Epidermal Growth Factor Receptor and the Changing Face of Oropharyngeal Cancer

Source: Journal of Clinical Oncology To the Editor: In their article, Chaturvedi et al1 document the rise in human papillomavirus (HPV) –associated cancers as a proportion of squamous cell carcinomas of the oropharynx over the last 25 years. The contemporary figures are mirrored by two recent British studies2,3 demonstrating that the majority of oropharyngeal cancers are now HPV related. In the accompanying editorial,4 Mroz et al rightly highlight the importance of evaluating HPV vaccination for both men and women in the light of these data and lament the lack of significant improvement in the outcomes for non–HPV-associated head and neck cancers. However, they also suggest that the benefit of targeting epidermal growth factor receptor (EGFR) through concurrent cetuximab may be confined to HPV-associated tumors. Although EGFR expression per se does not correlate closely with response to cetuximab, there is increasing evidence of an inverse correlation between p16INK4A expression (as a marker of HPV association) and EGFR expression shown by immunohistochemistry.5,6 Though suppressed by viral oncogenes, HPV-associated tumors retain wild-type P53,7 and patients with this tumor type have demonstrated excellent survival with existing protocols such as concurrent chemoradiotherapy or surgery with postoperative radiotherapy. Conversely, non-HPV tumors, harboring a range of mutations,8 may respond less well to DNA-damaging agents, but patients with these tumors might benefit from the addition of concurrent EGFR blockade to radiotherapy. Data from the recent SPECTRUM (Study of Panitumumab Efficacy in Patients With Recurrent and/or Metastatic Head and Neck Cancer) study of adding another EGFR-targeting monoclonal antibody, panitumumab,9 [...]

2012-03-09T10:34:29-07:00March, 2012|Oral Cancer News|
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Dentists key to quitting ‘smokeless tobacco’

Source: http://www.dentistry.co.uk/ The National Institute for Health and Clinical Excellence (NICE) is recommending a key role for dental professionals in their public health intervention proposals to help stop the use of smokeless tobacco by people of South Asian Origin. Dentists, dental nurses and dental hygienists may be asked to play a leading role as part of new proposals to stop the use of smokeless tobacco in the UK. NICE has published a consultation on their proposals, which recommends a key intervention and education role for dental professionals. It is also recommending more training for dental professionals to help them gain a greater understanding of smokeless tobacco including terminology, symptoms and approaches to successful intervention. Smokeless tobacco is associated with a number of health problems including nicotine addiction, mouth and oral cancer, periodontal disease, heart attacks and strokes, problems in pregnancy and following childbirth and late diagnosis of dental problems as smokeless tobacco products can often mask pain. Smokeless tobacco is mainly used by 'people of South Asian origin', which includes people with ancestral links to Bangladesh, India, Nepal, Pakistan or Sri Lanka. The draft guidance recommends that dental professionals take specific actions including: • Asking patients about their smokeless tobacco use and record the outcome in their patient notes • Making users aware of the potential health risks and advise them to stop, using a brief intervention • Referring users who want to quit the habit to tobacco cessation services that use counsellors trained in behavioural support • Recording the [...]

2012-03-07T15:45:16-07:00March, 2012|Oral Cancer News|
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Taiwan reports highest oral cancer survivor rate

Source: www.chinapost.com.tw/ Taiwan has reported the highest five-year survival rate for patients with oral cancer in the world, a hospital official said yesterday. On average, more than 70 percent of the oral cancer patients treated at National Taiwan University Hospital (NTUH) live for more than five years after being diagnosed, said Ko Jeng-yuh, head of the hospital's division of head and neck oncology. Citing a survey carried out by the American Joint Committee on Cancer, Ko said the survival rate in the United States for such patients in late stages of the disease was lower than 30 percent in 2010. The NTUH treated 1,288 patients with oral cancer between 2004 and 2009 and after complete treatment, more than 55 percent of the 476 stage-four patients lived for at least five more years, the hospital said. Taiwan has the world's highest number of patients suffering from oral cancer, as the majority of patients are middle-aged men who are also the bread winners for their families, said Lou Pei-jen, an NTUH doctor.

2012-03-07T15:33:15-07:00March, 2012|Oral Cancer News|
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HPV exposure increases men’s risk of cancer

Source: http://news.medill.northwestern.edu/ Author: Zen Vuong “We’re at the precipice of this epidemic,” said Dr. Ezra Cohen, who specializes in head and neck cancers. The culprit is sexually-transmitted human papillomavirus-16. Human papillomavirus-positive head and neck cancer cases have been rising about 3 percent every year for the last three decades, said Cohen of The University of Chicago Medicine, an institution that includes the University of Chicago Hospitals. HPV-16 infection is three times more likely in men than in women, he added. Cells of the upper respiratory system of both men and women are very similar to the surface of the cervix in women, said Dr. Kenneth Alexander, chief of infectious diseases at The University of Chicago Medicine. HPV is linked to cervical cancer as well. The Centers for Disease Control and Prevention estimates 10,800 new cases of HPV-associated cervical cancer in the United States each year. This number is nearly 35 percent larger than the 7,100 cases of HPV-associated head and neck cancers found in the United States each year. Oral sex is “probably the most important risk factor” in contracting HPV-16-related head and neck cancer, which “will become more common than cervical cancer in this decade,” he added. Some 5,600 men are diagnosed with HPV-associated head and neck cancers each year, whereas only 1,500 women suffer the same fate, according to the CDC. HPV-16, one of more than 150 strains, is a sexually transmitted condition. More than 40 HPV types can be sexually transmitted, according to the National Cancer Institute. [...]

2012-03-07T15:30:30-07:00March, 2012|Oral Cancer News|
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African Americans more likely to develop keloid after head and neck surgery

Source: http://www.news-medical.net/ Author: staff African Americans are seven times more likely than Caucasians to develop an excessive growth of thick, irregularly shaped and raised scarring on their skin - known as a keloid - following head and neck surgery, according to a new study from Henry Ford Hospital in Detroit. This finding, however, is much lower than that previously reported in medical literature, where rates of keloid development have been shown to be up to 16 percent in African Americans. Unlike regular scars, keloids do not subside over time and often extend outside the wound site. Keloids also may be painful to the touch and itchy. "Many African American patients are afraid to have head and neck surgery or any facial cosmetic procedures for fear of developing keloids at the incision sites," says Lamont R. Jones, M.D. vice chair, Department of Otolaryngology-Head and Neck Surgery at Henry Ford. "We hope our study helps to eliminate that fear by showing that keloid development on the head and neck following surgery is actually much smaller than other reports." Much of the uncertainty surrounding keloids is rooted in there being no known cause for their development. But Dr. Jones and his research team at Henry Ford hope to eliminate that unknown. They are embarking on another keloid study to find a new technique to identify the genes that may be responsible for keloid development. By identifying the genetic cause, it may be possible to develop better treatments for keloids in the near future. [...]

2012-03-07T15:24:01-07:00March, 2012|Oral Cancer News|
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Robotic surgery less invasive on HPV-related oral cancers

Source: Dr.Bicuspid.com March 1, 2012 -- Robotic surgery conducted through patients' mouths provides excellent results in removing squamous cell carcinoma at the back of the throat, especially in patients with HPV, according to a new Mayo Clinic study (Mayo Clinic Proceedings, March 2012, Vol. 87(3), pp. 211-212). "We were surprised that the cancer cure results were even better than the traditional treatments that we have been doing, but that is probably almost as much of a matter that these cancers are HPV-mediated for the most part, and they respond much better to treatment," said study author Eric Moore, MD, a head and neck surgeon at Mayo Clinic. "Importantly, the treatment preserved patients' ability to swallow, and their speech performance was excellent." Dr. Moore and his team followed 66 patients with oropharyngeal cancer who underwent transoral robotic surgery with the da Vinci robotic surgical system. Every few months, the patients underwent imaging studies, scans, and exams to determine if cancer was recurring. After two years, the researchers found that the patients' survival rates were greater than 92%, which is as high as some other surgical and nonsurgical treatments for oropharyngeal cancer. Because traditional surgery techniques to remove throat tumors can be traumatic, requiring cutting and reconstructing the mandible, neck, and tongue, the researchers were also interested in patients' healing after robotic surgery. "We found that with transoral robotic surgery, 96% of patients could swallow a normal diet within three weeks of treatment," Dr. Moore said. Less than 4% required a gastrostomy [...]

2012-03-01T16:21:18-07:00March, 2012|Oral Cancer News|
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Judge Rules Graphic Cigarette Warning Labels Unconstitutional

 Source: Time Magazine- Healtland The government’s effort to put graphic warning labels about the dangers of smoking on cigarette packs hit another legal snag on Wednesday. A Washington judge declared unconstitutional a Food and Drug Administration (FDA) mandate that would force cigarette makers to use the labels, which include images of a corpse of a smoker, smoking-damaged teeth and gums and diseased lungs, saying that it violated cigarette makers’ freedom of speech under the First Amendment. U.S. District Judge Richard Leon wrote in his ruling that the images “were neither designed to protect the consumer from confusion or deception, nor to increase consumer awareness of smoking risks; rather, they were crafted to evoke a strong emotional response calculated to provoke the viewer to quit or never start smoking.” SPECIAL: FDA Unveils Final Cigarette Warning Labels That’s been the argument of cigarette makers, who say that the images go beyond merely informing the public to forcing the manufacturers to advertise the government’s anti-smoking agenda, with the purpose of convincing smokers to give up the habit. Leon’s ruling fell in line with his previous decision in the case in November, when he issued a temporary injunction blocking the new labeling effort. That decision has already been appealed by the government. The Family Smoking Prevention and Tobacco Control Act of 2009 gave the FDA regulatory authority over tobacco products for the first time. Under that law, the FDA required cigarette makers to cover the top half of the front and back of cigarette [...]

2012-03-01T14:10:43-07:00March, 2012|Oral Cancer News|
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Evaluation of a combined triple method to detect causative HPV in oral and oropharyngeal squamous cell carcinomas: p16 Immunohistochemistry, Consensus PCR HPV-DNA, and In Situ Hybridization

Source: 7thspace.com Recent emerging evidences identify Human Papillomavirus (HPV) related Head and Neck squamous cell carcinomas (HN-SCCs) as a separate subgroup among Head and Neck Cancers with different epidemiology, histopathological characteristics, therapeutic response to chemo-radiation treatment and clinical outcome. However, there is not a worldwide consensus on the methods to be used in clinical practice. The endpoint of this study was to demonstrate the reliability of a triple method which combines evaluation of: 1. p16 protein expression by immunohistochemistry (p16-IHC); 2. HPV-DNA genotyping by consensus HPV-DNA PCR methods (Consensus PCR); and 3 viral integration into the host by in situ hybridization method (ISH). This triple method has been applied to HN-SCC originated from oral cavity (OSCC) and oropharynx (OPSCC), the two anatomical sites in which high risk (HR) HPVs have been clearly implicated as etiologic factors. Methylation-Specific PCR (MSP) was performed to study inactivation of p16-CDKN2a locus by epigenetic events. Reliability of multiple methods was measured by Kappa statistics. Results: All the HN-SCCs confirmed HPV positive by PCR and/or ISH were also p16 positive by IHC, with the latter showing a very high level of sensitivity as single test (100% in both OSCC and OPSCC) but lower specificity level (74% in OSCC and 93% in OPSCC).Concordance analysis between ISH and Consensus PCR showed a faint agreement in OPSCC (kappa = 0.38) and a moderate agreement in OSCC (kappa = 0.44). Furthermore, the addition of double positive score (ISHpositive and Consensus PCR positive) increased significantly the specificity of HR-HPV detection on [...]

2012-02-29T17:24:29-07:00February, 2012|Oral Cancer News|
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