Oral Cancer News

Pembrolizumab: New standard of care in head and neck cancer

Source: www.medscape.com
Author: Roxanne Nelson, RN, BSN

Immunotherapy with pembrolizumab (Keytruda, Merck & Co), either as monotherapy or in combination with chemotherapy, offers a new standard of care for patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC), say experts discussing the results from the company-sponsored KEYNOTE-48 trial.

Pembrolizumab plus chemotherapy yielded a significant survival benefit in comparison with standard therapy for both the total patient population and for patients whose tumors were positive for programmed cell death–ligand-1 (PD-L1).

Monotherapy with pembrolizumab yielded a significant overall survival benefit for patients with tumors that were PD-L1 positive; and in the total study population, overall survival was noninferior.

“Thus, pembrolizumab monotherapy is a new standard of care, first-line therapy option for patients with PD-L1-positive recurrent or metastatic HNSCC. Pembrolizumab with chemotherapy is also a new option for all patients, regardless of PD-L1 status,” comment Robert L. Ferris, MD, PhD, from the University of Pittsburgh, Pennsylvania, and Lisa Licitra MD, from the University of Milan, Italy, in a commentary that accompanies article in the Lancet.

“The positive results of KEYNOTE-048 represent substantial progress for patients with recurrent or metastatic HNSCC,” Ferris and Licitria add.

These comments echo the reactions from experts when the study was presented earlier this year at the annual meeting of the American Society for Clinical Oncology (ASCO), as reported by Medscape Medical News at that time.

Presenter Danny Rischin, MD, from the Peter MacCallum Cancer Center, Melbourne, Australia, said: “These data support pembrolizumab plus platinum-based CT [chemotherapy] and pembrolizumab monotherapy as new first-line standard-of-care therapies for relapsed/metastatic head and neck squamous cell carcinoma.”

At the ASCO meeting, the study was highlighted as “most important” by Francis P. Worden, MD, of the University of Michigan Rogel Cancer Center, Ann Arbor. He predicted that pembrolizumab in combination with chemotherapy will replace the EXTREME regimen (cetuximab with platinum-based therapy and fluorouracil) as first-line therapy in HNSCC.

However, while agreeing that the data are practice changing, Vinita Noronha, MD, of the Tata Memorial Cancer Center in Mumbai, India, emphasized that several questions remained unanswered.

In a discussion of the paper, Noronha pointed out that the findings do not provide guidance on which patients should receive pembrolizumab alone or in combination with chemotherapy, and there are also questions as to why both the response rate and progression-free survival rate failed to improve. It was also unclear whether there was a role for sequential therapy or whether all patients should receive the combination up front. Some of these questions have been addressed in the commentary to the Lancet article.

Study Details
KEYNOTE-048 was a randomized, phase 3 study that included 882 participants with untreated locally incurable recurrent or metastatic HNSCC. It was conducted at 200 sites in 37 countries.

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November, 2019|Oral Cancer News|

Year in review: Head and neck cancer

Source: www.medpagetoday.com
Author: Ian Ingram, Deputy Managing Editor, MedPage

In 2019, headlines in head and neck cancer were dominated by a new first-line approval in squamous cell carcinoma (SCC), further attempts at treatment deintensification in the lower-risk human papillomavirus (HPV) population, and a provocative trial looking at patients’ quality of life following either robotic surgery or radiation.

Immunotherapy OK’d in First-line
Based on data from the three-arm KEYNOTE-048 trial, the FDA approved pembrolizumab (Keytruda) for the first-line treatment of metastatic or unresectable recurrent head and neck SCC. The PD-1 immune checkpoint inhibitor was approved in combination with chemotherapy for all patients, or as monotherapy for those with PD-L1 expression.

Final results of the study demonstrated a 23% reduction in the hazard for death for the group treated with pembrolizumab plus platinum chemotherapy (cisplatin or carboplatin) and 5-fluorouracil. This group had a median overall survival of 13.0 months, as compared with 10.7 months for those treated with the EXTREME regimen of platinum chemotherapy plus 5-fluorouracil and cetuximab (Erbitux).

A pembrolizumab monotherapy arm of KEYNOTE-048 showed non-inferiority to EXTREME in all comers and superiority in patients with a PD-L1 combined positive score (CPS) ≥1, as represented by a 22% reduction in the hazard for death over the study period. In this CPS ≥1 population, which made up about 85% of the study population, median overall survival was 12.3 with pembrolizumab alone versus 10.3 months with EXTREME.

ORATOR Trial Upends Assumption of Surgical Superiority
In the first randomized trial to pit transoral robotic surgery (TORS) against radiotherapy for patients with oropharyngeal SCC, the ability to swallow and other outcomes appeared to be better with radiation — contradicting previous retrospective data that favored surgery.

With roughly 2 years of follow-up, the phase II trial of 68 patients met its primary endpoint, showing a statistically significant improvement in swallowing 1 year after treatment in the radiotherapy group.

This group had a nearly 7-point advantage on the 100-point MD Anderson Dysphagia Inventory (MDADI) scale compared with the surgery cohort (86.9 vs 80.1, respectively, P=0.042), suggesting that these patients may have improved swallowing function — the trial had prespecified that a 10-point difference would be considered “clinically meaningful.”

Investigators said the findings indicate that patients should be offered both treatment options.

Less Therapy in HPV-Positive Disease
At the American Society for Radiation Oncology (ASTRO) annual meeting, results from the HN002 trial showed impressive results with two de-escalation strategies in low-risk HPV-positive head and neck cancer. Among the 306 mostly non-smoking patients in the phase II multi-institutional study, those assigned to lower-dose (60 Gy) intensity-modulated radiotherapy (IMRT) plus weekly cisplatin had a 2-year progression-free survival (PFS) of 90.5%, as compared with 87.6% in a group treated with IMRT at 60 Gy alone.

Only the combination arm met the investigators’ prespecified PFS target, while both met their swallowing-related quality-of-life criteria. On the MDADI scale, patients reported scores of 85.3 (5.6-point decline from baseline) in the combined modality arm and 81.8 (6.2-point decline) in the radiation-alone arm. Overall survival (OS) rates at 2 years were greater than 95% for the two arms.

Meanwhile, a prospective study from the University of North Carolina reported 2-year rates of locoregional control and OS of 95% with a dual strategy of deintensified treatment for HPV-positive oropharyngeal cancer.

PFS at 2 years was 86%, and 91% of the 114 patients remained free of distant metastases. No grade ≥3 late adverse events occurred, and global quality of life improved from pretreatment to 2 years.

Experts emphasized, however, that deintensification should only be attempted in clinical trials

“What is the best treatment for patients with low-risk oropharynx cancer?” said ASTRO discussant Beth Beadle, MD, of Stanford University Medical Center in California, in discussing the HN002 trial. “Standard of care is standard of care, we do not have phase III data supporting de-escalation off protocol.”

Standard of care remains 70 Gy with concurrent cisplatin for patients with low-risk disease.

Retrospective Studies Provoke
A single-arm trial in New York reported that a treatment delay greater than 2 months from diagnosis was significantly associated with worse OS in patients with head and neck SCC.

In a group of 956 patients treated at an urban academic center, those with a time to treatment initiation (TTI) longer than 60 days were significantly more likely to die from their disease (odds ratio [OR] 1.69, 95% CI 1.32-2.18) and have disease recurrence (OR 1.77, 95% CI 1.07-2.93) compared to those treated within this timeframe. The 5-year overall survival for patients dropped from 64.5% to 47.0% when the TTI stretched beyond 60 days.

“If I invented a drug that could give a 20% improved survival in head and neck cancer patients, a disease where survival has not changed for many years, I would probably be getting handed a large amount of funding,” study author Vikas Mehta, MD, MPH, of Montefiore Medical Center in New York City, told MedPage Today.

“This study is just as important,” he continued. “Getting patients to treatment in a timely manner can independently improve survival.”

Another retrospective study pointed to the possible benefit of regular use of aspirin or other common nonsteroidal anti-inflammatory drugs (NSAIDs) for head and neck cancers with a particular gene mutation.

In 75 patients with PIK3CA mutations or amplification, users of NSAIDs for at least 6 months after curative treatment had significantly prolonged disease-specific survival (HR 0.23, 95% CI 0.09-0.62) and OS (HR 0.31, 95% CI 0.14-0.69) compared with non-regular NSAID users. The effect was seen regardless of patients’ HPV status. Predicted 5-year OS rates were 78% for the regular NSAID users and 45% for non-regular users.

Is Magic Mouthwash Just an Illusion?
Two medicated mouthwashes led to reductions in oral mucositis pain for head and neck cancer patients treated with radiotherapy, but not at a level deemed clinically important, a randomized phase III study found.

Within 4 hours of radiotherapy, pain from oral mucositis dropped by 11.7 points (as defined by the area under the curve) with a diphenhydramine-lidocaine-antacid rinse — or “magic mouthwash” — and 11.6 points with a doxepin mouthwash, compared with 8.7 points with placebo, researchers reported.

Compared with placebo, diphenhydramine-lidocaine-antacid led to a 3.0-point improvement (95% CI 0.1-5.9) while the doxepin mouthwash led to a 2.9-point improvement, both of which were less than what the investigators said would be clinically important differences going into the trial.

“These data tell us that magic mouthwash (or doxepin) is not the sole answer to managing mucositis — physicians should not prescribe magic mouthwash and expect magic!” Arjun Gupta, MD, of the Sidney Kimmel Comprehensive Cancer Center in Baltimore, who was not involved in the study, told MedPage Today.

“Most providers do not know the contents or concentrations of the ingredients in these mixed-medication formulations,” he said. “They could also contain unnecessary and harmful ingredients such as steroids and antibacterials/antifungals. How many other drugs do physicians prescribe without knowing the contents or concentration?”

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November, 2019|Oral Cancer News|

Supporting patients at every stage of living with head and neck cancers

Source: www.nursingtimes.net
Author: Wendy Robson

Wendy Robson, lead head and neck clinical nurse specialist at University Hospitals of North Midlands NHS Trust, shares her perspective on how her role supports the multidisciplinary team to care for patients living with head and neck cancers

Before, during and after treatment for head and neck cancers, the care pathway is complex and often overwhelming for patients. Without support, patients often have anxieties around cancer care and concerns related to employment and finances.

The Beyond Clinical Outcomes: UK patient experience in head and neck cancers survey report of patients living with head and neck cancers focused on how these cancers affect people and what they valued from cancer care. The report was funded by Bristol-Myers Squibb (BMS) and co-developed via a three-way partnership between BMS, The Swallows Head and Neck Cancer Patient Support Group and the Mouth Cancer Foundation – two charities that provide support and advice to patients living with head and neck cancers.1

It identified a need for an engaged multidisciplinary team to be involved throughout the patient pathway. Wendy Robson, head and neck clinical nurse specialist at University Hospitals of North Midlands (UHNM) agrees, stating that “we provide holistic support from day one regarding treatment and every other aspect of a patient’s life that is affected by a cancer diagnosis”.

Ms Robson and the team at UHNM are driving best practice care for head and neck cancer patients that aligns to national guidelines, offers support throughout the care pathway and helps patients return to their day-to-day lives at their own pace. Ms Robson’s responsibilities are usually split between meetings with the multidisciplinary team, oncology clinics and wards.

The team is formed of a range of specialists who work collaboratively and are engaged at each stage of head and neck cancer care.

  • Consultant oncologists;
  • Ear, nose and throat surgeons;
  • Clinical nurse specialists (CNSs);
  • Lymphoedema nurse specialists;
  • Oral and maxillofacial surgeons;
  • Restorative dentists;
  • Clinical psychologists;
  • Radiologists;
  • Speech and language therapists;
  • Dieticians;
  • Histopathologists;
  • Physiotherapists.

Continuity of care
With the CNS team helping to coordinate the multidisciplinary team and ensuring all members continually communicate with each other, they help enable the whole team to provide joined up care for patients from diagnosis to post-treatment care.

The CNSs lead an allied health professional clinic, managing patients who are new to the clinic and those on the ward. Key members of the multidisciplinary team are present at the clinics, which ensures patients receive specialist support in a prompt and timely manner. The team prepares patients for care before and after diagnosis and treatment – this can include surgery, radiotherapy, or chemotherapy.

The report found that 32% of patients surveyed self-reported difficulties eating a balanced diet and 37% experienced communication challenges, highlighting the need for support when dealing with functional changes and physical disfigurement caused by treatment and surgery.1

Therefore, the CNS provides patients with a resource pack and coordinates pre-treatment care in collaboration with dieticians and speech and language therapists to ensure appointments are in place to support:

  • The patient’s current standard of nutrition and whether tube feeding may be required;
  • Challenges with verbal communication and functional changes patients may experience following treatment, such as issues with swallowing;
  • The social concerns a patient may have, by referring them to the appropriate services for financial support and advice on how to return to work after receiving treatment.

After a patient has received treatment for their cancer, they return to the clinic to discuss potential concerns when returning home. These can be clinical or non-clinical, demonstrating how central the CNS is to providing continuity of care for patients.

The CNS coordinates post-treatment care by referring patients to the in-hospital Macmillan Cancer Support Centre and community-based care services to help patients return to their everyday life. The ongoing post-treatment care provided by UHNM is vital, as the potential side-effects, primarily resulting from radiotherapy and chemotherapy, can be challenging and may take years to manifest and affect a patient’s quality of life.

Going one step further, Ms Robson explained that currently at UHNM, patients usually attend the follow up clinic for up to five years. “We support them from their first day in the clinic and we constantly communicate as a multidisciplinary team to ensure we can provide continued care through each stage of cancer.”

The CNS orchestrates additional support services for patients living with head and neck cancers that go beyond standard care, demonstrating commitment to patients.

The buddy system
At UHNM, patients are buddied with volunteer patients who have been through the clinic and experienced similar care. This support system is split between head and neck cancer, laryngectomy and thyroid specialties, with buddies participating in a Macmillan training course to be able to provide an additional level of support for patients whenever it’s needed.

Caring for carers
Carers are often a group that can feel less supported in the care of loved ones. The recent report showed only 7% of patients surveyed received any type of domestic carer support.1 Carers form a key part of the support network for patients with head and neck cancers and Ms Robson invests in building relationships with them to make them feel supported. The CNS team support carers in between consultations with the multidisciplinary team by hosting social events at UHNM, that focus on the health and well-being of patients.

Psychological support at UHNM
Another finding from the report showed less than half of patients (46%) reported that they were offered services for emotional and psychological support.1 UHNM provides additional psychological support for patients dealing with head and neck cancers. CNSs undergo advanced communication skills and level 2 psychological support training to be equipped with the vital skills to have difficult conversations, such as communicating a diagnosis or a change of treatment plan, as well as helping patients to overcome the physical disfigurement that can result from treatment or surgery. If a patient requires further support, clinical psychologists are available to help patients living with head and neck cancers throughout the care pathway. It’s a great example of how important an engaged multidisciplinary team is in the care of patients.

Putting the patient at the centre of decision making
Of the patients surveyed, 16% did not feel very involved in decisions made by the lead health professional, and this is something UHNM meets head on.1

Putting patients at the centre of a treatment decision is made more complex by the multitude of factors affecting a patient who has undergone, or is undergoing, treatment for head and neck cancer. As the survey demonstrates, there are a number of unique psychological and physical factors to consider alongside new therapeutic advances that have been introduced to the treatment landscape. From surgery through to post-treatment care, CNSs help to build a care pathway that is right for each patient given their everyday challenges. By providing rationale and advice for each treatment option, the patient is included in the decision-making process and feels engaged in their care.

The CNS not only plays a key role in coordinating the multidisciplinary team, they also ensure that services support patients so they can carry on living their lives, “from managing referrals to speech therapists, dieticians and dentists, to providing support for carers and buddying patients up with other patients, we play a part in patient survivorship, as well as improving the patient experience of living with head and neck cancer, and beyond,” said Ms Robson.

References
1Bristol-Myers Squibb (2019) Beyond Clinical Outcomes: UK Patient Experience in Head and Neck Cancers. www.theswallows.org.uk/wp-content/uploads/2019/08/APPROVED-HN-Report-final-1.pdf

Declaration of interest: This article has been developed and funded by Bristol-Myers Squibb Pharmaceuticals Limited (BMS). BMS has had full editorial control over the content.

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November, 2019|Oral Cancer News|

Doctors try CRISPR gene editing for cancer, a 1st in the US

Source: AP News
Date: 11/6/19
Author: Marilynn Marchione

The first attempt in the United States to use a gene editing tool called CRISPR against cancer seems safe in the three patients who have had it so far, but it’s too soon to know if it will improve survival, doctors reported Wednesday.

The doctors were able to take immune system cells from the patients’ blood and alter them genetically to help them recognize and fight cancer, with minimal and manageable side effects.

The treatment deletes three genes that might have been hindering these cells’ ability to attack the disease, and adds a new, fourth feature to help them do the job.

“It’s the most complicated genetic, cellular engineering that’s been attempted so far,” said the study leader, Dr. Edward Stadtmauer of the University of Pennsylvania in Philadelphia. “This is proof that we can safely do gene editing of these cells.”

After two to three months, one patient’s cancer continued to worsen and another was stable. The third patient was treated too recently to know how she’ll fare. The plan is to treat 15 more patients and assess safety and how well it works.

“It’s very early, but I’m incredibly encouraged by this,” said one independent expert, Dr. Aaron Gerds, a Cleveland Clinic cancer specialist.

Other cell therapies for some blood cancers “have been a huge hit, taking diseases that are uncurable and curing them,” and the gene editing may give a way to improve on those, he said.

Gene editing is a way to permanently change DNA to attack the root causes of a disease. CRISPR is a tool to cut DNA at a specific spot. It’s long been used in the lab and is being tried for other diseases.

This study is not aimed at changing DNA within a person’s body. Instead it seeks to remove, alter and give back to the patient cells that are super-powered to fight their cancer — a form of immunotherapy.

Chinese scientists reportedly have tried this for cancer patients, but this is the first such study outside that country. It’s so novel that it took more than two years to get approval from U.S. government regulators to try it.

The early results were released by the American Society of Hematology; details will be given at its annual conference in December.

The study is sponsored by the University of Pennsylvania, the Parker Institute for Cancer Immunotherapy in San Francisco, and a biotech company, Tmunity Therapeutics. Several study leaders and the university have a financial stake in the company and may benefit from patents and licenses on the technology.

Two of the patients have multiple myeloma, a blood cancer, and the third has a sarcoma, cancer that forms in connective or soft tissue. All had failed multiple standard treatments and were out of good options.

Their blood was filtered to remove immune system soldiers called T cells, which were modified in the lab and then returned to the patients through an IV. It’s intended as a one-time treatment. The cells should multiply into an army within the body and act as a living drug.

So far, the cells have survived and have been multiplying as intended, Stadtmauer said.

“This is a brand new therapy” so not it’s not clear how soon any anti-cancer effects will be seen. Following these patients longer, and testing more of them, will tell, he said.

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November, 2019|Oral Cancer News|

Despite only a 50% HPV vaccination rate in adolescents, cervical precancer incidence rates drop

Source: www.targetedonc.com
Author: Tony Berberabe, MPH

Although a vaccine for the human papillomavirus (HPV) is widely available, an average of 34,800 HPV-associated cancers attributable to the virus, including cervical, vaginal, vulva, penile, anal, and oropharynx were reported in the United States from 2012 through 2016, according to data published in Morbidity and Mortality Weekly Report.1 The estimated number of cancers attributable to HPV types targeted by the 9-valent HPV vaccine (9vHPV) is also rising. These recent increases are due in part to an aging and growing population and increases in oropharyngeal, anal, and vulvar cancers, lead author Virginia Senkomago, PhD, MPH, an epidemiologist and senior service fellow at the Centers for Disease Control and Prevention in Atlanta, Georgia, said in an email.

Although HPV vaccination is an important component of cancer prevention, only about 50% of adolescents have received the vaccine. Of cancer cases attributable to the HPV types targeted by the vaccine, 19,000 (59%) occurred in female patients and 13,100 (41%) occurred in male patients.

But there is some good news.

Senkomago said HPV infections and cervical precancers have dropped significantly since the vaccine was introduced. Infections with HPV types have dropped 86% among teenage girls. Among vaccinated women aged 20 to 24 years, the percentage of cervical precancers caused by the HPV types most often linked to cervical cancer dropped by 40%. The vaccination is recommended through age 26 for all individuals, especially for those who were not vaccinated when they were younger. The vaccine is not recommended for individuals older than 26 years, but some adults between 27 and 45 years may decide to get the HPV vaccine based on a discussion with their clinician. HPV vaccination provides less benefit to adults in this age range, as more have already been exposed to HPV, said Senkomago.

Further, it is anticipated that compliance should increase because the original 3 doses every 2 months now seems to be getting replaced by 2 doses with similar efficacy rates.

Previous annual estimates of cancers attributable to the types targeted by 9vHPV were 28,500 (2008-2012),2 30,000 (2010-2014),3 and 31,200 (2011-2015).4

“HPV is a distinct subset of head and neck cancers. It now exceeds cervical cancer as a major health burden in the [United States] because, in part, there’s no effective screening strategy,” said Robert L. Ferris, MD, PhD, director of the University of Pittsburgh Medical Center’s Hillman Cancer Center in Pittsburgh, Pennsylvania, and co–physician editor in chief of Targeted Therapies in Oncology. A number of challenges exist in the treatment of patients with HPV-positive head and neck cancer, Ferris said. These include lack of a screening tool and relatively low adherence to vaccination. The disease also has a long latency period,5 adding to the difficulty in treatment.

“These patients don’t have traditional risk factors,” Ferris continued. “They may just present to their doctor with a lump in the neck area with very few symptoms. They usually have no history of tobacco use or exposure history, so they can be overlooked for weeks and months before a needle biopsy is ordered. Needle biopsy can be diagnostic.”

Of the 32,100 HPV cancer types, those with the highest incidence were oropharyngeal and the lowest was vaginal (FIGURE 1), the report said.1

“We are striving to vaccinate as many people as possible. Right now our goals are identifying groups with the lower rates, such as people who live in rural areas, and working to remove unique barriers to vaccination they may face,” Senkomago said.

Senkomago added that the most surprising finding was that oropharyngeal cancer was the most common cancer attributable to HPV types targeted by 9vHPV in most states, except in Texas, where cervical cancer was most common, and in Alaska, New Mexico, New York, and Washington DC, where estimates of oropharyngeal and cervical cancers attributable to the 9vHPV-targeted types were the same (FIGURE 2).1

In particular, Senkomago said, these findings can inform community oncologists of the burden of HPV-associated cancers, especially in light of the increase of cases of oropharyngeal, anal, and vulvar cancers. Increasing awareness of the burden of the 7 HPV-associated cancers, individually and as a group, is a powerful prevention tool. Oncologists can advocate for strategies such as screening and HPV vaccination. In addition, community oncologists can work together with cancer survivors to engage communities to vaccinate and get screened as appropriate, she said.

Ferris cautioned against changing treatment algorithms too soon, especially before prospective clinical trials result are fully analyzed. “We need specific clinical trials before we can reduce the intensity of therapy because we don’t want to impair the very good survival, which can be 80% to 90%, in these patients and put that at risk,” he said. “We don’t want to jeopardize that strong survival rate. Those prospective clinical trials are ongoing, and those results should be reported out intensively in 2020, 2021, and beyond.”

Although the report focused on only the 9vHPV vaccine, a quadrivalent vaccine is also available. Investigators are evaluating whether any shift in the subtypes of HPV that cause cervical or head and neck cancer has been detected with the implementation of the quadrivalent vaccine. Senkomago said scientists continue to evaluate HPV types before and after vaccine introduction in population-based studies. To date, they have not found any evidence that type replacement is occurring.6

References:
1. Senkomago V, Henley J, Thomas CC, Mix JM, Markowitz LE, Saraiya M. Human papillomavirus—attributable cancers—United States, 2012-2016. MMWR Morb Mortal Wkly Rep. 2019;68(33):724-728. doi: 10.15585/mmwr.mm6833a3.
2. Viens LJ, Henley SJ, Watson M, et al. Human papillomavirus–associated cancers — United States, 2008–2012. MMWR Morb Mortal Wkly Rep. 2016;65(26):661-666. doi: 10.15585/mmwr.mm6526a1
3. Cancers associated with human papillomavirus, United States—2010–2014. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no1-hpv-assoc-cancers-UnitedStates-2010-2014.htm. Accessed September 12, 2019.
4. Cancers associated with human papillomavirus, United States—2011–2015. Centers for Disease Control and Prevention website. cdc.gov/cancer/uscs/about/data-briefs/no4-hpv-assoc-cancers-UnitedStates-2011-2015.htm. Accessed September 12, 2019.
5. Human papillomavirus (HPV). Centers for Disease Control and Prevention website. cdc.gov/hpv/parents/cancer.html. Accessed September 10, 2019.
6. Mesher D, Soldan K, Lehtinen M, et al. Population-level effects of human papillomavirus vaccination programs on infections with nonvaccine genotypes. Emerg Infect Dis. 2016;22(10):1732-1740. doi: 10.3201/eid2210.160675.

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November, 2019|Oral Cancer News|

Research to examine possible links between periodontal disease and oral cancer

Source: eu.dental-tribune.com
Author: Dental Tribune International staff

As worldwide oral cancer rates continue to climb, our understanding of what causes the disease to occur, thankfully, also continues to grow. Tobacco use and excessive alcohol consumption have been established as primary risk factors, and researchers are now investigating another potential source for this condition: the bacteria that cause periodontal disease.

The research is being led by Dr Louise Belfield, a lecturer in biomedical science at the University of Plymouth’s Peninsula Dental School, in collaboration with the university’s Institute of Translational and Stratified Medicine. Since cancer requires blood vessels to grow and metastasise, the research team is planning to build on existing evidence that shows how certain bacteria that cause periodontal disease are linked to angiogenesis.

To do so, the research team will develop miniature tumours and blood vessels in a laboratory setting, adding the bacteria with the aim of clarifying how they function and what effect they have on the blood vessels.

According to a press release from the university, if the research ascertains that the bacteria make the blood vessels grow more rapidly and similarly to those associated with tumours and identifies the process by which this is achieved, the results could form the basis of a new screening programme to detect oral cancer risk earlier. This would make it possible to begin treatment in a more timely manner.

“We know that tumours in the mouth, unlike many other tumours, are in constant contact with bacteria, but we don’t know exactly how the bacteria affect tumour and vessel growth yet,” said Belfield.

“The bacteria may not cause the cancer, but they may do something to make the progression of the cancer speed up. One way they could do this is via the blood vessels, encouraging them to grow more rapidly or in a way which helps the tumour to grow. So if we find out what this is and how it works, it can help us develop and put screening processes in place to detect and reduce the numbers of those bacteria,” she continued.

Dental Tribune International (DTI) has previously reported on a study which confirmed the crucial role of dental professionals in detecting oral cancer early. This early detection can greatly improve the prognosis of sufferers.

“Oral cancer is a horrific disease with poor survival rates—only around 50% of those diagnosed are alive five years later. It is an in-your-face, no-hiding, disfiguring disease, and the treatment can be very protracted, complex and costly,” said Dr David Conway, Professor of Dental Public Health at the University of Glasgow’s School of Medicine, Dentistry and Nursing, in an interview with DTI last year.

“The earlier it is detected, however, the better the outcome can be,” Conway added.

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November, 2019|Oral Cancer News|

Oral sex blamed for rise of mouth cancer in UK

Source: www.medicaldaily.com
Author: Darwin Malicdem

The number of people diagnosed with mouth cancer has significantly increased by 135 percent over the past 20 years in the United Kingdom. Experts believe the increase comes amid the growing number of Brits engaging in oral sex.

Nonprofit Oral Health Foundation (OHF) issued a report showing oral cancer rates “have more than doubled in a generation” across the U.K. In 2018 alone, seven people died every day from the disease in Great Britain and Northern Ireland.

“While most cancers are on the decrease, cases of mouth cancer continue to rise at an alarming rate,” Nigel Carter, chief executive of the OHF, told the Daily Mail. “It changes how somebody speaks, it makes eating and drinking more difficult, and often changes a person’s physical appearance.”

The foundation said the sexually transmitted human papillomavirus (HPV) caused 73 percent of the oropharyngeal mouth cancers. But drinking alcohol also contributed to the higher rates of the disease in the U.K.

OHF said 33 percent of mouth cancer diagnoses over the past decades were linked to consumption of alcoholic beverages. Smoking was associated with 17 percent of the cases.

The foundation launched Mouth Cancer Action Month in early November that aims to spread awareness of mouth cancer and its signs and symptoms.

“We want everyone to be more mouth aware during this year’s campaign,” Carter said in a press release. “This means being able to identify the signs and symptoms of mouth cancer, understand what is more likely to put us at greater risk, and importantly, know where to go if you spot anything out of the ordinary.”

He added early diagnosis has been effective to prevent deaths in the past years. Philip Lewis, of the Mouth Cancer Foundation, also highlighted that public awareness programs and self examination would help address the health issue.

In the U.S., the number of mouth cancer is also increasing. The Oral Cancer Foundation reported that nearly 54,000 Americans are being diagnosed with the disease every year.

Mouth cancer kills one person per hour in the country, leading to 13,500 deaths every year.

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November, 2019|Oral Cancer News|

Study shows checkpoint inhibitor prolongs survival in patients with certain head and neck cancers

Source: medicalxpress.com
Author: Anne Doerr, Yale University

The checkpoint inhibitor pembrolizumab (Keytruda) increases the survival time of patients with advanced head and neck cancers, according to a new global study led by Yale Cancer Center (YCC). The data was published today in the journal The Lancet.

The findings of the phase 3 study show that, compared to the standard therapy, overall survival was significantly improved for participants with previously untreated recurrent or metastatic head and neck cancers.

“This research demonstrates that this checkpoint inhibitor, with or without chemotherapy, should be the first drug used for these types of cancers,” said the study’s lead investigator, Barbara Burtness, M.D., a professor of medicine (medical oncology) and co-leader of developmental therapeutics at YCC. “This is a very positive advance in treatment for our patients.”

Burtness added that early results from this clinical trial, KEYNOTE-048, led to FDA approval earlier this year of pembrolizumab as first-line therapy in untreated recurrent or metastatic head and neck squamous-cell carcinoma, which include cancers of the oral cavity, oropharynx, hypopharynx and larynx.

While the median survival benefit was calculated in months, some patients treated with pembrolizumab lived much longer and did significantly better than patients who were not treated with the checkpoint inhibitor, Burtness noted.

The study looked at 882 participants enrolled in 200 medical centers in 37 countries, who were randomly assigned to one of three different groups: those receiving pembrolizumab, those treated with pembrolizumab and chemotherapy, and those getting the standard therapy with cetuximab and chemotherapy. Cetuximab is a drug designed to shut down a protein which makes cancer cells more responsive to growth factors. The chemotherapy used was platinum and 5-fluorouracil.

Pembrolizumab used alone improved average survival to 14.9 months, compared to 10.7 months for standard therapy. Use of pembrolizumab combined with chemotherapy improved survival to an average of 13 months.

Furthermore, survival differences between patients treated with pembrolizumab and those who weren’t remained apparent years after treatment.

Investigators found that at three years, 33 percent of patients treated with pembrolizumab monotherapy were alive, as well as about 26 percent of participants in the pembrolizumab/chemotherapy groups, compared with only 8 percent of those in the standard treatment group.

“The difference with immunotherapy is the durability of the effect it has on survival,” Burtness said. “These agents seem to change the tumor microenvironment, altering the natural history of the cancer.”

Patients treated with pembrolizumab alone experienced fewer side effects, and participants in the other two groups experienced about the same level of adverse effects.

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November, 2019|Oral Cancer News|

Tiny cancer tracers could boost survival rates

Source: www.bignewsnetwork.com/
Author: PanArmenian.Net staff

Nanoparticles that can detect complex cancer cells and potentially improve five-year survival rates are headed for human trials.

South Australian company Ferronova has developed the nanoparticles that are designed to identify early stage tumor and related cancer cells, Medical Xpress says. Ferronova Chief Executive Stewart Bartlett said the tiny cancer tracers were expected to be trialled on oral cancer patients at the Royal Adelaide Hospital in April 2020, pending key approvals.

Bartlett said once Ferronova’s polymer-coated iron oxide nanoparticles were injected into patients they would show up on an MRI within about 15 minutes.

‘The way they work in cancer is they’re designed to be detected around a solid tumor’ he said.

‘They’ll actually be picked up by your lymphatic system as a foreign body and follow the same pathway as any cancer spread from a primary tumor would follow.

‘If you can actually know where those particles are going you can also determine where the cancer would have gone.’

Ferronova was spun out of a nanoparticles research collaboration between the University of South Australia and New Zealand’s Victoria University, with backing from IP investors Powerhouse Ventures and UniSA Ventures. Bartlett said preclinical trials at the Mawson Lakes lab had given the company confidence to use the particles on humans. He said the treatment was expected to be 90 percent accurate.

‘We’ve added a molecule to the particles so they go to the first lymph node and they are retained in the first lymph node, which no other magnetic particles do,’ Bartlett said.

‘The advantage of that is you can do these injections and do an MRI after 15 minutes. But if you don’t have surgery for another two or three days that’s OK because they [the particles] stay in the first node.’

He said the technique had so far been used in cancers such as breast and melanoma.

‘If you look at the patients who are diagnosed with localized cancer, their five-year survival rates are pretty much 100 percent,’ Bartlett said.

‘Our technology was to make this possible in complex cancers.

‘A good example would be lung cancer. In the early stage lung cancers, that are assumed to be localized, the five-year survival rate is about 50 percent.

‘Our objective is to really improve the five-year survival rate for those more complex cancers that don’t take advantage of that method.’

University of South Australia biomedical engineer Professor Benjamin Thierry and Ph.D. student Valentina Milanova are collaborating on the trial. Prof Thierry has previously led a study investigating the impact of radiotherapy on the body’s tissues.

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November, 2019|Oral Cancer News|

Oral mucositis: preventing the side effect before undergoing cancer treatment

Source: www.curetoday.com/
Author: Katie Kosko

Oral mucositis can be painful and, in some cases, require hospitalization of patients being treated for cancer with chemotherapy and other radiation therapies. However, along with your care team, you can take steps to prevent this uncomfortable side effect.

In an interview CURE®, Dr. Alessandro Villa, assistant professor in oral medicine and dentistry at the Harvard School of Dental Medicine, Brigham and Women’s Hospital in Boston, spotlighted the number of patients with cancer who are affected by oral mucositis, explained the benefits of two agents approved by the Federal Drug Administration (FDA) for intervention and explored how patients can control the side effect from the comfort of their homes.

CURE®: Can you explain what types of cancer treatment cause oral mucositis?
Villa: Oral mucositis is an iconic toxicity of cancer therapy and remains one of the most painful and disrupting side effects of radiation therapy and chemotherapy. When I talk about radiation therapy, I talk about patients with head and neck cancer. In these patients, usually 100% receiving radiation therapy develop oral mucositis. We also see mucositis in approximately 60% to 80% of patients who undergo bone marrow transplants. And finally, we see it in 20% to 40% of patients who receive conventional chemotherapy for any cancer.

What are the consequences of oral mucositis?
Oral mucositis is one of the most painful toxicities in patients receiving radiation therapy to the head and neck. It’s the number one cause of hospitalization in these patients. It can sometimes be so severe and painful that patients can’t speak, swallow or eat. It’s a very debilitating toxicity. If they are not able to eat, they may end up receiving a feeding tube. The cost associated with oral mucositis is higher than $17,000 per patient. There is still a huge unmet need out there for patients.

What questions should patients and/or caregivers ask their health care team about oral mucositis?
The first question I would have them ask is, what can I expect? Because it can be different between radiation and chemotherapy. And as we have discussed, they can also ask: What can I do at home to minimize this risk? And what are the preventative measures?

How can oral mucositis be prevented?
The FDA has approved two agents for mucositis intervention. One is called palifermin, which is approved for the prevention of severe oral mucositis in patients who receive certain treatment in preparation for bone marrow transplant. The second agent, which is for mitigation of mucositis in patients treated with radiation for head and neck cancer, is a rinse called benzydamine hydrochloride.

Cryotherapy is recommended by the American Society of Clinical Oncology in patients who receive a specific chemotherapy, 5-fluorouracil or more commonly 5FU. Patients can swish on ice chips for about 30 minutes starting about five minutes before the drug is administered. And to control mucositis pain, morphine may be used in patients who undergo stem cell transplantation.

What can patients do at home to help avoid the side effect or reduce its severity?
There are specific recommendations that patients should follow to minimize oral mucositis. One of them is maintaining good oral hygiene using a soft toothbrush. Patients can also use a saline solution 3-4 times a day, then rinse and spit. Cleansing of the mouth and good lubrication of the inside of the cheeks and lips can help with the pain and inflammation. The reason behind it is that, from a scientific standpoint, the microbiome (the bacteria and all the bugs that we have in the mouth) can contribute in the development and worsening of the mucositis. The cleaner the mouth, the better it is. Of course, patients may be sensitive to certain toothpastes, so it’s important to use mild-flavored fluoridated toothpaste when brushing. In some cases, patients should avoid spicy, acidic or hot foods because these may trigger symptoms for the patient.

How is the side effect monitored?
This depends on the type of treatment they are receiving. If they are receiving radiation, they come in the hospital Monday through Friday, so they are monitored daily.

For those with chemotherapy, most of these drugs are administered through IV in the hospital. However, there are some new chemotherapies given by mouth and patients take these at home, but they can give different side effects.

Is there anything else that you would like to add about oral mucositis?
Right now, this is a huge unmet clinical problem for patients and a devastating toxicity, but the development for oral mucositis is pretty robust with a wide range of new agents. This is promising, and there are some good results in current clinical trials with some of these new agents in progress. If I’m being optimistic, I think that there should be new options ready for approval in the next 5-10 years. There is a lot in the pipeline.

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November, 2019|Oral Cancer News|