6/10/2006 Chicago IL Lauren Heist Beep (www.beepcentral.com) For lots of people, oral sex seems fun and risk-free. You can’t get pregnant, and it’s pretty difficult to get AIDS. What’s not to like? See, you won’t get pregnant if you give or receive oral sex, but you can get infected with Human Papillomavirus (HPV) -- most commonly known as the virus that causes genital warts. HPV has been known to cause cervical cancer for years, but new research has proven that some forms of this common sexually transmitted disease can lead to cancer of the mouth and throat, according to the American Cancer Society. HPV is one of the most common sexually transmitted diseases in the world -- 75 to 80 percent of all Americans between the ages of 15 and 49 have been infected with the virus, according to the American Social Health Association. In fact, you’re probably infected right now and don’t even know it. That’s because when the virus is inactive, it’s very difficult to spot. You can get a normal pap smear and still be a carrier. When the virus becomes active, it often shows up as genital warts. HPV, whether active or inactive, is transmitted by skin-to-skin contact, so you can get HPV even if you or your partner is wearing a condom or even if you’re having oral sex instead of regular sex. “If you’re wearing a condom, there are parts of your anatomy that aren’t protected,” says Brian Hill, executive director of the Oral [...]

6/9/2006 Gainesville, FL William M. Mendenhall et al. Journal of Clinical Oncology, Vol 24, No 17 (June 10), 2006: pp. 2618-2623 The purpose of this article is to review the role of intensity-modulated radiotherapy (IMRT) in the standard management of patients with head and neck cancer through a critical review of the pertinent literature. IMRT may result in a dose distribution that is more conformal than that achieved with three-dimensional conformal radiotherapy (3D CRT), allowing dose reduction to normal structures and thus decreasing toxicity and possibly enhancing locoregional control through dose escalation. Disadvantages associated with IMRT include increased risk of a marginal miss, decreased dose homogeneity, increased total body dose, and increased labor and expense. Outcomes data after IMRT are limited, and follow-up is relatively short. Locoregional control rates appear to be comparable to those achieved with 3D CRT and, depending on the location and extent of the tumor, late toxicity may be lower. Despite limited data on clinical outcomes, IMRT has been widely adopted as a standard technique in routine practice and clinical trials. The use of IMRT involves a learning curve for the practitioner and will continue to evolve, requiring continuing education and monitoring of outcomes from routine practice. Additional standards pertaining to a variety of issues, including target definitions and dose specification, need to be developed. Phase III trials will better define the role of IMRT in coming years. Authors: William M. Mendenhall, Robert J. Amdur, Jatinder R. Palta Authors' affiliation: From the Department of Radiation Oncology, [...]

6/9/2006 Alexandria, VA Carole Fakhry, Maura L. Gillison Journal of Clinical Oncology, Vol 24, No 17 (June 10), 2006: pp. 2606-2611 Human papillomavirus (HPV) is now recognized to play a role in the pathogenesis of a subset of head and neck squamous cell carcinomas (HNSCCs), particularly those that arise from the lingual and palatine tonsils within the oropharynx. High-risk HPV16 is identified in the overwhelming majority of HPV-positive tumors, which have molecular-genetic alterations indicative of viral oncogene function. Measures of HPV exposure, including sexual behaviors, seropositivity to HPV16, and oral, high-risk HPV infection, are associated with increased risk for oropharyngeal cancer. HPV infection may be altering the demographics of HNSCC patients, as these patients tend to be younger, nonsmokers, and nondrinkers. There is sufficient evidence to conclude that a diagnosis of HPV-positive HNSCC has significant prognostic implications; these patients have at least half the risk of death from HNSCC when compared with the HPV-negative patient. The HPV etiology of these tumors may have future clinical implications for the diagnosis, therapy, screening, and prevention of HNSCC. Authors' affiliation: From the Departments of Viral Oncology, Aerodigestive Malignancy, and Cancer Prevention and Control, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and the Departments of Epidemiology and Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

6/9/2006 Madison, WI Stuart J. Wong, Mitchell Machtay, Yi Li Journal of Clinical Oncology, Vol 24, No 17 (June 10), 2006: pp. 2653-2658 Patients with locally recurrent head and neck cancer previously treated with radiation have a poor prognosis. Administration of a second course of radiation to tissues within a previous radiation portal, has been traditionally considered unsafe. Survival rates of highly selected patients treated with concurrent chemotherapy and re-irradiation may be as high as 25% at 2 years—exceeding the outcome of matched historical controls treated with chemotherapy alone (10%). However, many questions exist regarding the use of re-irradiation. Uncertainty exists over the criteria for selecting patients who are most appropriate for treatment with re-irradiation. Even greater concern exists regarding toxicity and functional sequelae associated with the use of re-irradiation. Whether the benefits of re-irradiation on locoregional disease control and survival outweigh its potentially severe and life-threatening adverse effects is not clear. In this review, we will discuss re-irradiation and other treatment options for squamous cell carcinoma patients with previously irradiated, locoregional recurrent or second primary tumors in the head and neck, and describe a recently initiated randomized trial comparing chemotherapy plus re-irradiation with chemotherapy. Authors' affiliation: From the Division of Neoplastic Diseases, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Jefferson Medical College/ Bodine Cancer Center, Philadelphia, PA; and Harvard School of Public Health, Dana-Farber Cancer Institute, Boston, MA

6/9/2006 Iowa City, IA staff CancerConsultants.com According to results presented at the 42nd annual meeting of the American Society of Clinical Oncology (ASCO), initial therapy for head and neck cancer that includes standard chemotherapy plus Erbitux® (cetuximab) provides anticancer responses in 100% of patients. Approximately 40,000 people in the U.S. are diagnosed with head and neck cancer every year. Cancers of the head and neck include several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx (upper part of throat, behind ear), oropharynx (middle part of throat, including soft palate, base of tongue, and tonsils), and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would die from head and neck cancer. The epidermal growth factor receptor (EGFR) pathway is a biologic pathway that plays a role in cellular replication and is often over-expressed in cancer. Erbitux, a monoclonal antibody (or protein), is designed to bind to the EGFR and inhibit the receptor’s effects on cellular replication. This ultimately reduces or prevents growth and spread of cancer cells in some cancers. Recently, Erbitux was approved by the FDA for use combination with radiation therapy for the treatment of locally or regionally advanced squamous cell carcinoma of the head and neck (cancer that has spread from its site of origin but not to distant sites in the body), or as a single agent in recurrent or metastatic squamous cell carcinoma of the head and neck (cancer that has spread to [...]

6/9/2006 Chevy Chase, MD Gillison, Maura L. MD, PhD; Shah, Keerti V. MD, DrPH Current Opinion in Oncology (www.co-oncology.com) There is increasing molecular and epidemiologic evidence that human papillomavirus (HPV) is associated with a distinct subset of head and neck squamous cell carcinomas. The strength and consistency of HPV DNA presence in oropharyngeal cancers bolster the argument that this association is likely causal. HPV-positive tonsillar cancer in particular is emerging as a specific disease entity with distinct molecular, pathologic, and clinical characteristics. Recent data suggest that the incidence of tonsillar carcinoma in the United States is increasing, despite a decline in tobacco use, supporting the existence of other important risk factors such as HPV infection. Individuals with a history of an HPV-associated anogenital cancer and HIV-infected men are at increased risk for tonsillar carcinoma. This review focuses on the recent literature (since 1998) investigating the relationship between HPV and head and neck cancer development, using the current paradigm for causal inference in epidemiologic research attributed to Sir A. Bradford Hill. Data examining the association of HPV with pathogenesis of head and neck squamous cell carcinoma before 1999 were previously reviewed in this journal. Source: Current Opinion in Oncology. 13(3):183-188

6/7/2006 Atlanta, GA staff Newswise.com The blood of patients with head and neck cancer appears to have unique patterns of protein expression that one day could serve as a screening test for the highly aggressive cancer that is often diagnosed too late, researchers say. Studies comparing protein expression in 78 patients with head and neck cancer to 68 healthy controls revealed numerous differences in protein expression, Medical College of Georgia researchers say. “We found scores and scores of proteins that were differentially expressed,” says Dr. Christine Gourin, MCG otolaryngologist specializing in head and neck cancer and the study’s lead author. “We found there are at least eight proteins whose expression significantly differs between controls and people with cancer.” This protein fingerprint correctly classified study participants as cancer patients with a high degree of sensitivity and specificity – 82 percent and 76 percent, respectively, according to research published in the current issue of Archives of Otolaryngology. “If these results hold up over time, they would suggest that this would be a good screening test for at-risk people,” Dr. Gourin says. “Right now there is no good, effective screening test for head and neck cancer short of physical examination. Unfortunately it takes the development of symptoms to warrant a visit to the doctor, such as a sore throat; ear, tongue or mouth pain; painful eating or swallowing; or a change in the voice. Sometimes the first sign is a lump in the neck which is already a sign of an advanced tumor [...]

6/6/2006 New York, NY staff Bloomberg.com Patients with inoperable head and neck cancers are more likely to be cured if they are given Sanofi-Aventis SA's best-selling cancer drug Taxotere in addition to chemotherapy, a new study shows. The combination represents a new standard of care for patients with the disease, which historically has had a low survival rate, said Marshall R. Posner, director of head and neck oncology at Dana-Farber Cancer Institute. Overall survival after three years was 62 percent with patients who received Taxotere, compared with 48 percent for those who didn't. The cancer typically doesn't reappear in patients more than two years after treatment, he said. The number of patients developing the cancer, however, is on the rise. "We've doubled the cure rate" since the 1970s and 1980s, Posner said in an interview at the American Society of Clinical Oncology meeting in Atlanta, where he presented the results. "The standard has changed. This survival data can't be ignored." Taxotere was added to two generic chemotherapy medicines only at the start of therapy for patients with advanced cancer of the larynx, pharynx, tongue, palate or jaw. Another group in the 538-patient study was given only the chemotherapy drugs. All then received a combination of chemotherapy and radiation. Survival from the cancers that strike about 40,000 Americans each year has historically been low, with about 7,400 deaths annually, according to the American Cancer Society. The researchers were able to reduce the intensity of the chemotherapy in the study when Taxotere [...]

6/6/2006 Atlanta, GA Kawanza Newson TheState.com A vaccine against cervical cancer also prevents other types of gynecological cancers and could lower the incidence of tumors in the head and neck, too, according to a new study released Sunday. "If we vaccinate everybody in the U.S., we could probably impact head and neck cancer in approximately 20 years," said Marshall R. Posner, an associate professor at Harvard Medical School and medical director of the head and neck oncology program at Dana-Farber Cancer Institute in Boston. On Sunday, researchers at a cancer meeting in Atlanta released data showing that Gardasil, manufactured by Merck & Co., was 100 percent effective in preventing vaginal and vulvar cancers associated with the human papillomavirus, or HPV, in more than 18,000 women and adolescents from the United States, South America and Asia. For the study, researchers gave females ages 15-26 up to three doses of the vaccine over a six-month period and followed them for two years. None of the women who received the vaccination developed HPV-related vaginal or vulvar precancers, compared to 24 women in the control group. "In human disease, there has never been a vaccine this effective," said Jorma Paavonen, the professor and chief in the department of obstetrics and gynecology at the University of Helsinki in Finland who presented the study. "It's going to make a major impact and we certainly hope, in the future, this vaccine will be part of the national vaccine program, not only in the U.S., but elsewhere in [...]

6/6/2006 Iowa City, IA staff CancerConsultants.com According to an article recently published in Bone Marrow Transplantation, sucking on ice chips may help to prevent oral mucositis associated with high doses of the chemotherapy agent Alkeran® (melphalan). Oral mucositis (OM) is a common side effect among patients undergoing high-dose cancer therapy and stem cell transplantation. In OM therapy causes damage to the lining of the mouth and digestive system, which can range from irritation to severe pain and ulceration. If OM becomes severe, it can cause so much pain that patients are not able to swallow and need a feeding tube or a tube placed in a vein (total parenteral nutrition or TPN) for nutrition and hydration. Furthermore, OM can lead to a full-body infection and/or a delay in treatment, which may ultimately result in suboptimal outcomes. Researchers continue to evaluate the optimal ways to manage or, ideally, prevent OM in patients treated with high doses of therapy. Researchers from the Fred Hutchinson Cancer Research Center recently conducted a clinical trial to evaluate the effectiveness of ice chips to prevent or reduce OM in patients treated with high doses of Alkeran. This trial included 40 patients with multiple myeloma. Twenty-one patients received ice chips (cryotherapy) 30 minutes prior to treatment and continued to use the ice chips for six hours. Nineteen patients received normal saline instead of ice chips. Severe OM occurred in 14% of patients treated with ice chips, compared with 74% of patients treated with saline. Individuals treated with [...]