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When a dentist dies from oral cancer

Source: www.dentistrytoday.com Author: Dr. Parul Dua Makkar & Dr. Sanjukta Mohant Dr. Manu Dua, a dentist practicing in Calgary, Alberta, discovered a lesion on his tongue around his 33rd birthday. He showed a photo of it to his sister, Parul, who is a dentist practicing in New York. “Get it biopsied,” she pleaded. He replied, “It can’t be cancer. I’m too young.” Less than 2 years later, Dr. Manu Dua died from oral cancer. He was 34. Manu had no risk factors for oral cancer. He was young and didn’t smoke. He only had an occasional drink. He was athletic and had a healthy diet. No one would suspect that the lesion on his tongue was cancer, not even him, not even the oral surgeon who thought it was lichen planus and prescribed him a steroid. His symptoms worsened: trouble speaking, pain on eating, and difficulty sleeping. Then came the devastating biopsy result – Stage 2 squamous cell carcinoma of the tongue. The cancer was treated by removing the left half of Manu’s tongue and the lymph nodes from the left side of his neck. His tongue was repaired using the radial artery from his left arm and skin from his right thigh. He had to learn to speak, chew and swallow again. He recovered quickly and returned to the dental office that he recently opened. Less than a year later, he noticed swelling on the left side of his neck after he had a restoration. The cancer was back. [...]

2021-12-15T16:57:01-07:00December, 2021|Oral Cancer News|
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Liquid biopsy provides accurate, fast Dx of HPV-associated head and neck cancer

Source: www.medpagetoday.com Author: Mike Bassett, Staff Writer, MedPage Today The use of liquid biopsy for the diagnosis of human papillomavirus (HPV)-associated head and neck squamous cell carcinoma (HNSCC) was more accurate, faster, and less expensive than standard tissue-based biopsies, according to a prospective observational study. The sensitivity and specificity of this circulating tumor HPV DNA-based approach were 98.4% and 98.6%, respectively, with positive and negative predictive values of 98.4% and 98.6%, reported Daniel L. Faden, MD, of Massachusetts General Hospital and Harvard Medical School in Boston, and colleagues. The diagnostic accuracy of this non-invasive approach was significantly higher than standard of care (Youden index 0.968 vs 0.707, P<0.0001), they noted in Clinical Cancer Research. In addition, liquid biopsy reduced the time to diagnosis from a median of 41 days to 15 days, and estimated costs associated with this method were about 36% to 38% less than the traditional biopsy approach. "Currently the way we diagnose HPV-associated cancer is either with a needle biopsy of a neck lymph node or a tissue biopsy from the oropharynx -- and these approaches have a couple of different limitations," Faden told MedPage Today. Not only are they invasive and painful for patients, but needle biopsy of a neck lymph node has high failure rates due to a lack of adequate cellular material. "So, patients might have to undergo a repeat biopsy to get the diagnosis we are waiting for," he noted. "That adds time to diagnosis, and we know that time from presentation to [...]

2021-12-03T05:54:26-07:00December, 2021|Oral Cancer News|
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Etiglimab/Nivolumab combination shows promise in solid tumors

Source: www.targetedonc.com Author: Sara Karlovitch The combination of etigilimab, an anti-TIGIT antibody, in combination with nivolumab (Opdivio) has demonstrated anti-tumor efficacy and acceptable safety data in patients with solid tumors, according to a press release on the interim results of the phase 1b/2 ACTIVATE trial by Mereo BioPharma Group plc. The phase 1b/2 study (NCT04761198) has a target enrollment of 125 participants and an estimated study completion date of June 2023. The primary end point is objective response rate. During the study, patients will receive an infusion of etigilimab every 2 weeks and an infusion of nivolumab every 2 weeks. Cohorts include squamous cell carcinoma of the head and neck, cervical cancer on or after chemotherapy, gastric or gastroesophageal junction adenocarcinoma, endometrial carcinoma, tumor burden high and microsatellite stable solid tumors, rare disease with high TIGIT expression, ovarian cancer, and endometrial carcinoma post standard of care therapy. At the time of data cutoff, 22 patients were included in the safety analysis. Twenty patients were evaluable with a minimum of at least one scan and 15 were included in the efficacy analysis. The analysis found that 1 patient in the cervical cancer cohort had a complete response. In the ovarian cancer cohort, 1 patient had a partial response. Four patients with stable disease was seen in ovarian cancer, cervical cancer, and uveal melanoma. Additionally, the ovarian cancer cohort has crossed futility for expansion into the second stage of the study. The combination was found to be well tolerated, and no new [...]

2021-12-02T08:25:04-07:00December, 2021|Oral Cancer News|
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Geographic disparities in head and neck cancer survival in Upstate New York 2011-2019

Source: www.docwirenews.com Author: DocWire News Featured Reading This article was originally published here Head Neck. 2021 Nov 29. doi: 10.1002/hed.26945. Online ahead of print. ABSTRACT PURPOSE: To examine the association between distance to care-center and urban-rural residence on 5-year overall survival (OS) from head and neck cancer (HNC). MATERIALS AND METHODS: Five-year OS was retrospectively measured from date of initial diagnosis for patients with HNC treated at a single tertiary care center. Distances were calculated based on ZIP code of patient’s residence and care center. Multilevel Weibull regression was used to adjust for confounders and identify disparities in 5-year all-cause mortality. RESULTS: A total of 670 patients included in study. Multivariable analysis revealed older age or late-stage cancer at diagnosis, and HPV negative status were associated with poorer OS. Patients residing in isolated small rural town (HR = 2.20, p = 0.015) or small rural town (HR = 2.07, p = 0.015) had lower OS. Distance to care center was not associated with OS (HR = 0.996, p = 0.11). CONCLUSIONS: Greater rurality was associated with poorer OS among HNC patients in Upstate New York.

2021-12-01T15:19:36-07:00December, 2021|Oral Cancer News|
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Treatment paradigms are shifting for locally advanced HPV-positive head and neck cancers

Source: www.onclive.com 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|
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Oral cancer and COVID-19

Source: dentistry.co.uk 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|
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Detecting suspicious lesions: what do I say next?

Source: dentistry.co.uk 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|
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Improving the management of HNSCC: next steps

Source: www.cancernetwork.com 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|
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Two markers help predict head and neck cancer prognosis

Source: labblog.uofmhealth.org 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|
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Most men benefit from initial and catch-up cancer prevention vaccination

Source: www.precisionvaccinations.com 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|
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