Using artificial intelligence to help cancer patients avoid excessive radiation

Source: medicalxpress.com Author: by Case Western Reserve University A Case Western Reserve University-led team of scientists has used artificial intelligence (AI) to identify which patients with certain head and neck cancers would benefit from reducing the intensity of treatments such as radiation therapy and chemotherapy. The researchers used AI tools similar to those they developed over the last decade at the Center for Computational Imaging and Personal Diagnostics (CCIPD) at Case Western Reserve. In this case, they asked the computer to analyze digitized images of tissue samples that had been taken from 439 patients from six hospital systems with a type of head and neck cancer known as human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma (OPCSCC). The computer program successfully identified a subset of patients who might have benefited from a significantly reduced dose of radiation therapy. While that analysis was retrospective—meaning the computer analyzed data from patients in which the eventual outcome was already known—the researchers said their next step could be to test its accuracy in clinical trials. Their research was published recently in the Journal of the National Cancer Institute. The work was led by Anant Madabhushi, CCIPD director and the Donnell Institute Professor of Biomedical Engineering at the Case School of Engineering, along with Germán Corredor Prada, a research associate in the CCIPD lab. 'Overtreating patients' Although most others with HPV-driven cancer would still benefit from aggressive treatment—along with patients whose cancer was unrelated to the virus—the researchers said their study revealed a significant group was [...]

Chemotherapy and radiation therapy issues: What audiologists need to know

Source: journals.lww.com Author: A. Croutch, Carl AuD With hearing loss, tinnitus, and imbalance as among the numerous side-effects of cancer treatment,1 audiologists play a critical role in monitoring patients receiving chemotherapy and radiation therapy. Sensorineural hearing loss (SNHL) attributed to chemotherapy and radiation therapy is usually permanent, making audiometric monitoring essential to detect its early occurrence.2 Cisplatin, carboplatin & radiation therapy Chemotherapy is used to treat cancer, control the growth and spread of cancer cells, and ease cancer symptoms. Cisplatin and carboplatin are two common antineoplastic agents used to treat testicular, ovarian, breast, esophageal, lung, and head and neck cancers among others. Besides hearing loss, these can cause other side effects including kidney, gastrointestinal disorders, allergic reactions, decreased immunity to infections, and hemorrhaging. Cisplatin was first found to have cytotoxic properties in the 1960s, and in 1978 was the first platinum compound approved by the FDA for cancer treatment.3 On the other hand, carboplatin is less potent than cisplatin and does have fewer side effects, especially on kidney problems.3 Both drugs work by interfering with DNA repair mechanisms causing DNA damage and inducing apoptosis in cancer cells. Cancerous cells cannot limit cell division as do normal cells. Normal cells cease dividing when they encounter similar cells whereas cancerous cells do not. The effectiveness of chemotherapy is determined by its ability to damage the RNA or DNA that gives the cell instructions to copy itself. The cells will die if they are unable to divide. The more quickly they are dividing, [...]

2021-09-09T06:48:49-07:00September, 2021|Oral Cancer News|

Giving hope: research on rare head and neck cancer treatment options

Source: www.curetoday.com Author: Antonia DePace Findings from a phase 3 clinical trial demonstrated improved tumor shrinkage rates with the immune checkpoint inhibitor toripalimab and a first-line chemotherapy combination for nasopharyngeal carcinoma, a tumor that occurs in the nasopharynx (located behind the nose and above the back of the throat). The promising results may open the door to new clinical trials assessing triplet therapies with Food and Drug Administration (FDA)-approved drugs and provide hope for better treatment options for this patient population. Results from the JUPITER-02 trial were presented at the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting. In 2020, toripalimab received a breakthrough-therapy designation (approval to expedite drug development) for metastatic nasopharyngeal carcinoma. Of note, toripalimab is approved in China for several indications, but it is not FDA approved. Currently, the worldwide standard of care for these patients is first-line chemotherapy with gemcitabine and cisplatin. “By adding immunotherapy to the combination, we hope to improve survival and increase the time from starting therapy to progression of the cancer,” said Dr. Glenn Hanna, director of the Center for Salivary and Rare Head and Neck Cancers at Dana-Farber Cancer Institute in Boston, in response to the trial results. “If the triplet (therapy) has better rates of tumor shrinkage and prolongs survival with a reasonable side effect profile, that’s a win.” The possible addition of a novel regimen is exciting. “Treatment advances for late-stage nasopharyngeal carcinoma have lagged behind those of other cancers,” Dr. Julie R. Gralow, ASCO chief medical officer [...]

Calls grow for treatment deintensification of HPV-positive OPC

Source: ww.pharmacytimes.com Author: Bryan Fitzgerald, PharmD, BCOP Health-System Edition, July 2021, Volume 10, Issue 4 Oropharyngeal cancer (OPC) is a type of head and neck cancer that affects structures in the back of the throat, including the base of the tongue, the posterior pharynx, the soft palate, and the tonsils.1 In the United States, rates of OPC are increasing each year, with an estimated 54,010 new cases in 2021.2 Well-established risk factors include alcohol abuse; exposure to tobacco, including chewing tobacco, cigarettes, and pipes; and infection with human papillomavirus (HPV). With an estimated 43 million infections in 2018, HPV is the most common sexually transmitted infection in the United States.3 HPV infection is causally linked with cancers of the anogenital region, including anal, cervical, penile, vaginal, and vulvar cancers. When HPV is spread orally, infections can also lead to the development of OPC. In the United States, more than 70% of OPC cases are caused by HPV.4 HPV is a group of more than 100 viruses, including certain high-risk strains associated with the development of cancer. The HPV-16 strain is responsible for causing the majority of HPV-positive (HPV+) OPC cases, with HPV-18, HPV-33, and HPV-35 also contributing, albeit significantly less than HPV-16.1 In these high-risk HPV strains, the viral genome encodes several oncogenic proteins that inhibit tumor suppressor proteins, leading to chromosomal instability and malignancy in infected cells. HPV+ OPC is considered a genetically distinct form of OPC. Compared with HPV-negative (HPC–) OPC cases, HPV+ OPC is associated with a [...]

Henderson throat cancer patient rallies after cutting-edge treatment

Source: www.reviewjournal.com Author: Mary Hynes, Las Vegas Review-Journal In February, a cancerous tumor caused extreme swelling in Ruben Solis’ neck and face, blocking his airway. After an emergency tracheotomy, an incision to his windpipe that allowed him to breathe, Solis had to decide whether he wanted to enter a clinical trial to receive an experimental treatment. The 54-year-old Henderson resident was skeptical. But with stage 4 laryngeal cancer that had spread to his lungs, he was running out of options. Three months later, after three treatments, the tumors in his throat and lungs have dramatically shrunk and the swelling subsided. “I feel much better,” Solis said Monday. The father and grandfather, who worked in banquets and as a food and beverage manager on the Strip before falling ill, is the first person in the world to receive a combination of two experimental drugs, Enoblituzumab and Retifanlimab, as part of a new clinical trial for head and neck cancer, according to Comprehensive Cancer Centers of Nevada, the local site participating in the global study. Solis and his oncologist, Dr. Anthony Nguyen, spoke with reporters prior to the patient receiving his fourth infusion of the two drugs. The treatment is a new form of immunotherapy, which boosts the body’s immune system to combat the cancer. “So his immune system is actually being manipulated, turned on, to actually fight the cancer from inside,” Nguyen said. In this way it is different from traditional chemotherapy. “When we think of chemotherapy and cancer medicine, we [...]

New therapy shortens treatment for HPV-related cancers of the tonsils, tongue

Source: medicalxpress.com Author: From Mayo Clinic News Network, Mayo Clinic News Network Patients with HPV-related oropharyngeal cancer who undergo surgery and are treated with chemotherapy, may be able to forgo significant radiation therapy without increasing the risk of their cancer spreading, according to the results of a clinical trial led by researchers at Mayo Clinic. "We found that decreasing the amount of radiation therapy after a minimally invasive robotic surgery improved the quality of life of patients with HPV-related oropharyngeal cancer while delivering excellent cure rates," says Dr. Eric Moore, a Mayo Clinic otolaryngologist. "In essence, we found exactly the right amount of treatment to deliver without over-treating these patients." Dr. Moore and his colleagues compared 79 patients treated at Mayo Clinic for HPV-related tonsil and tongue cancer with surgery and two weeks of radiation therapy to a group of 115 patients with the same cancer who were treated with surgery, and the standard six weeks of radiation therapy and chemotherapy. Dr. Moore and his colleagues found no decrease in survival or cancer recurrence in the group that received two weeks of radiation therapy, compared to the group that received six weeks of radiation therapy. He says that by decreasing the amount of radiation therapy after minimally invasive robotic surgery, physicians were able to improve the quality of life of patients and achieve excellent cure rates. "In essence, we found exactly the right amount of treatment to deliver without overtreating," says Dr. Moore. Dr. Moore says Mayo Clinic now offers [...]

Deal-making in head and neck cancer to start yielding dividends for patients

Source: www.thepharmaletter.com Author: staff A frenzy of deal-making activity in head and neck cancer is bringing late-stage clinical candidates into view, according to GlobalData. Intelligence from the data and analytics provider shows that there have been some 340 licensing agreements since 2004 in head and neck cancer, amounting to an approximate total value of $35 billion. Aarohi Rede, oncology analyst at GlobalData, said: “The past few years have seen several licensing deals globally for clinical development in head and neck cancer. Merck KGaA’s collaboration with Debiopharm has the potential to transform the current treatment paradigm for head and neck squamous cell carcinoma (HNSCC) by combining xevinapant, a new molecular entity, with Merck KGaA’s strong commercialization capabilities.” Of the total licensing agreements signed, the highest recorded licensing agreements took place in North America, followed by Asia-Pacific, while the lowest recorded number of deals belonged to South and Central America. Dr Rede added: “Head and neck cancer is largely a chemotherapy-dominated market, but the past few years have seen effective use of Keytruda (pembrolizumab) and Bristol Myers Squibb’s Opdivo (nivolumab) in the recurrent or metastatic settings. The current clinical development pipeline has around 20 late-stage agents in the immuno-modulating therapy or cell inhibitor classes, thus revealing a robust late-stage pipeline that is highly conducive to future partnerships for licensing and commercialization, and is expected to contribute to significant market growth over the next ten years.” Many of these licensing deals involve strategic partnerships between Asia-Pacific, namely Chinese manufacturers, and US pharmaceuticals for [...]

On treating advanced head and neck cancer without cisplatin – an oncology grand rounds discussion

Source: www.medpagetoday.com Author: Mark L. Fuerst An oncology grand rounds discussion with Sachin Jhawar, MD. Head and neck squamous cell carcinoma (HNSCC) represents a heterogeneous set of diseases with different features and treatment recommendations. Physicians face challenges in initial treatment decision-making and response assessments, including the changing role of surgery, the incorporation of human papilloma and Epstein Barr virus status, as well as the potential for treatment de-escalation using patient-related and tumor-related factors. A recent "Oncology Grand Rounds" article in the Journal of Clinical Oncology provides an overview of treating advanced HNSCC when cisplatin is not an option, including concurrent chemotherapy, cetuximab, targeted therapy, and immunotherapy. In the following interview, the paper's lead author, Sachin Jhawar, MD, of Ohio State University Comprehensive Cancer Center in Columbus, reviews the main issues. What is the focus of the article? Jhawar: We focused on patients with locally advanced disease who would be receiving definitive non-surgical treatment when possible treatment with concurrent cisplatin, delivered either every 3 weeks or weekly, is always the preferred treatment. We specifically wanted to delve into the subset of patients who we would not recommend to receive cisplatin because of age or comorbidities. This could be concurrent chemotherapy (carboplatin/paclitaxel), concurrent cetuximab, and altered or standard fractionation radiation schedules without systemic therapy, as well as when to consider immunotherapy and palliative radiation for those with recurrent or metastatic disease. There is also a great deal of institutional preference involved. At our institution, we prefer concurrent carboplatin/paclitaxel in patients who cannot [...]

Thousands of Britons with deadly mouth cancer will be spared gruelling chemotherapy thanks to immune-boosting drug

Source: www.dailymail.co.uk Author: Eve Simmons for The Mail on Sunday Thousands of Britons with deadly mouth cancer will now be spared grueling chemotherapy thanks to an immune-boosting drug. The treatment, given the green light by health chiefs last week, offers fresh hope to patients whose cancer has either spread or deemed inoperable. Currently, these patients have two options to prolong their life – chemotherapy and weekly infusions of potent cancer drugs, which often leave patients debilitated and confined to bed for the short time they have left. But now immunotherapy drug pembrolizumab can help some patients with the disease live up to 30 per cent longer than they would with chemotherapy, with 50 per cent fewer side effects. Last week's ruling by UK health watchdog NICE, which was based on the results of final-stage international trials, permits the treatment not only for advanced mouth cancer but also cancers of the nose, sinuses and salivary glands, known collectively as head and neck cancers. Doctors must first test patients' tumours for a protein called PD-L1, which limits the immune system's ability to find and destroy the cancer. Immunotherapy drugs such as pembrolizumab blocks PD-L1, helping the body's fighter cells to attack tumours.The majority of people with advanced head and neck cancer will test positive for PD-L1. Roughly 12,000 Britons are diagnosed with these cancers every year – mostly men over the age of 70. In the majority of cases, head and neck cancers are spotted at a late stage as they are [...]

Home-based chemo skyrockets at one US center

Source: www.medscape.com Author: Nick Mulcahy In the fall of 2019, the University of Pennsylvania in Philadelphia started planning a pilot program of home-based chemotherapy for two treatment regimens (one via infusion and one via injection). Six months later, the Cancer Care at Home program had referred 40 patients. The uptake within the university's large regional health system was acceptable but not rapid, admitted Amy Laughlin, MD, a hematology-oncology fellow involved with the program. Then COVID-19 arrived, along with related travel restrictions. Suddenly, in a 4-week period (March 10 to April 7), an additional 135 patients had been referred ― a 300% increase from earlier. The list of chemotherapies delivered went from two to seven, with more coming. "We're not the pilot anymore ― we're the standard of care," Laughlin told Medscape Medical News. "The impact [on patients] is amazing," she said. "As long as you are selecting the right patients and right therapy, it is feasible and even preferable for a lot of patients." For example, patients with hormone-positive breast cancer who receive leuprolide (to shut down the ovaries and suppress estrogen production) ordinarily would have to visit a Penn facility for an injection every month, potentially for years. Now, a nurse can meet patients at home (or before the COVID-19 pandemic, even at their place of work) and administer the injection, saving the patient travel time and associated costs. This home-based chemotherapy service does not appear to be offered elsewhere in the United States, and a major oncology organization [...]

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