to be granted orphan status in Europe. The portfolio comprises assets with high commercial potential and will leverage our future growth”, stated COO, Judith Greciet. Dedicated to cancer and supportive care treatment with a focus on resistance targeting [...]

2011-11-06T10:14:20-07:00November, 2011|Oral Cancer News|
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ADA updates guidelines for managing ONJ risk patients

Source: www.drbicuspid.com Author: Rabia Mughal, Contributing Editor A patient receiving antiresorptive therapy for the prevention and treatment of osteoporosis has a low risk of developing osteonecrosis of the jaw (ONJ), and benefits of the medication outweigh the risk of ONJ, according to an advisory statement from the ADA. The statement, "Managing the Care of Patients Receiving Antiresorptive Therapy for Prevention and Treatment of Osteoporosis," is based on a literature review by an advisory committee of the ADA Council on Scientific Affairs and updates ADA's 2008 advisory statement (Journal of the American Dental Association, November 2011, Vol. 142:11, pp. 1243-1251). ONJ associated with antiresorptive agents has mostly been referred to as bisphosphonate-associated ONJ, but nonbisphosphonate antiresorptive agents are now available that also could be associated with ONJ, the panel noted. That is why they refer to the condition as antiresorptive agent-induced ONJ (ARONJ). A relatively new condition, bisphosphonate-associated ONJ, has received tremendous media attention because of a flurry of lawsuits against the makers of Fosamax and Zometa alleging that the medications led to ONJ. These lawsuits have been a factor in raising patients' and dentists' awareness of the condition, according to Helen Ristic, PhD, director of scientific information for the ADA's Division of Science and one of the panelists who contributed to the report. "The first calls the ADA received from dentists about ARONJ were in response to advertisements by lawyers and media reports," she said. Still, much about the condition remains a mystery, in part because there has not been [...]

2011-11-06T10:10:08-07:00November, 2011|Oral Cancer News|
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