chemoradiation – Page 3 – Oral Cancer News

Prognostic Significance of HPV Status in Oropharyngeal Cancer

OncologySTAT Editorial Team Dr. Maura Gillison is Professor of Medicine, Epidemiology, and Otolaryngology at Ohio State University in Columbus. OncologySTAT: The results of the Radiation Therapy Oncology Group (RTOG) 0129 trial showed that the human papillomavirus (HPV) is an independent prognostic factor in oropharyngeal cancer. Could you tell us about the rationale for this study? Dr. Gillison: Over the last 10 years, our research has shown that cancers of the oropharynx are actually 2 completely different diseases that can look quite similar. One subset is caused HPV infection, and the other is more closely associated with long-term use of alcohol and tobacco. Initial studies suggested that the presence of HPV in a patient’s tumor had prognostic significance, but study limitations made that conclusion dubious. We set out to determine whether or not HPV was indeed an independent prognostic factor in head and neck cancer. To show whether there was a direct relationship between HPV infection and head and neck cancer, we needed to prospectively study a uniformly treated and uniformly staged patient population. Thus, we used the study population from the trial conducted by the RTOG. We divided the patients into 2 groups—those whose tumors were caused by HPV and those whose tumors were not—and we compared survival outcomes for the 2 groups. The results showed that HPV status was the single most important predictor of patient outcome, even more so than disease stage and other well-known prognostic factors such as performance status and presence of anemia. In fact, after [...]

Charlotte Parker2012-04-18T10:16:03-07:00April, 2012|Oral Cancer News|

Timing of Post-TX Imaging Key in Head, Neck Cancer

Source: MedScape Today Summary The investigators report on a systematic review and meta-analysis of 51 studies involving 2335 patients with head and neck squamous cell carcinoma who underwent post-treatment or surveillance with 18F-fluorodeoxyglucose (FDG) PET or FDG-PET/CT. The random-effects model-weighted mean pooled sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for detection of residual disease at the primary tumor site were 79.9% (95% CI, 73.7%-85.2%), 87.5% (95% CI, 85.2%-89.5%), 58.6% (95% CI, 52.6%-64.5%), and 95.1% (95% CI, 93.5%-96.5%), respectively. The respective values for detection of residual post-treatment neck nodes were 72.7% (95% CI, 66.6%-78.2%), 87.6% (95% CI, 85.7%-89.3%), 52.1% (95% CI, 46.6%-57.6%), and 94.5% (95% CI, 93.1%-95.7%). In a subgroup analysis on timing of PET after completion of therapy, scans performed after 12 weeks had significantly higher diagnostic performance than scans done within 12 weeks, but only for residual neck nodes and not for residual disease at the primary tumor site. No statistically significant difference in diagnostic accuracy was noted between stand-alone PET and PET/CT. Viewpoint Well-performed systematic reviews and meta-analyses are important contributions to the literature.[1] In this meta-analysis, the diagnostic performance of dedicated PET and PET/CT with FDG was investigated by pooling the data from a relatively large cohort of patients with head and neck cancer who had been treated with chemoradiation. The pooled evidence demonstrated good diagnostic performance for FDG-PET and FDG-PET/CT, regardless of the type of scanner, with very high NPV but somewhat suboptimal PPV; this is due to the nonspecificity of FDG, [...]

Charlotte Parker2012-02-22T09:47:08-07:00February, 2012|Oral Cancer News|

PET/CT Detects Early Recurrence of Head and Neck Cancer

Source: Elsevier Global Medical News Routine use of positron emission tomography/computed tomography scans can detect locoregional recurrences of squamous cell carcinoma of the head and neck before they became clinically apparent, according to a retrospective chart review of 234 patients who had been treated with chemoradiation between 2006 and 2010.  The finding suggests that routine use of positron emission tomography/computed tomography (PET/CT) may improve the outcome of salvage therapy, said Dr. Yasir Rudha, who reported the study at the Multidisciplinary Head and Neck Symposium sponsored by the American Society for Radiation Oncology.  PET/CT was associated with a high false positive rate, which should be considered when ordering radiological exams and biopsies, but a negative post therapy PET scan appears to be an excellent predictor of freedom from future locoregional recurrence, said Dr. Rudha of St. John Hospital/Van Elslander Cancer Center, Grosse Pointe Woods, Mich.  The technology is relatively new, and its use for routine follow-up in patients with head and neck cancer is still controversial, he acknowledged. "Only a few publications have reported the value of PET examination at a fixed time interval after the end of treatment," he said. "PET scan is often ordered in our hospital as a routine surveillance tool following successful completion of treatment."  The review of charts for all 234 patients identified 45 who had achieved clinical no-evidence-of-disease status at the time of post treatment imaging. In this group, PET/CT scanning at 6-9 weeks identified 15 patients with abnormalities that required further evaluation. Of those, eight patients (53%) were [...]

Charlotte Parker2012-02-06T11:45:04-07:00February, 2012|Oral Cancer News|

New Therapies and Prognostic Techniques Highlighted in Head and Neck Cancer

The Asco Post D. Neil Hayes, MD, MPH, of the University of North Carolina at Chapel Hill, described efforts to position the epidermal growth factor receptor (EGFR) inhibitor cetuximab (Erbitux) in head and neck cancer treatment. Surprisingly negative results came from the phase III Radiation Therapy Oncology Group (RTOG) 0522 trial (N = 940), which showed no benefit to adding cetuximab to the radiation/cisplatin platform for front-line therapy of advanced head and neck squamous cell carcinoma.1 At 2 years, progression-free survival was approximately 64% in both arms; overall survival was 79.7% with chemoradiation (P = .68) and 82.6% with the addition of cetuximab (P = .17). Rates of locoregional relapse and distant metastases were also similar. Cetuximab increased grade 3/4 mucositis (43% vs 33%;P < .004), in-field skin toxicity (25% vs 15%;P < .001), and out-of-field skin reactions (19% vs 1%;P < .001), but toxicity beyond 90 days was similar between the arms. "RTOG 0522 was the study of the year in head and neck cancer. Unfortunately, it was flat-out negative," Dr. Hayes noted. No differential effect emerged by p16 (HPV status). "While 70% of patients had oropharynx tumors (suggesting HPV positivity), tissue collection was lacking in half the patients. Our ability to make inferences with this amount of missing data is very limited," Dr. Hayes said. Even as a negative study, RTOG 0522 is practice-changing. "Many physicians have been treating with this regimen, assuming this study would be positive," he said. "But we now have no data to support this." Cetuximab Equivalent [...]

Oral Cancer Foundation News Team - A2011-10-18T09:58:29-07:00October, 2011|Oral Cancer News|

Head and Neck Cancer Patients Benefit in Multidisciplinary Clinics

Source: Journal of Clinical Oncology Head and neck cancer (HNC) is a multidisciplinary condition. Multi-modality treatment is standard, especially the use of chemoradiation. Proper imaging (CT, MRI and PET), more accurate pathologic assessment and thoroughly tailored treatment plans that limits radiation fields and doses and take into consideration surgical options that minimize morbidity (endoscopic and robotic procedures) are essential. Furthermore, dental, swallowing, speech, nutritional, financial and social support are also cornerstones in this comprehensive approach. However, the most important function might be the role of the nurse navigator in order to offer true coordinated care for our patients. Within William Beaumont Oncology Network we initiated multi-disciplinary clinics for HNC in January 2010 in which our specialists meet the patients together after discussion at the tumor board to streamline management. Methods: In this initial analysis we studied 15 randomly chosen patients’ way through our health care system in 2009, and compared with 15 randomly chosen patients in 2010, after the initiation of the Multi-Disciplinary Clinic. All patients had biopsy verified HNC, the vast majority being squamous cell carcinomas, and were stage III or stage IV. The radiation techniques were unchanged during study and treating physicians remained the same as well. Results: The first group of patients that did not go through our multi-disciplinary clinic had a mean time of 59 days (range 4-156) from pathologic diagnosis to start of radiation. Corresponding mean time for patients going through the multi-disciplinary clinics was 33 days (range 18-86), a decrease of 44%. Conclusions: Coordinated [...]

Oral Cancer Foundation News Team - A2011-06-13T09:22:14-07:00June, 2011|Oral Cancer News|

HPV and EGFR are hottest topics in head and neck cancer

Source: www.medscape.com Author: Zosia Chustecka The hottest topic in head and neck cancers is the role of human papillomavirus (HPV) in the disease, although there is also a lot interest in treatment with EGRF inhibitors, especially the second-generation products, according to an expert here at the European Society for Therapeutic Radiology and Oncology 11th Biennial Conference. HPV has only been associated with head and neck cancer in the last few years, but it is now clear that patients who are positive for the virus have a better prognosis, said Cai Grau, MD, DMSC, professor of oncology at Aarhus University Hospital, Denmark. He chaired a session during which both hot topics were discussed. "These patients have a better prognosis, irrespective of treatment, and their risk of a second cancer is virtually zero," added session participant Lisa Licitra, MD, medical oncologist at the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan, Italy. However, there is a difference between patients in the United States and those in Europe with regard to risk, she told meeting attendees. For American patterns, Dr. Licitra cited the analysis published last year in the New England Journal of Medicine (2010;363:24-35), which reported a risk model for death from oropharyngeal squamous cell carcinoma on the basis of HPV status, pack-years of tobacco smoking, and tumor and nodal stage. In this 266-patient cohort, 43% were low risk, 30% were intermediate risk, and 27% were high risk. Dr. Licitra reported that when she performed the same analysis [...]

Oral Cancer Foundation News Team - A2011-05-17T06:56:01-07:00May, 2011|Oral Cancer News|

High Interest in HPV and EGRF When Referring to Head and Neck Cancer

Source: MedScape Today May 12, 2011 (London, United Kingdom) — The hottest topic in head and neck cancers is the role of human papillomavirus (HPV) in the disease, although there is also a lot interest in treatment with EGRF inhibitors, especially the second-generation products, according to an expert here at the European Society for Therapeutic Radiology and Oncology 11th Biennial Conference. HPV has only been associated with head and neck cancer in the last few years, but it is now clear that patients who are positive for the virus have a better prognosis, said Cai Grau, MD, DMSC, professor of oncology at Aarhus University Hospital, Denmark. He chaired a session during which both hot topics were discussed. "These patients have a better prognosis, irrespective of treatment, and their risk of a second cancer is virtually zero," added session participant Lisa Licitra, MD, medical oncologist at the Istituto Nazionale per lo Studio e la Cura dei Tumori in Milan, Italy. However, there is a difference between patients in the United States and those in Europe with regard to risk, she told meeting attendees. For American patterns, Dr. Licitra cited the analysis published last year in the New England Journal of Medicine (2010;363:24-35), which reported a risk model for death from oropharyngeal squamous cell carcinoma on the basis of HPV status, pack-years of tobacco smoking, and tumor and nodal stage. In this 266-patient cohort, 43% were low risk, 30% were intermediate risk, and 27% were high risk. Dr. Licitra reported that when [...]

Oral Cancer Foundation News Team - A2011-05-12T10:12:51-07:00May, 2011|Oral Cancer News|

SciClone Pharmaceuticals Inc enrols first patient in Phase 2b trial of SCV-O7 for oral mucositis

Source: www.therapeuticsdaily.com Author: staff Specialist pharmaceutical company SciClone Pharmaceuticals Inc (NASDAQ:SCLN) revealed on Tuesday that the company has enrolled the first patient in its phase 2b clinical trial of SCV-07 for the prevention of oral mucositis (OM), a painful, debilitating and costly toxicity caused by chemoradiotherapy regimens used to treat head and neck cancer. The company said that the study will examine three doses of SCV-07, including two higher doses than those used in the recent phase 2a study, to assess the drug's impact on modifying the course of OM in patients with head and neck cancer. This multi-centre, randomised, double-blind, placebo-controlled study will enroll approximately 160 subjects who are receiving standard chemoradiation therapy for treatment of cancers of the head and neck. Subjects will be randomly assigned to one of the trial's four treatment arms: placebo and SCV-07 at doses of 0.1 mg/kg, 0.3 mg/kg and 1 mg/kg. According to the company, SCV-07 (gamma-D-glutamyl-L-tryptophan) is a small molecule which appears to stimulate the immune system through inhibition of STAT3 signaling and the resulting effects on T-helper 1 cells.

Oral Cancer Foundation News Team - A2011-01-14T09:11:19-07:00January, 2011|Oral Cancer News|

Integration of epidermal growth factor receptor inhibitors with preoperative chemoradiation

Source: Clincancerres Author: Annelies Debucquoy1, Jean-Pascal Machiels2, William H. McBride3, and Karin Haustermans1 Corresponding Author: Annelies Debucquoy, Laboratory of Experimental Radiotherapy, Department of Radiation Oncology, CDG Building, Box 815, UH Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. Phone: 32-16-346900; Fax: 32-16-346905; E-mail:[email protected]. Abstract In many different cancer cell types, the epidermal growth factor receptor (EGFR) pathway becomes hyperactivated because of overproduction of the ligand, overproduction of the receptor, or constitutive activation of the receptor. The overproduction of EGFR and its ligands correlates with poor prognosis in several solid tumors such as lung, colon, and ovary. These observations led to the development of EGFR inhibitors for anticancer treatment. In the last few years, promising results have been obtained in several tumor types, with EGFR inhibitors given as monotherapy or in combined treatments. In particular, cetuximab in combination with curative-intent radiotherapy in head and neck cancer increases median survival over radiation alone. Similarly, the same approach might benefit patients with locally advanced rectal cancer. Unfortunately, the first clinical studies combining chemoradiation with cetuximab in rectal cancer gave disappointing results. Translational research suggested that the low response rate observed might have been due to the strong antiproliferative effect of cetuximab that may have compromised the activity of chemotherapeutics that target proliferating cells. This result indicates the need for more translational research to unravel how the molecular mechanisms might be manipulated to optimize the combined treatment regimen and to identify biomarkers that can select those patients who will derive most benefit. Clin Cancer Res; 16(10); OF1–6. ©2010 AACR. [...]

Charlotte Parker2010-05-03T18:01:14-07:00May, 2010|Oral Cancer News|

Limited mouth opening after primary treatments for head and neck cancer

Source: Stanford University Author: Weber, S Dommerich, HW Pau, and B Kramp OBJECTIVES: Patients after surgery and radiation/chemoradiation for treatment of head and neck cancer often suffer from oral complications. These problems may be caused by surgery and radiation. Patients complain, for example, of swallowing problems and limited mouth opening (trismus). METHODS: The maximal interincisal mouth opening (MIO) was measured in patients treated with surgery and radiation/chemoradiation for head and neck cancer at the Department of Otorhinolaryngology at the University of Rostock. These patients also completed a 20-item questionnaire concerning nutritional, sensual, and speech disorders and pain. RESULTS: One hundred one patients (16 female and 85 male) returned the questionnaire and were included in the study. About 50% of the patients had a limited mouth opening (<36 mm); patients with oropharyngeal cancer had a significant higher risk for trismus (p = .024) than patients with other head and neck cancers, especially compared to patients with laryngeal cancer (p = .013). The questionnaire showed that especially patients with oral cancer report about problems with opening the mouth (73%), eating (65%), drinking (73%), xerostomia (92%), speech disorders (68%), and voice (62%). Patients with laryngeal cancer only reported about problems with xerostomia (62%), speech (83%), and voice (90%), similar to patients with pharyngeal cancer. CONCLUSIONS: About half of the patients who underwent primary treatment for oral and oropharyngeal cancer developed trismus and reported about problems with opening the mouth, eating, drinking, dry mouth, voice, and speech. Trismus has a negative impact on quality [...]

Charlotte Parker2010-04-19T22:25:48-07:00April, 2010|Oral Cancer News|