3/7/2006 Iowa City, IA staff cancerconsultants.com According to a recent article published in the International Journal of Radiation Oncology, Biology, Physics, the treatment combination of chemotherapy plus radiation therapy results in improved outcomes compared to aggressive radiation therapy for cancers of the oropharynx or hypopharynx that cannot be surgically removed. Approximately 40,000 people in the US are diagnosed with head and neck cancer every year. Cancers of the head and neck comprise several types of cancers affecting the nasal cavity and sinuses, oral cavity, nasopharynx, oropharynx, and other sites throughout the head and neck. In 2005 the American Cancer Society estimated that 11,000 people would from head and neck cancer. The oropharynx is the part of the throat that lies behind the mouth. The hypopharynx is the bottom part of the throat that leads to the esophagus (tube leading to the stomach) and the larynx (tube where air passes to the lungs). Standard treatment for cancer of the oropharynx or hypopharynx is largely determined by the stage (extent to which the cancer has spread) as well as the specific locations to which the cancer has spread. The patient’s overall medical condition is also a consideration. Treatment typically consists of radiation therapy, chemotherapy with surgery, or surgery alone. Unfortunately, a significant portion of patients are not able to undergo surgery; this condition is referred to as “unresectable”. Cancer is typically considered unresectable due to the extent of spread of the cancer, the structures to which the cancer has spread, or the [...]

3/5/2006 Chicago, IL Martin K. Bench, DDS J Am Dent Assoc, Vol 137, No 3, 294 Letters: I am writing in response to Dr. Charles Hapcook’s November JADA column, "Risk Management Considerations for Oral Cancer" ( JADA 2005;136: 1566–7[Medline] ). Dr. Hapcook writes, "For abnormalities or suspicious lesions found during the evaluation, the dentist should either schedule the patient for a reevaluation or properly refer the patient. Failure to follow these procedures on a timely basis can result in a more severe medical and dental consequence for the patient and an onerous legal consequence for the dentist, especially in the case of oral cancer." Many JADA readers, no doubt, are well aware of the value of the oral brush biopsy in the early detection of precancerous and cancerous oral lesions. The great majority of oral abnormalities are not "suspicious" and, therefore, do not warrant referral or need for biopsy. Rather, dentists are faced, almost daily, with evaluating lesions that have minimal or no suspicious features, and no obvious etiology. It is precisely these types of lesions that dentists should evaluate with the brush biopsy, since some will prove to be pre-cancerous or cancerous, despite their benign appearance. These types of lesions develop in all ages, including in young patients, in those with no risk factors for oral cancer and, increasingly, in women. Personally, I have found the brush biopsy to be an invaluable and reliable tool in my practice. The brush biopsy provides my referring dentists and, more importantly, my [...]

3/5/2006 Chicago, IL David T. Wong, DMD, DMSc J Am Dent Assoc, Vol 137, No 3, 313-321 Background: The ability to monitor health status, disease onset and progression, and treatment outcome through noninvasive means is a highly desirable goal in health care promotion and delivery. Oral fluid is a perfect medium to be explored for health and disease surveillance. Methods: Two prerequisites exist before the goal of salivary diagnostics can be achieved: identification of specific biomarkers associated with a health or disease state and the development of technologies that can discriminate between the biomarkers. A recent initiative of the National Institute of Dental and Craniofacial Research has created a roadmap to achieve these goals through the use of oral fluids as the diagnostic medium to scrutinize the health and/or disease status of patients. This is an ideal opportunity to optimize state-of-the-art saliva-based biosensors for salivary biomarkers that discriminate between diseases. Results: Seven technology groups are developing point-of-care salivary diagnostic technologies. Three groups are working together toward deciphering the salivary proteome. Conclusion: These collective efforts and the convergence of salivary diagnostic technologies and the salivary proteome will present unparalleled opportunities to explore the diagnostic potential of saliva for oral and systemic diseases.

3/3/2006 Bethesda, MD Naghma Khan et al. Cancer Research 66, 2500-2505, March 1, 2006 Cell signaling pathways, responsible for maintaining a balance between cell proliferation and death, have emerged as rational targets for the management of cancer. Emerging data amassed from various laboratories around the world suggests that green tea, particularly its major polyphenolic constituent (–)-epigallocatechin-3-gallate (EGCG), possesses remarkable cancer chemopreventive and therapeutic potential against various cancer sites in animal tumor bioassay systems and in some human epidemiologic studies. EGCG has been shown to modulate multiple signal transduction pathways in a fashion that controls the unwanted proliferation of cells, thereby imparting strong cancer chemopreventive as well as therapeutic effects. This review discusses the modulations of important signaling events by EGCG and their implications in cancer management.(Cancer Res 2006;66(5):2500–5) Authors: Naghma Khan, Farrukh Afaq, Mohammad Saleem, Nihal Ahmad and Hasan Mukhtar Authors' affiliation: Department of Dermatology, University of Wisconsin-Madison, Madison, Wisconsin

3/3/2006 Philadelphia, PA staff 10NBC HealthWatch (www.nbc10.com) Treatments for oral cancers can be very difficult and even disfiguring. But now, local doctors are the first in the world to use robotic surgery for cancerous head and neck tumors. The surgery spares patients the devastating side effects of more traditional surgery. The revolutionary technique was developed in Philadelphia. The surgery robot is changing 57-year-old Philip Preston's life without destroying his appearance. When Preston was told he had cancer at the base of his tongue, he and his wife, Beverly, felt like they had been slapped. "I was blown away. I couldn't believe it," Beverly Preston said. The second punch came when they learned what surgery would mean. "A very big incision, very devastating destructive cuts through a lip, a jaw bone, through the teeth," said Dr. Robert O'Malley, of the Hospital of the University of Pennsylvania. Many people end up with facial deformities. They can have trouble speaking and swallowing. They may need reconstructive surgery or a tracheotomy -- a tube inserted into the neck to breathe. But Preston became one of the first people in the world to have another option. Surgeons at the Hospital of the University of Pennsylvania told him they could remove the cancerous tumor and avoid the traditional side effects. Surgeons control the robot from a nearby console. The robot gives doctors a 3-D image and lets doctors use miniature surgical instruments that fit directly into the mouth and reach areas that are impossible for their [...]

3/1/2006 Beijing, China Hepeng Jia [email protected] Are China's regulations too lax? China in November became the first country to have approved two drugs based on gene therapy. The approvals have fueled quick growth in the field, but they may be a sign that China's drug regulation is too lax, experts caution. China's State Food and Drug Administration in October 2003 approved Gendicine to treat head and neck cancers. The drug uses an adenovirus to deliver the tumor suppressor gene p53 into tumor cells. Ins November 2005, the agency approved Shanghai Sunway Biotech's H101, also an adenovirus, which targets cancer cells that lack p53. More than 50% of all cancers have abnormal expression of p53 (Oncology 13, 148–154; 1999). In the West, the approach to gene therapy has been cautious since the death in 1999 of 18-year-old Jesse Gelsinger in a gene therapy trial at the University of Pennsylvania. More recently, French researchers used the technique to treat ten children with the so-called 'bubble boy' disease, but that trial was put on hold in 2003 after two of the children developed leukemia. In China, however, both the government and the public have embraced the technology. The success of the two approved products has boosted the number of gene therapy trials in China from 5 in late 2003 to 19 in 2006. "The huge numbers of highly cooperative patients, the low cost for research and clinical trials and the positive support from the government has enabled China to lead the world in [...]

3/1/2006 New York, NY staff Cancerpage.com The use of subcutaneous amifostine to reduce the toxic effects of radiation therapy and chemotherapy is feasible in patients with head and neck cancer, Swiss physicians report. However, nausea and vomiting and hypotension are relatively common adverse events associated with the drug. Amifostine (Ethyol; Essex-Chemie AG, Lucerne, Switzerland) is an organic thiophosphate that protects normal tissues from free radicals produced by radiation therapy or chemotherapy. It is FDA approved as an intravenously administered drug, but subcutaneous administration is believed to have less toxic effects. Dr. Mahmut Ozsahin and colleagues at Centre Hospitalier Universitaire Vaudois in Lausanne retrospectively evaluated 33 consecutive patients treated with accelerated concomitant-boost radiation therapy, 26 of whom also received cisplatin alone or cisplatin plus fluorouracil. The parotid glands were included in the planning radiation therapy volume. According to their report in the Archives of Otolaryngology Head and Neck Surgery for February, the patients received a 200-mg dose of the oral anti-emetic dolasetron mesylate 1 to 2 hours prior to amifostine treatment. Amifostine 500 mg was injected subcutaneously into the abdomen 15 to 30 minutes prior to radiation therapy. Fifteen patients appeared to be tolerant to amifostine, whereas 11 discontinued its use because of nausea and vomiting and 6 discontinued because of hypotension. Acute effects of treatment included grades 1 to 3 dysphagia, mucositis and skin erythema. Late toxic effects included grade 2 or higher xerostomia in 8 of 19 patients who received at least 20 amifostine injections and in 9 of [...]

3/1/2006 Washington, D.C. press release US Food and Drug Administration (www.fda.gov) The Food and Drug Administration (FDA) today announced the approval of Erbitux (cetuximab) for use in combination with radiation therapy to treat patients with squamous cell cancer of the head and neck (SCCHN) that can not be removed by surgery (unresectable SCCHN). This is the first drug approved for head and neck cancer that has shown a survival benefit in this population. Erbitux was also approved today for use alone (monotherapy) to treat patients whose head and neck cancer has spread (metastasized) despite the use of standard chemotherapy. "Patients suffering from all forms of cancer have a common goal – to treat the disease and prolong life," said Steven Galson, MD, Director of FDA's Center for Drug Evaluation and Research. "We consider this approval an important advance in the treatment of head and neck cancer because it has been shown to help some patients live longer. The approval of Erbitux monotherapy to shrink tumors in patients with metastatic disease who no longer respond to other forms of treatment is also important. Patients need as many effective treatment options as possible." Erbitux, which received a priority review, is the first drug approved to treat head and neck cancer since methotrexate became available in the 1950s. Approval of Erbitux in combination with radiation therapy was based on a study that showed it prolonged survival by 20 months compared to treatment with radiation alone. Approval of Erbitux monotherapy was based on evidence [...]

2/28/2006 Bethesda, MD Ken Garber Journal of the National Cancer Institute, Vol. 98, No. 5, 298-300, March 1, 2006 Oncolytic virus research got a welcome boost last November when Chinese regulators approved the world's first oncolytic viral therapy for cancer, Shanghai Sunway Biotech's genetically modified adenovirus H101. "It's fantastic for the field," said John Bell, Ph.D., of the Ottawa Health Research Institute in Canada. "We needed to have something that was a success, and so I think this is a good first start." Oncolytic viruses are live viruses that selectively kill cancer cells. Shanghai Sunway Biotech expects to begin marketing H101 in July for treating head and neck cancer. The company is also testing the virus in lung cancer and has bought the rights to Onyx-15, an almost identical virus that Onyx Pharmaceuticals took into phase III trials in 2000 but later dropped after its marketing partner bailed out. Now the Chinese effort has breathed new life into the Onyx virus. Sunway's next step, says company president Hu Fang, M.D., is to compare it with H101 in a Chinese trial. The company will then apply to test one of the viruses in Europe and the United States. "The first choice is Onyx-15, but we can't exclude the H101," Hu said. Virus Interruptus The Chinese resurrection of Onyx-15 gives it a second chance after the aborted U.S. run that began in 1996. That year, Onyx biochemist Frank McCormick, Ph.D.—now the director of the University of California, San Francisco, Comprehensive Cancer Center—had [...]

2/28/2006 Cleveland, OH David J. Adelstein et al. Journal of Clinical Oncology, Vol 24, No 7 (March 1), 2006: pp. 1064-1071 Purpose: A retrospective review with long-term follow-up is reported from the Cleveland Clinic Foundation studying radiation and concurrent multiagent chemotherapy in patients with locoregionally advanced squamous cell head and neck cancer. Patients and methods: Between 1989 and 2002, 222 patients were treated with 4-day continuous infusions of fluorouracil (1,000 mg/m2/d) and cisplatin (20 mg/m2/d) during weeks 1 and 4 of either once daily or twice daily radiation therapy. Primary site resection was reserved for patients with residual or recurrent primary site disease after chemoradiotherapy. Neck dissection was considered for patients with N2 or greater disease, irrespective of clinical response, and for patients with residual or recurrent neck disease. Results: With a median follow-up of 73 months, the Kaplan-Meier 5-year projected overall survival rate is 65.7%, freedom from recurrence rate is 74.0%, local control without the need for surgical resection rate is 86.7%, and overall survival rate with organ preservation is 62.2%. Including patients undergoing primary site resection as salvage therapy, the overall local control rate is 92.4%. Regional control rate at 5 years is 92.4%. Among patients with N2-3 disease, regional control was significantly better if a planned neck dissection was performed. Distant control at 5 years was achieved in 85.4% of patients and was significantly worse in patients with hypopharyngeal primary sites and patients with poorly differentiated tumors. Conclusion: Concurrent multiagent chemoradiotherapy can result in organ preservation and [...]