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Early findings suggest clinical and lab-based approach critical to tracking head and neck cancer recurrence

Source: medicalxpress.com Author: Anna Megdell, University of Michigan Early findings of two studies from the University of Michigan Rogel Cancer Center shed light on new ways to anticipate recurrence in HPV-positive head and neck cancer sooner. The papers, published in Cancer and Oral Oncology, offer clinical and technological perspectives on how to measure if recurrence is happening earlier than current blood tests allow, and provide a framework for a new, more sensitive blood test that could help in this monitoring. "When metastatic head and neck cancer returns, it impacts their quality of life and can be disfiguring, interfering with the ability to talk, swallow, and even breathe," said Paul Swiecicki, M.D., associate medical director for the Oncology Clinical Trials Support Unit at Rogel. "As of now, there's no test to monitor for its recurrence except watching for symptoms or potentially using a blood test which may not detect cancer until shortly before it clinically recurs." The paper in Cancer aims to identify different clinical ways that providers can more strategically track for recurrence. To do this, Swiecicki and his team needed to first understand what patient population was at the highest risk to then figure out an appropriate monitoring pattern. The team examined 450 patients with metastatic head and neck cancer, including people with HPV-positive and HPV-negative cancer. HPV-positive cancer is caused by the human papillomavirus and is increasingly more common in head and neck cancer patients. The team identified some predictors of when recurrences would happen, and to what [...]

2023-09-08T05:39:02-07:00September, 2023|Oral Cancer News|
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Best practices for immunotherapy for metastatic head and neck cancer

Source: www.medpagetoday.com Author: Mark L. Fuerst , Contributing Writer, MedPage Today This Reading Room is a collaboration between MedPage Today® and: Medpage Today Immunotherapy with anti–programmed cell death protein 1 (PD-1) immune checkpoint inhibitors (ICIs) is now an essential treatment for patients with recurrent and metastatic head and neck squamous cell carcinoma (HNSCC), and ICIs also show promise for patients with nasopharyngeal carcinoma and other rare head and neck cancer types. A recently released ASCO Guideline on immunotherapy and biomarker testing in recurrent and metastatic HNSCCs provided evidence-based recommendations. A new related document by expert panel co-chairs Emrullah Yilmaz, MD, PhD, of the Cleveland Clinic, and Loren K. Mell, MD, of the University of San Diego, and colleagues poses questions and answers about the guideline. The following is a summary: For patients with recurrent and metastatic head and neck cancer, which biomarkers should be used in the selection of anti–PD-1 immune checkpoint inhibitor therapy? We recommend programmed death ligand 1 (PD-L1) combined positive score (CPS) testing for recurrent and metastatic HNSCC. PD-L1 reports come via immunohistochemistry using CPS or tumor proportion score. CPS has emerged as a preferred biomarker in HNSCC and has been used in landmark head and neck clinical trials such as KEYNOTE-048. Tumor mutational burden (TMB), another emerging biomarker for predicting response to anti–PD-1 ICIs, was studied in KEYNOTE-158. TMB is not used routinely in HNSCC, but may help in cases where PD-L1 CPS is unavailable or for rare head and neck cancers. In first-line treatment of [...]

2023-09-04T08:50:20-07:00September, 2023|Oral Cancer News|
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Antibiotic prescriptions linked to significant delays in head and neck cancer diagnosis

Source: www.healio.com Author: Drew Amorosi Key takeaways: Researchers reported increased rates of antibiotic prescriptions in the 3 months prior to head/neck cancer diagnosis. Antibiotic prescriptions appeared linked to longer time between symptom onset and diagnosis. Approximately 15% of individuals with head and neck cancer received an antibiotic prescription within 3 months of diagnosis, study results showed. Those who received antibiotic prescriptions had significantly longer time to head and neck cancer diagnosis than those who did not receive antibiotics, findings published in JAMA Otolaryngology–Head & Neck Surgery showed. “These patients have been through the health care system for many months without an accurate diagnosis,” Sean T. Massa, MD, assistant professor in the department of otolaryngology — head and neck surgery at Saint Louis University School of Medicine, told Healio. “Prescribing antibiotics is a common practice and was associated with a delay in diagnosis,” he added. “For adults with a neck mass or swelling lasting more than 2 weeks, the most likely cause is a tumor, so patients should be evaluated through further testing and referral to a specialist.” Background Head and neck specialists have observed a steady stream of patients with neck masses mistakenly prescribed antibiotics because symptoms mirror that of infection, Massa said. This occurs despite 2017 guidelines from American Academy of Otolaryngology — Head and Neck Surgery (AAO-HNS) for evaluation of neck mass among adults. The guidelines recommend against prescribing antibiotics without other infectious symptoms. “We wanted to see if patients who received antibiotics took longer to get from [...]

2023-09-02T07:50:29-07:00September, 2023|Oral Cancer News|
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Dr Jennifer Choe discusses head and neck dancer relapse, new treatment trials, promising responses

Source: www.ajmc.com Author: Brooke McCormick Jennifer Choe, MD, PhD, shared her thoughts on why head and neck cancer patients relapse after radiation therapy, new head and neck cancer treatment trials, and promising responses from these trials. Choe is a head and neck oncologist at Vanderbilt University Medical Center and was a presenter at The American Journal of Managed Care®’s Institute for Value-Based Medicine® held in Nashville, Tennessee on August 17, 2023. Transcript Can you explain some of the thought behind why there is disease relapse in head and neck cancers after radiation treatment? There's a lot of theoretical basis as to why we think this is the case. A lot is driven by just aggressive biology; it's really not known. Head and neck cancers are considered immune responsive, technically speaking, but the response rates still are pretty low, in general, and whether or not the immune system and head and neck cancer patients are depressed compared to other cancers. I, in theory, think that a part of it is actually the radiation creating an environment where there could be a reduction in the body's ability to regulate the immune system. There's an immune suppressed state for these patients that could be due to radiation of the lymph nodes that's decreasing the ability for the immune system to respond, but also the local radiation induced immune suppression effects that may be producing a more conducive environment for the cancer to return. What are some of the trials evaluating new treatment regimens [...]

2023-09-02T07:41:01-07:00September, 2023|Oral Cancer News|
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Doctors couldn’t operate on my tumour, but this robot did — and it may have saved my life

Source: www.cbc.ca Author: Glenn Deir This is a First Person column by author Glenn Deir, who lives in St. John's, Newfoundland. Glenn Deir has special thanks for the robot who operated on his tonsil cancer. Long before I had cancer, and long before I lived in Japan, the rock band Styx released a synthesizer-drenched song with the hook "Domo arigato, Mr. Roboto." Forty years later I, too, found myself thanking a robot. Its name is da Vinci. Da Vinci resembles a giant spider with four arms, and my journey to lying beneath those arms began with a niggling problem: I was having discomfort swallowing. Even sipping water sometimes stung. A flexible scope up my nose and down my throat revealed an apparent ulcer on my tonsil, the right tonsil, my one remaining tonsil. But given my history, my doctor couldn't ignore it. Ah, my history. Sixteen years ago, I contracted cancer in the left tonsil thanks to the human papillomavirus. That's the same virus that causes cervical cancer. Most folks shed the HPV virus with no harm done, but I had crappy luck. The subsequent radiation had me retching into a toilet for weeks. I turned into an advocate for the HPV vaccine. The da Vinci robot operates on Glenn Deir. (Glenn Deir) "Sex gave me cancer," I used to say. "You don't want your little boy to grow up and go through what I went through." What I wanted to ask Dr. Boyd Lee was, "So, what's [...]

2023-08-29T12:24:57-07:00August, 2023|Oral Cancer News|
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Interdisciplinary group focuses on developing personalized oral cancer vaccine

Source: web.musc.edu Author: Leslie Cantu Jason Newman, M.D., Angela Yoon, D.D.S., and Shikhar Mehrotra, Ph.D., are working together on a project to develop a personalized vaccine to prevent oral cancer from returning. Photo by Clif Rhodes Interdisciplinary innovation is a hallmark of MUSC Hollings Cancer Center, and it doesn’t get much more interdisciplinary than this – three people, one each with an M.D., a D.D.S., and a Ph.D., working together to develop a new type of personalized vaccine to prevent oral cancer recurrence. “The amazing thing to me is that Jason Newman and I started on the same day at MUSC, which was March 1 of last year. He came from UPenn. I came from Columbia, and Shikhar has been at MUSC forever. It's just three different people who never knew each other before that time, and then we somehow got together and the synergy was there,” said Angela Yoon, D.D.S. Yoon, a professor in the James B. Edwards College of Dental Medicine who focuses on cancer biomarkers and immunomodulatory therapy, is leading the effort in collaboration with the two professors from the College of Medicine: Jason Newman, M.D., Head and Neck Cancer Division director, and Shikhar Mehrotra, Ph.D., scientific director of the Center for Cellular Therapy. They’re getting their project started using funding provided by Hollings. Periodically, Hollings awards funds to MUSC departments as a way to reinvest in faculty members who are conducting cancer research. Participating in clinical trials and on scientific committees and writing new [...]

2023-08-29T11:04:49-07:00August, 2023|Oral Cancer News|
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Cancer stem cells’ biomarker ALDH1&2 increased expression in erosive oral lichen planus compared to oral leukoplakia

Source: www.cureus.com Author: Zisis V, Giannakopoulos N N, Schmitter M, et al. Abstract Introduction: ALDH1&2 has been considered an oral cancer stem cell (CSC) marker. Oral carcinogenesis is a process that usually passes through oral potentially malignant disorders (OPMD). Oral lichen planus (OLP) consists of immune-related chronic disorders that have been included in the OPMDs due to their possible transformation into oral cancer. The aim of this study was to investigate the early presence of ALDH1&2 in OLP compared to early oral leukoplakias (OL), especially mildly and non-dysplastic OL. Materials and methods: The study type is experimental, and the study design is characterized as semiquantitative research which belongs to the branch of experimental research. The study sample consisted of paraffin-embedded OLP biopsy samples from the archives of the Department of Oral Medicine/Pathology, School of Dentistry, Aristotle University of Thessaloniki, Greece, during the period 2009-2019. The study sample contained 24 cases of OLP (14 erosive and 10 reticular) and 30 cases of OL (16 cases of moderately and severely dysplastic OL and 14 cases of mildly and non-dysplastic OL). The CSC-related biomarker ALDH1&2 was examined using semiquantitative immunohistochemistry (monoclonal antibody sc-166362, Santa Cruz Biotechnology, Dallas, Texas, USA, 1:100). ALDH1&2 expression was evaluated through a scale of 1 to 3 depending on the percentage of positive epithelial cells and was compared to normal epithelium as well as cases of OL (the most prominent OPMD). The statistical analysis was performed with the Pearson chi-square test and the significance level was set at p≤0.05. [...]

2023-08-29T07:06:54-07:00August, 2023|Oral Cancer News|
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Merck and Eisai say late-stage trial of treatment for head and neck cancer did not meet goals

Source: www.marketwatch.com Author: Ciara Linnane Merck & Co. Inc. and Eisai Co. Ltd. said Friday a late-stage trial of a treatment for head and neck cancer failed to meet its main goals and the companies have decided to shut it down. The Phase 3 trial sought to evaluate Merck’s Keytruda plus Lenvima, an orally available multiple receptor tyrosine kinase inhibitor (TKI) discovered by Eisai, as a first-line treatment for patients with recurrent or metastatic head and neck squamous cell carcinoma. The primary endpoints were overall survival, progression-free survival and objective response rate. Two planned interim analyses conducted by an independent data monitoring committee found in the first analysis that Keytruda and Lenvima achieved a statistically significant improvement in PFS and ORR compared with Keytruda and placebo. But the second analysis, the two did not demonstrate an improvement in OS compared to KEYTRUDA plus placebo, “and the likelihood of reaching the protocol-specified threshold for statistical significance for OS was evaluated by Merck and Eisai and deemed to be low,” said the companies. The partners have decided to close the study and are informing investigators of that decision.

2023-08-27T05:43:33-07:00August, 2023|Oral Cancer News|
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Machine learning in the detection of oral lesions with clinical intraoral images

Source: www.cureus.com Author: Karthikeyan Ramalingam et al. Abstract from article: Introduction: Artificial intelligence in oncology has gained a lot of interest in recent years. Early detection of Oral squamous cell carcinoma (OSCC) is crucial for early management to attain a better prognosis and overall survival. Machine learning (ML) has also been used in oral cancer studies to explore the discrimination between clinically normal and oral cancer. Materials and methods: A dataset comprising 360 clinical intra-oral images of OSCC, Oral Potentially Malignant Disorders (OPMDs) and clinically healthy oral mucosa were used. Clinicians trained the machine learning model with the clinical images (n=300). Roboflow software (Roboflow Inc, USA) was used to classify and annotate images along with Multi-class annotation and object detection models trained by two expert oral pathologists. The test dataset (n=60) of new clinical images was again evaluated by two clinicians and Roboflow. The results were tabulated and Kappa statistics was performed using SPSS v23.0 (IBM Corp., Armonk, NY). Results: Training dataset clinical images (n=300) were used to train the clinicians and Roboflow algorithm. The test dataset (n=60) of new clinical images was again evaluated by the clinicians and Roboflow. The observed outcomes revealed that the Mean Average Precision (mAP) was 25.4%, precision 29.8% and Recall 32.9%. Based on the kappa statistical analysis the 0.7 value shows a moderate agreement between the clinicians and the machine learning model. The test dataset showed the specificity and sensitivity of the Roboflow machine learning model to be 75% and 88.9% respectively. Conclusion: In [...]

2023-08-24T08:14:57-07:00August, 2023|Oral Cancer News|
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Best practices for immunotherapy for metastatic head and neck cancer

Source: www.medpagetoday.com Author: Mark L. Fuerst , Contributing Writer, MedPage Today Immunotherapy with anti–programmed cell death protein 1 (PD-1) immune checkpoint inhibitors (ICIs) is now an essential treatment for patients with recurrent and metastatic head and neck squamous cell carcinoma (HNSCC), and ICIs also show promise for patients with nasopharyngeal carcinoma and other rare head and neck cancer types. A recently released ASCO Guideline on immunotherapy and biomarker testing in recurrent and metastatic HNSCCs provided evidence-based recommendations. A new related document by expert panel co-chairs Emrullah Yilmaz, MD, PhD, of the Cleveland Clinic, and Loren K. Mell, MD, of the University of San Diego, and colleagues poses questions and answers about the guideline. The following is a summary: For patients with recurrent and metastatic head and neck cancer, which biomarkers should be used in the selection of anti–PD-1 immune checkpoint inhibitor therapy? We recommend programmed death ligand 1 (PD-L1) combined positive score (CPS) testing for recurrent and metastatic HNSCC. PD-L1 reports come via immunohistochemistry using CPS or tumor proportion score. CPS has emerged as a preferred biomarker in HNSCC and has been used in landmark head and neck clinical trials such as KEYNOTE-048. Tumor mutational burden (TMB), another emerging biomarker for predicting response to anti–PD-1 ICIs, was studied in KEYNOTE-158. TMB is not used routinely in HNSCC, but may help in cases where PD-L1 CPS is unavailable or for rare head and neck cancers. In first-line treatment of patients with PD-L1 CPS ≥ 1 recurrent and metastatic HNSCC, can pembrolizumab [...]

2023-08-19T06:39:22-07:00August, 2023|Oral Cancer News|
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