The widespread application of trans-oral robotic surgery in HPV-related head and neck cancer: one size does not fit all

Over the past years, trans-oral robotic surgery (TORS) has gained momentum and wide applicability in the treatment of early-stage low-risk HPV-related oropharyngeal squamous cell carcinoma (OPSCC). This is in large part due to initial large single-institution series documenting good clinical outcomes using this approach. This culminated in the design and execution of the Eastern Cooperative Oncology Group trial 3311 (E3311) that provided a framework for applying this modality in the management of predominantly low-risk HPV-related OPSCC. Even though results from E3311 have been widely adopted as the guide to implementing TORS in this disease, it is noteworthy that significant care in planning surgical aspects of the trial implementation took place. Namely, sites were mandated to implement a quality assurance process through documentation of surgical credentialing. Vetting the accruing ECOG3311 surgeons appeared to minimize complications related to critical aspects of the study. In addition, one has to account for a certain selection bias when patients are enrolled in a clinical trial. If an experienced TORS surgeon has not assessed the patient as a surgical candidate and documented eligibility, there is an increased likelihood of affecting the reported rate of complications. Complications from TORS can be major, such as the rare and idiosyncratic yet real risk for severe postoperative bleeding, which puts patients at risk of death without feeding arterial vessel ligation. Among other complications that have not been systematically tracked in prior studies is reduced swallowing function, which may vary with volume and location of resected tissue, as well as availability and adherence [...]

2024-12-23T10:59:28-07:00December, 2024|Oral Cancer News|

Exploring the link between HPV infection and head and neck cancers

Source: www.targetedonc.com Author: Jordyn Sava In an interview with Targeted Oncology for Head and Neck Cancer Awareness Month, Noel Laudi, MD, MRCP, discussed the link between human papillomavirus infection and head and neck cancers. There is a complex relationship that exists between human papillomavirus (HPV) and head and neck cancers. According to Noel Laudi, MD, MRCP, “no one is immune to HPV-related head and neck cancers, with certain demographics at higher risk.” Common areas of occurrence for HPV-related head and neck cancer are in the mouth, including tonsils, soft palate, oropharynx, and base of tongue. HPV can cause cancer by staying in the system for 1 to 3 years and affecting lymphatic tissue in fertile areas of the mouth. HPV-related head and neck cancers often present late due to silent growth. Those at a higher risk of developing HPV-related head and neck cancer include those with more sexual partners and those exposed to oral sex. Additionally, smoking increases the risk of cancer for those with HPV, creating a double risk with the virus and smoke. Laudi, of Allina Health Cancer Institute, emphasized that the HPV vaccine is effective in preventing these cancers, with the ideal age for vaccination being around 11 to 13 years old. However, there is an unmet need for better screening methods and higher vaccination rates of children to prevent HPV-related cancers. “I think the vaccine has been a huge move in the right direction. The treatment is very tough, and if we can prevent the cancer [...]

Head and neck cancer surgeons test fluorescent dye for marking nerves

Source: web.musc.edu Author: Leslie Cantu Alexandra Kejner, M.D., right, operates using the Alume Biosciences nerve visualization dye. Photo provided Head and neck cancer surgeons at MUSC Hollings Cancer Center are excited about the possibilities of a new nerve fluorescing product they’re testing in a phase III clinical trial. Developed by Alume Biosciences, the product is a dye that combines a fluorescing molecule with a peptide that binds to nerves, illuminating them to make them easier for surgeons to spot. “Taking the tumor out is easy – finding the nerve and making sure you save the nerve is the critical part. This is a trial to help determine if using this dye during surgery improves the ability of surgeons to visualize and preserve nerves,” said Jason Newman, M.D., Head and Neck Cancer Division director. Some areas of the body have more nerves than others, and the head and neck area is one where many small nerves control critical functions. “I always tell patients, ‘If we take out a tumor in your cheek, that could be a three-hour surgery. If you took the same tumor out of the skin of your back, it could be a 10-minute surgery right in the office. And the difference is that the nerve that moves your entire face is there on the cheek,’” Newman said. Alexandra Kejner, M.D., was the first at Hollings to use the product, on a patient who needed a total thyroidectomy. “During that surgery, we’re monitoring the recurrent laryngeal nerve [...]

Researchers discover urine-based test to detect head and neck cancer

Source: www.newswise.com Author: Michigan Medicine - University of Michigan Researchers from the University of Michigan Health Rogel Cancer Center have created a urine-based test that detects pieces of DNA fragments released by head and neck tumors. The test could potentially facilitate early detection of this cancer type, which currently does not have a reliable screening method. Human papillomavirus (HPV) is widely recognized for causing cervical cancer, but is increasingly found to cause cancers in the mouth, throat and other head and neck regions. Early detection is critical because detecting a cancer at an earlier stage can lead to better outcomes for patients. Using whole genome sequencing, the Rogel group showed that cell-free DNA fragments released by tumor cells, which are passed on from the bloodstream into urine through the kidneys, are predominantly ultra-short, with fewer than 50 base pairs. Given their small size, these fragments are likely to be missed using conventional urine or blood-based liquid biopsy tests in detecting circulating tumor DNA (ctDNA). The research was led by Muneesh Tewari, M.D., Ph.D., professor of hematology and oncology, J. Chad Brenner, Ph.D., associate professor of otolaryngology-head and neck surgery, and Paul L. Swiecicki, M.D., associate medical director for the Oncology Clinical Trials Support Unit at Rogel. Initial results are published in JCI Insight. “In this study we provide evidence to support the hypothesis that conventional assays do not detect ultrashort fragments found in urine, since they are designed to target longer DNA fragments. Our team used an unconventional approach to [...]

Insilico Medicine’s AI-driven approach yields promising PTPN2/N1 inhibitor for cancer immunotherapy

Source: www.news-medical.ne Author: InSilico Medicine staff In recent years, cancer immunotherapy, exemplified by PD-1 and its ligand PD-L1 blockade, has made remarkable advances. But while immunotherapy drugs offer new treatment possibilities, only about 20% to 40% of patients respond to these treatments. The majority either don't respond or develop drug resistance. Researchers are now looking for ways to enhance the scope of tumor immunotherapy in order to benefit a wider range of patients. One such avenue is through the protein tyrosine phosphatase non-receptor type 2 (PTPN2) and its close superfamily member, PTPN1, identified in previous research as crucial modulators involved in the regulation of immune cells signaling pathways that promote tumorigenesis by attenuating tumor-directed immunity. While promising, the development of PTPN2/PTPN1 inhibitors has faced challenges as a result of unfavorable pharmacokinetics due to the highly cationic active site and the relatively shallow nature of the protein surface. In a significant milestone, researchers at Abbvie discovered the dual PTPN2/N1 inhibitor ABBV-CLS-484 through structure-based drug design and optimization of drug-like properties. Now, clinical stage artificial intelligence (AI)-driven drug discovery company Insilico Medicine ("Insilico") has initiated a program with a fast-follow strategy to design a novel PTPN2/N1 inhibitor with drug-likeness properties and in vivo oral absorption, supported by the Company's generative AI drug design engine Chemistry42. The research was published in the European Journal of Medicinal Chemistry on April 5. Scientists inputted the structure of the known PTPN2/N1 inhibitor as a reference compound to Chemistry42 as a starting point and generated a series [...]

The growing role for cfHPV-DNA testing in OPSCC therapeutic development

Source: www.biopharmadive.com Author: Sysmex Inostics,sponsored content Human papillomavirus (HPV) plays a key role in the development of oropharyngeal squamous cell carcinoma (OPSCC). Approximately 80% of all OPSCC cases in the U.S. are associated with HPV.1 In fact, the incidence of HPV-associated OPSCC in men has surpassed that of cervical cancer in women, making OPSCC the most common cancer caused by HPV in the U.S.2 As pharmaceutical companies seek to develop targeted therapeutics for HPV-associated cancers, access to robust biomarkers can prove invaluable for drug development. cfHPV-DNA in plasma meets this need and represents an attractive biomarker for grading treatment response and recurrence surveillance. Here, we’ll discuss the growing role for cfHPV-DNA as a biomarker in developing novel therapeutics targeting HPV-associated OPSCC and how HPV-SEQ — a quantitative, ultrasensitive test for cfHPV-DNA — can be leveraged during development for such therapies. The rise of cfHPV-DNA as a biomarker for HPV-associated OPSCC It has long been known that HPV-associated oropharyngeal cancers shed HPV-DNA into the circulatory system. However, drug developers now have an opportunity to not only detect but also quantify cfHPV-DNA in plasma to assess the effectiveness of therapeutics during development. “With real-time insights, you can get a very keen sense of how the tumor is responding to intervention during a clinical trial, including de-escalation clinical trials,” explained Nishant Agrawal, MD, co-director, head and neck surgical oncology at University of Chicago Medicine. “In the past, measuring responses has taken months or even years. But with cfHPV-DNA testing, you can do it [...]

‘Paradoxical’ data show routine imaging lacks benefit for head and neck cancer survivors

Source: www.healio.com Author: Matthew Shinkle Key takeaways: Researchers saw no statistical difference between patient groups with respect to treatment outcomes. Larger studies are needed to further evaluate this study’s findings. Compared with expectant management, imaging-based surveillance did not improve outcomes among patients in remission after completion of primary radiation therapy for head and neck cancer, according to data published in JAMA Network Open. Although imaging “in the context of clinical suspicion” for this specific patient population is common and typically beneficial, according to researchers, the results of this study show that such a practice is not valuable for asymptomatic patients. “The results of the present study, while seemingly paradoxical, are consistent with those of others which have failed to demonstrate a benefit to surveillance imaging among patients who have successfully completed treatment for head and neck cancer,” Allen M. Chen, MD, MBA, professor and chair of the department of radiation oncology at University of California, Irvine, Chao Family Comprehensive Cancer Center, and researchers wrote. Researchers conducted a retrospective, comparative effectiveness review to evaluate the potential benefit of surveillance imaging among asymptomatic patients with head and neck cancer currently in remission following completion of chemoradiation. The study included 340 adults (59% men; 43% white) who had achieved a complete metabolic response to initial treatment for newly diagnosed squamous cell carcinoma of the head and neck between January 2014 and June 2022. Researchers defined surveillance imaging as the acquisition of a PET with CT, MRI or CT of the head and neck [...]

CERN detector could help treat brain tumors with greater precision

Source: www.inceptivemind.com Author: Ashwini Sakharkar Mária Martišíková (left), the project leader from Heidelberg University Hospital and German Cancer Research Center (DKFZ), and DKFZ researcher Laurent Kelleter. Credit: Heidelberg University Hospital / H.Schroeder Scientists are testing a new device that will help them more accurately target cancer cells during ion radiotherapy for head and neck tumors. Scientists from the German National Center for Tumor Diseases (NCT), the German Cancer Research Center (DKFZ), and the Heidelberg Ion Beam Therapy Center (HIT) at Heidelberg University Hospital are currently testing the imaging device on their first patients. The device includes a small Timepix3 pixel detector developed at CERN, which allows head and neck tumors to be closely monitored during ion radiotherapy, making them easier to target and thus helping limit the treatment’s side effects. “One of the most advanced methods for treating head and neck tumors involves irradiation with ion beams. This has one unique feature: it can be precisely tailored to the depth inside the human head where the particles should have the maximal effect”, explains Mária Martišíková, the head of the DKFZ team. Like other forms of irradiation, ion radiation can have drawbacks. While it can be effective in targeting tumors, it can also affect healthy tissue surrounding the tumor. In the case of brain tumors, this can be particularly challenging, as damage to the optic nerve or a patient’s memory is possible. Ideally, the irradiated area around the tumor should be minimized while maximizing the dose to the tumor. [...]

Rhod Gilbert: Doctor reveals how ‘brutal’ therapy tackled comedian’s cancer

Source: www.bbc.com Author: Natalie Grice, BBC News Prof Mererid Evans says Rhod Gilbert "wanted something positive to come out of his experience" "A patient once described it to me as brutal, and it's really stuck with me, because it's difficult to go through." What's so brutal? It's the cancer treatment Prof Mererid Evans routinely prescribes to the people who come to her, hoping she will save their lives, and which she aims to improve with research she is leading. It was the same word used by Welsh comedian Rhod Gilbert when in 2022 he found himself sitting in front of the consultant oncologist after being diagnosed with throat, neck, tongue and tonsil cancer. Rhod Gilbert was a patron of Velindre Cancer Centre for 10 years before his diagnosis Her famous patient suddenly put her consulting room at Velindre Cancer Centre, Cardiff, in the limelight when he made a documentary about his treatment. "Rhod wanted something positive to come out of his experience," said Prof Evans, 54, head and neck specialist at Velindre Cancer Centre in Cardiff, a professor at Cardiff University's cancer and genetics division, and head of the Wales Cancer Research Centre. "We talked about the treatment he'd be receiving and I think he felt it was an opportunity to highlight what it's like going through cancer treatment." The resulting Channel 4 programme, A Pain in the Neck for SU2C, followed Gilbert through diagnosis, treatment and the aftermath. Head and neck cancer is the eighth [...]

A case for radiation enhancement in head and neck cancer

Source: www.medscape.com Author: M. Alexander Otto, PA, MMS Two new exploratory studies of radioenhancers used in combination with radiation therapy in the treatment of head and neck cancers showed that these agents can boost the effectiveness of radiotherapy in these cancers. The two phase 2 studies, presented at the 2024 American Society for Radiation Oncology (ASTRO) Head and Neck Cancer Symposium on March 1, 2024, found an increase in 1-year local control rate, progression-free survival, and overall survival. In one study, which explored the use of the hedgehog pathway inhibitor vismodegib alongside radiation therapy, researchers found that all but one patient with locally advanced, unresectable basal cell carcinoma (BCC) demonstrated 1-year local control — a significantly better rate than that expected from radiation alone — and 83% were alive at 5 years. The second, which explored the use of hafnium oxide nanoparticles (NBTXR3) prior to radiation therapy, also reported promising results. Patients with T3/4 locally advanced head and neck squamous cell carcinoma of the oropharynx or oral cavity who were ineligible for chemoradiation demonstrated a median overall survival of 18.1 months vs 12 months, the life expectancy with radiation alone. Although small, both studies suggest a role for radioenhancers in head and neck cancer, Jonathan Schoenfeld, MD, a head and neck cancer radiation oncologist at the Dana Farber Cancer Institute, in Boston, Massachusetts, told Medscape Medical News.

Go to Top