Patients with oral cancer may get relief from dry mouth through MU research

Source: www.columbiamissourian.com
Author: Tia Alphonse

Gary Rackers bit his tongue one night, and it began to bleed. Thinking it wasn’t serious, he waited a couple of weeks, but something still didn’t feel right.

So, he asked his wife to take a look. She was shocked, Rackers said. His tongue was black.

After seeing his family physician and a local ear, nose and throat doctor in Jefferson City, Rackers was referred to Ellis Fischel Cancer Center. There, he connected with a physician who specialized in surgical treatment for patients with head and neck cancers. He was diagnosed with squamous cell carcinoma — a common oral cancer. The doctor ended up surgically removing half of Rackers’s tongue and nearly all of his teeth, and he began radiation and chemotherapy treatments.

Since then, Rackers said he‘s had 33 radiation treatments and three rounds of chemotherapy. He is pleased and proud of the work his physician did, he said. Because of her, he’s in the recovery phase: “I’m doing good…and I’m feeling good.”

Many head and neck cancer patients like Rackers lose their ability to produce saliva after radiation treatment. He said it doesn’t affect him much during the day, but his mouth gets quite dry at night. Dry mouth frequently disturbs his sleep, he said, causing him to often fetch water or juice for relief.

“If I could get through the night,” he said, the days are easy.

MU researcher and former dentist Olga Baker hopes to help patients like Rackers by dedicating her efforts to something most of us take for granted — saliva. Through her research, she hopes to find better solutions to combat dry mouth, particularly among cancer patients whose glands have been destroyed by radiation therapy.

When she practiced dentistry, Baker said she encountered many patients who struggled with dry mouth. Although the condition is often viewed as insignificant, those who underproduce saliva often develop mouth sores, cavities and a host of other issues. Baker said she has even worked with patients who have trouble talking because their inner cheeks stick to their teeth without natural lubrication from saliva. She has also treated patients who feel as if they are choking at night without the fluid to keep their airways moist.

Multiple groups of people suffer from chronic dry mouth. Patients who undergo radiation treatment for neck and head cancer are among a common group that often loses the function of salivary glands. After treatment, many of these glands stop working and can no longer naturally produce saliva, Baker said. She has seen patients who suffer from Sjögren’s syndrome, an autoimmune disease that causes inflammation that destroys the salivary glands. Other patients are born without functioning salivary glands at all.

“For these patients, there is no cure,” Baker said. “So, we’re working on different options.”

In the past, she worked to produce artificial saliva from plant-based resources and researched resolvins, lipids derived from the Omega-3 fatty acids commonly found in fish oil. This can be a potential treatment for dry mouth in Sjögren’s syndrome patients. These kind of solutions provide temporary relief, working as a spray that can be applied throughout the day to mimic the effects of saliva lubrication.

Baker’s current research into saliva production is dedicated to finding a more long-term solution to dry mouth, specifically for patients whose glands have been destroyed by radiation therapy. The therapy Baker is researching uses a specialized hydrogel that targets the affected glands. She has zeroed in on a protein called laminin-111, which is important to the embryonic process and has long been associated with regenerative properties. Baker said her previous research found that the protein helped restore salivary gland function when only single molecules were used.

She looked at recent studies on the way trimers, a combination of three molecules of a given protein, could give greater results than single molecules. She became interested in testing trimers of laminin-111 on salivary glands to see whether the protein could further restore salivary function in mice.

The experiment tested mice that had undergone radiation treatment and lost salivary function. Proteins from the treatment are put into hydrogels to make a more efficient delivery system. The gel was applied to the mice, and their saliva secretion was monitored. The treatment has proved effective in mice that lose salivary gland function due to radiation. Baker said the next step is to expand her research into larger animals and ultimately do clinical trials on human patients.

Meanwhile, Rackers is adjusting to his recovery. He said he no longer eats spicy foods, and he can’t stand the tanginess of condiments like barbecue and mustard. He can, however, still enjoy most foods.

“Tonight, I’m making smoked sausage, fried potatoes and steamed vegetables,” he said. “And I can eat that.”

2021-02-04T20:59:31-07:00February, 2021|Oral Cancer News|

University of Cincinnati research unveils possible new combo therapy for head and neck cancer

Source: www.eurekalert.org
Author: Research News, University of Cincinnati

Head and neck cancer is the sixth most common cancer worldwide, and while effective treatments exist, sadly, the cancer often returns.

Researchers at the University of Cincinnati have tested a new combination therapy in animal models to see if they could find a way to make an already effective treatment even better.

Since they’re using a Food and Drug Administration-approved drug to do it, this could help humans sooner than later.

These findings are published in the journal Cancer Letters.

Christina Wicker, PhD, a postdoctoral fellow in the lab of Vinita Takiar, MD, PhD, led this research which she says will hopefully extend the lives of patients one day.

“Head and neck cancer, like any cancer, is truly life-altering,” she says. “Head and neck cancer could impact your throat, tongue or nose, and patients often can’t swallow, talk or eat; it truly takes away some of the most social, enjoyable parts of life.”

Researchers in this study combined radiation therapy with a drug (telaglenastat) that stops a key enzyme in a cell pathway that becomes altered in cancer cells, causing those cells to grow rapidly and resist treatment. Wicker says this drug has already been studied in multiple clinical trials to see if it could improve treatment of various cancers.

“Until now, no one has examined if this drug has the potential to improve radiation treatment in head and neck cancer. Most importantly, this drug compound has been well tolerated by patients and causes minimal side effects,” she says.

Using animal models, researchers found that the drug alone reduced the growth of head and neck cancer cells up to 90%, and it also increased the efficacy of radiation in animals with head and neck tumors by 40%.

“With these results, and especially with previous clinical trials showing that the drug is well tolerated by patients, there is the potential to move more rapidly into head and neck cancer clinical trials,” Wicker says. “In the future, we hope this drug will be used to make radiation treatments for head and neck cancer even more effective.”

Currently, the most common treatment for that cancer is radiation therapy, but the cancer eventually returns in up to half of patients, Wicker says, and often it doesn’t respond as positively to treatment the second time around.

“When [traditional] drugs are less effective, cancer growth becomes difficult to control, which can lead to the cancer quickly spreading to other organs,” she says. “It is very important that scientists and clinicians develop new cancer treatments to improve treatment of this type of cancer, and hopefully our findings will provide one more option to help patients.”

UK Innovators target nanoparticles at inoperable cancers

Source: www.politicshome.com
Author: from Medicines Discovery Catapult

At a point of critical clinical need for improved treatments for pancreatic and head and neck cancers, a partnership of healthcare innovators set out to revolutionise radiotherapy for inoperable, and the most difficult to treat tumours.

With the aim of achieving a higher quality of life for those with unfavourable prognoses, this project, funded by Innovate UK, the UK’s innovation agency, brings together partners with a wealth of experience and specialist know-how in the areas of nanoparticle development, drug delivery and bioimaging.

The pioneering work being conducted will target cancerous cells more selectively, enabling a reduced dose of radiation, which would lower the toxic effects a patient receives as a result.

This targeted approach will employ Xerion Healthcare’s non-toxic radiosensitiser – this heightens the cells’ sensitivity to radiotherapy, increasing the likelihood of successful treatment while reducing the often devastating side effects.

To ensure the nanoparticles carrying the therapeutic agent reaches deep inside the tumour, Active Needle Technology’s unique delivery system conveys the treatment to the cancerous cells with the assistance of ultrasonic vibrations, which not only allow accurate placement, but also enables an optimal distribution throughout the tumour and limits damage of healthy cells in the process.

Medicines Discovery Catapult’s (MDC) advanced pre-clinical imaging suite and state-of-the-art expertise in complex medicines validation will undertake in-life imaging of the nanoparticle distribution, allowing the partners to validate its biodistribution in tumour and across other tissues and organs.

Ian Quirk, CEO of Active Needle Technology said:

“For patients suffering from a range of late stage cancers, treatment options can be limited. The effectivity and accuracy of Active Needles delivery of Xerion Healthcare’s ground-breaking new anti-cancer treatment is poised to revolutionise radiotherapy, and offer the hope of recovery for vast numbers of patients. We’re delighted to be working with Medicines Discovery Catapult to take the technology one step closer to the clinic.”

Dr Gareth Wakefield, Chief Technology Officer from Xerion Healthcare said:

“Effective direct tumoural delivery of anti-cancer agents is a key stepping stone to getting our nanoparticle products into clinical trials and into treatment programs for patients with inoperable tumours. Partnering with Active Needles unique ultrasonic delivery system and MDC’s real time imaging allows us to optimise the delivery system for maximum efficacy.

“Late presenting inoperable tumours require very high dose radiotherapy for successful treatment. This can often have very severe side effects or simply not be possible due to nearby sensitive organs. This project gives us a way to boost the effectiveness of the treatment without increasing the whole body dose.”

Professor Peter Simpson, Chief Scientific Officer at Medicines Discovery Catapult (MDC) said:

“MDC is pleased to be providing our state of the art imaging facilities and complex medicines expertise in this exciting collaboration with Active Needle Technology and Xerion Healthcare – to assess the biodistribution and efficacy of this nanoparticle approach.

“Complex medicines have the potential to address patients’ problems which conventionally administered small molecules and monoclonal antibodies cannot. This project is a very encouraging example of exploring how using an advanced drug delivery technology could improve drug biodistribution, and so improve the targeting and efficacy of potentially toxic therapeutics.”

Although great progress has been made in the treatment of some common cancers, there remain many indications where there has been little improvement in care over decades. Pancreatic cancer is on course to become the second leading cause of cancer mortality by 2030 with head and neck cancer currently seeing a 50% mortality rate. It has never been more timely or pertinent for research in this space to be undertaken.

2020-12-19T08:18:56-07:00December, 2020|Oral Cancer News|

FDA clears IND application for cell therapy to treat radiotherapy-induced dry mouth

Source: www.healio.com
Author: staff

The FDA cleared an investigational new drug application for a mesenchymal stromal cell therapy to treat radiotherapy-induced xerostomia, also known as dry mouth.

Researchers at University of Wisconsin Carbone Cancer Center developed the therapy, which uses the patient’s interferon-gamma activated marrow stromal cells.

Xerostomia is a one of the most common adverse effects of radiation therapy for head and neck cancers and may cause difficulties eating, speaking and sleeping, in addition to oral health complications.

“There is a critical need for improved treatments for this condition,” Randy Kimple, MD, PhD, associate professor of human oncology at University of Wisconsin School of Medicine, said in a press release. “For most patients, the best care we can provide currently is to encourage them to eat specially prepared food, suck on hard sugar-free candies and carry a water bottle with them all day.”

Kimple told Healio the therapy process involves the patient undergoing a bone marrow biopsy to harvest mesenchymal stromal cells.

Kimple — who will lead the forthcoming phase 1 trial for the therapy — said the cells will be prepared by the Program for Advanced Cell Therapy’s lab at UW Health’s University Hospital. Patients will receive the therapy via injection into the submandibular gland after completion of radiation therapy.

The phase 1 trial soon will begin enrolling up to 30 patients and will be conducted by University of Wisconsin School of Medicine and Public Health as a single-center study of patients treated at Carbone Cancer Center.

Study participants will be monitored for safety and development of adverse effects after receiving the cell therapy injection.

“Patients will also provide samples of their saliva and complete quality-of-life questionnaires to help determine if the treatment is effective,” Kimple said.

Researchers hope to complete the first phase of the trial within a year, according to Kimple.

2020-09-12T10:26:52-07:00September, 2020|Oral Cancer News|

UCM computer science professor researches use of AI in cancer treatment

Source: www.dailystarjournal.com
Author: Sara Lawson

New research by a University of Central Missouri faculty member uses an innovative Artificial Intelligence (AI) technique to allow physicians to predict which patients are at low risk of distant metastasis in order to help minimize severe side effects from radiation treatment. The research conducted by Zhiguo Zhou, assistant professor of computer science, is titled “Multifaceted radiomics for distant metastasis prediction in head-and-neck cancer.” Zhou’s research was published in the journal, Physics in Medicine and Biology, and subsequently reported in the July 2020 issue of Physics World.

Zhou, who has explored AI in medicine for 10 years, joined the UCM faculty in 2019. He began working on this recently published study more than three years ago while serving in the Department of Radiation in oncology at the University of Texas Southwestern Medical Center in Dallas. One of his UT colleagues, Jing Wang, served as co-author on the journal article.

Zhou said the research proposes a novel model for predicting metastasis in head-and-neck cancer after radiotherapy with “outstanding results.” It is a study he believes could provide a general framework which could be extended to predict treatment outcomes for primary cancers in other parts of the human body. While the research now undergoes a validation process that involves a multi-institutional prospective study, Zhou is hopeful that it can be applied in clinical settings within the next two to three years.

“Nowadays, radiotherapy has become one of the most important treatment methods in cancer therapy,” Zhou said. “The basic principal is to use radiation to kill the (primary) tumor and minimally deliver the dose (of radiation) to the surrounding normal organs. However, radiation is also harmful to the human body and it is very difficult to achieve this ideal situation.”

In fighting cancer, one of the challenges doctors face is how to effectively use radiotherapy to control the metastasis or spread of the disease without harming the patient in other ways. Physicians working with cancer patients must weigh different outcomes to address an optimal treatment plan, Zhou said.

“We think the solution is, if we can accurately predict the treatment outcome or response before radiotherapy, we can optimally make the treatment plan,” Zhou said. “This is the basic idea of why we need to do this research.”

As noted in the Physics World article, “As with cancers elsewhere in the body, early-stage cancers of the head and neck are treated using radiotherapy with increasing success. When treatment fails, it is often down to the growth of new tumors far from the site of the initial disease.

Predicting which patients are most likely to develop distant metastasis is vital so that low-risk patients can be spared the severe side effects that accompany the systemic treatments used to control cancer proliferation.”

In seeking to develop a reliable model to predict distant metastasis, Zhou and his research collaborators utilized PET and CT diagnostic and treatment planning images of 188 patients with head-and-neck cancer that were obtained from different institutions. These patients had received follow-up consultations with their care providers and the images were already seen by physicians. The researchers were able to extract from each patient 257 features that included intensity, geometric and textural characteristics in addition to other data related to patient age, gender and progression of the disease.

Zhou said since 2012 a prediction model called radiomics has existed, which uses a characterization algorithm to extract data to help further understanding of a patient’s likelihood of experiencing the spread of cancer from the initial tumor to other organs or lymph nodes. His research, called “M-radiomics,” takes a multifaceted approach to radiomics in order to produce a more reliable and accurate prediction model. Three different algorithms are used in this process to help address challenges related to the integration of data from multiple imaging modalities, sensitivity-specificity optimization and use of multiple data machine learning classifiers simultaneously.

“In M-radiomics we can integrate these three challenges into one framework,” Zhou said. “The results are very promising for distant metastasis prediction in head-and-neck cancer.”

Zhou is continuing his research in M-radiomics, in addition to pursuing other interests related to artificial intelligence in medicine. His work at UCM also involves teaching an undergraduate introduction to biomedical informatics course and a graduate-level course on artificial intelligence. Supportive of student research, Zhou mentors and instructs five graduate students who work with him on research, each of whom is also doing their own research project. He said he is looking forward to getting more undergraduate students involved in research as his career as UCM progresses.

2020-09-06T06:44:52-07:00September, 2020|Oral Cancer News|

Common causes of dysphagia in seniors may differ by sex, study finds

Source: www.mcknights.com
Author: Alicia Lasek

Common causes of swallowing problems may differ significantly between older men and women, according to physician researchers.

In a two-year swallowing clinic study, neuromuscular and esophageal problems were the most frequent causes of dysphagia among 109 study participants, reported Jeremy Applebaum, M.D., from Johns Hopkins University. Many patients (16%) had either diverticula (a soft pouch in the esophagus that can collect food particles), reflux (14%) or scarring caused by radiation treatment (8%). These problems also were associated with significant quality-of-life burden, the researchers added.

Causal differences were also found between the sexes. Men were more likely to have oropharyngeal dysphagia, a difficulty with initiating swallowing as food is introduced to the pharynx and esophagus from the mouth. In contrast, women were more likely to present with esophageal dysphagia, which can have several causes and is typically associated with the sensation of food sticking in the throat or chest after starting to swallow.

Higher rates of smoking and head and neck cancer may explain the prevalence of oropharyngeal problems found in male participants, whereas the esophageal problems in women likely were due to the high prevalence of reflux disease among that cohort, the authors surmised. They did not find significant differences in cause between older age cohorts.

Up to 33% of people age 65 and older are known to have swallowing problems due to physical changes, yet dysphasia also may be the result of underlying disease, the investigators said.

“A complaint of dysphagia in older adults should therefore be regarded as pathologic, especially given the wide spectrum of neuromuscular and structural disorders that increase in prevalence with age,” wrote Applebaum and colleagues. “We hope to inform more nuanced, patient-based approaches to this increasingly important topic,” they concluded.

The study was published in OTO Open: The Official Open Access Journal of the American Academy of Otolaryngology–Head and Neck Surgery Foundation.

Surgery, radiation yield similar efficacy for early squamous cell carcinoma of lip

Source: www.healio.com
Author: Earl Holland Jr.

Both surgery and radiation therapy were beneficial methods of treating early-stage lip squamous cell carcinoma, according to findings presented at the American Academy of Dermatology virtual meeting.

Kevin Phan, MD, of the dermatology department at Liverpool Hospital, Sydney, Australia, and Mahmoud Dibas, MD, of Sulaiman Al Rajhi Colleges, College of Medicine, Saudi Arabia, sought to examine the survival rates in low-stage lip squamous cell carcinoma (SCC) between patients who had surgery alone and patients who had radiation therapy alone.

“Squamous cell carcinoma of the lip composes 25% to 30% of all oral cancers,” the authors wrote. “Lip SCC is often detected at an early stage, due to the highly visible location and slow growth pattern.”

Results from the Surveillance, Epidemiology, and End Results database between 2010 and 2014 were analyzed. Overall survival and cancer-specific survival were measured.

The researchers identified 900 patients with early-stage lip SCC who had received either radiation alone (36 patients) or surgery alone (864 patients).

Patients who underwent surgical procedures had better overall survival and cancer-specific survival rates compared with patients who had radiation alone, the study found. The treatment modality did not have a significant effect on either survival rate; the radiation-alone group had an adjusted hazard ratio of 1.94 (95% CI; 0.83-4.53), while the surgery-alone group had an adjusted hazard ratio of 1.04 (95% CI; 0.07-15.55).

“Our results support the notion that surgery and [radiation therapy] appear to be equally effective in treating early-stage lip SCC,” the researchers wrote.

Less intense treatment safe for HPV+ throat cancer

Source: www.miragenews.com
Author: public release, University of Pittsburgh School of Medicine

A less intense treatment for human papillomavirus positive (HPV+) throat cancer—using robotic surgery followed by low-dose radiation—could provide as much benefit as standard higher-dose radiation and chemotherapy while preserving a patient’s throat function, and with potentially less toxicities, according to researchers at UPMC Hillman Cancer Center and Yale Cancer Center.

The results of their randomized phase two clinical trial will be presented virtually this week at the American Society of Clinical Oncology (ASCO) annual meeting during the Head and Neck Oral Abstract Session (Abstract 6500).

“These results present a promising deintensification approach that has proven to be safe in patients with intermediate risk, locally advanced oropharynx cancer,” said Robert Ferris, M.D., Ph.D., director, UPMC Hillman Cancer Center and a surgical oncologist specializing in head and neck cancer, who was lead investigator of the trial. The results are not yet published in a peer-reviewed journal.

About 60% of oropharynx cancer, in which cancer cells form in the back of the throat, base of the tongue and tonsils, is associated with HPV infection. The incidence has been increasing in recent years, especially in individuals under the age of 45.

Following robotic surgery, patients with HPV-associated throat cancer would typically undergo high dose radiation and chemotherapy. While robotic surgery allows for more precise and optimal preservation of the organs and surrounding tissue, there is still concern with the toxicities from the chemotherapy and consequences of tissue damage from radiation therapy, particularly in a younger population.

“Most throat cancers caused by HPV have good outcomes, and the cancer doesn’t return or spread to other parts of the body after treatment,” said Ferris, who also is professor, Department of Otolaryngology, of Immunology, and of Radiation Oncology, University of Pittsburgh School of Medicine.

“In this trial, we studied the pathologic features of the tumors obtained at surgery to determine patients’ risk of recurrence—low, intermediate or high—to then administer the right amount of postoperative treatment for each risk group.”

Patients at low risk were observed. Patients at intermediate risk were randomized to two arms of radiation alone, at standard or lower doses of radiation. Patients at high risk were assigned to usual high-dose radiation therapy plus chemotherapy.

For patients at low and intermediate risk, the two-year, progression-free survival rate was approximately 95%, and reducing radiation or chemotherapy intensity did not increase the risk of recurrence.

“The tissue samples and imaging studies collected in the course of this trial are a rich resource for studying the biology of intermediate- and high-risk disease, in work that is ongoing,” said ECOG-ACRIN Head and Neck Committee Chair Barbara Burtness, M.D., professor of medicine, and co-leader, Developmental Therapeutics Program, Yale Cancer Center and Yale School of Medicine.

Note:
The ECOG-ACRIN Cancer Research Group designed and conducted the trial with funding from the National Cancer Institute, part of the National Institutes of Health.

Novel intervention looks to improve timeliness, equity of head and neck cancer care delivery

Source: www.miragenews.com
Author: staff report, Medical University of South Carolina

Many factors go into surviving cancer.

Hollings Cancer Center researcher Evan Graboyes, M.D., specializes in head and neck cancer, a disease with poor survival prospects despite intense therapy with combinations of surgery, radiation and chemotherapy. While head and neck cancer only accounts for 4% of all cancer cases each year in the US, it has a high mortality rate. The American Cancer Society estimates that more than 14,000 patients died from this disease in the U.S. in 2019.

Overall, only 50% of head and neck cancer patients are alive at five years. Unfortunately, the mortality rate is even worse for African American head and neck cancer patients. That’s why researchers are looking for new strategies to improve patient survival and decrease racial disparities in outcomes for these patients.

Graboyes and MUSC Hollings Cancer Center researchers Chanita Hughes-Halbert, Ph.D., Katherine Sterba, Ph.D., Hong Li, Ph.D., and Graham Warren, M.D., Ph.D., have teamed up to develop and test a novel intervention to improve the timeliness, equity and quality of head and neck cancer care delivery, which they think might one day be the key to improving survival for these patients.

Funded by a $1.3 million 5-year grant from the National Cancer Institute, their study – Improving the Timeliness and Equity of Adjuvant Therapy Following Surgery for Head and Neck Cancer-started in September 2019 and built upon important research funded by grants from Hollings Cancer Center.

Graboyes explained that for patients with advanced head and neck cancer who are treated with surgery, national guidelines recommend that postoperative radiation therapy should start within six weeks of surgery.

“However, we know from our research that despite national guidelines, over half of the patients nationally don’t get radiation started in a timely fashion. Patients who have delays with radiation are more likely to die and have their cancer recur,” he said. “We are trying to find new ways to deliver timely head and neck cancer care. It’s an appealing way to help improve survival for this group.”

Innovative approach
The study is designed in three parts. The first part aims to identify the underlying reasons for why delays starting postoperative radiation are so common for this patient population. The researchers then developed a new multilevel health care delivery intervention called NDURE (Navigation for Disparities and Untimely Radiation thErapy), that specifically targets the barriers that lead to delays.

In the second part of the grant, the researchers will pilot the NDURE intervention in a small group of patients to make sure that it’s feasible and acceptable and refine the intervention based on participant feedback. In the third and final part of the study, they will compare NDURE to standard care in a randomized controlled trial to see whether NDURE is effective at decreasing treatment delays.

“This study interests me because it is clinically important. To help patients with head and neck cancer live longer, you don’t need to invent a new drug. All you need to do is get them the treatment they’re supposed to be getting. If we can find a way to deliver timely guideline-recommended care, it could have such a large impact on their survival,” he said

“It’s also a scientifically important study. Head and neck cancer treated with surgery followed by radiation is a great model system for us to understand how we deliver cancer care. Right now, we spend a lot of time and effort helping get people in to initiate cancer care. However, we understand a lot less about how cancer patients move through complicated treatment plans.”

Graboyes said South Carolina is primarily a rural state with some geographic barriers that present obstacles for patients to navigate. “Many of the patients will have surgery at a regional center like MUSC, then because radiation is five days a week for six weeks, they’ll get radiation at a different facility closer to where they live. We have to coordinate cancer care across health care systems, which presents some barriers that can lead to treatment delays.”

Graboyes emphasized that head and neck cancer is a major concern for the state of South Carolina and Hollings Cancer Center, a National Cancer Institute-Designated Cancer Center. The two major causes of head and neck cancer are smoking and human papillomavirus (HPV). The state’s population is affected by both, due to high rates of tobacco use and very low rates of HPV vaccination.

“As a result, Hollings has recognized this issue and has really invested a lot in the clinical enterprise of head and neck cancer because it’s such a problem in South Carolina.”

Hollings also has a strong cancer control program dedicated to reducing issues of health disparities and equity in the state, he explained.

“We think that NDURE, our intervention targeting the multilevel barriers to timely head and neck postoperative radiation, will be an effective way to help improve timely cancer care delivery for these patients, which will lead to higher rates of survival and low recurrence and decrease racial disparities and outcomes. That’s very exciting to our team.”

Did you know?
About 70% of cancers in the oropharynx (which includes the tonsils, soft palate and base of the tongue) are linked to HPV.

Dedicated to the mission of raising HPV vaccination rates for teens and young adults, Hollings Cancer Center has initiated a $700,000 three-year project. The Centers for Disease Control and Prevention recommends speaking with a doctor about the HPV vaccination. The HPV vaccine can prevent new infections with the types of HPV that most often cause oropharyngeal and other cancers.

Gabapentin shows efficacy as opioid alternative for patients with head and neck cancer

Source: www.healio.com
Author: Jennifer Byrne

For many patients with head and neck cancer, treatment-associated oral mucositis is a source of severe pain. Managing this pain is a priority for physicians and interdisciplinary care teams.

Although opioid painkillers historically have been used for this purpose, researchers at Roswell Park Comprehensive Cancer Center investigated the use of gabapentin, a drug used to alleviate nerve pain, as an alternative to narcotics for this patient population.

“Virtually all patients will require some type of pain relief or analgesic medication during the course of chemotherapy and radiation,” study author Anurag K. Singh, MD, professor of oncology and director of radiation research at Roswell Park, told Healio. “We’ve been studying better ways to improve pain control in this population because standard narcotics just don’t work that well. Patients tend to use a lot and they still experience pain, but they are sleepier.”

A dose-dependent effect
In their study, published in Cancer, Singh and colleagues randomly assigned 60 patients with head and neck squamous cell carcinoma to one of two treatment regimens: high-dose gabapentin (2,700 mg daily), progressing sequentially to hydrocodone-acetaminophen and fentanyl when needed (n = 31), or low-dose gabapentin (900 mg daily) progressing to methadone as needed (n = 29).

Safety and toxicity served as the study’s primary endpoints. Pain, opioid requirement and quality of life served as secondary endpoints.

Results showed no difference in pain between the treatment groups, but more patients in the high-dose gabapentin group did not need an opioid while receiving treatment (42% vs. 7%; P = .002). Patients whose treatment progressed to methadone rather than hydrocodone and fentanyl had significantly better quality-of-life outcomes in terms of general health (P = .05), physical functioning (P = .04) role functioning (P = .01) and social functioning (P = .01).

“The bottom line is there was a dose-dependent effect of gabapentin,” Singh told Healio. “When you go from 7% in the lower-dose arm, or 0% if you weren’t giving gabapentin at all, to 42% in the higher-dose arm, that’s a really obvious difference.”

‘Potential arrow in our quiver’
The team at Roswell Park has begun using gabapentin as a first-line approach to pain for patients with head and neck cancer, Singh said.

“We use even higher-dose gabapentin now. We go up to 3,600 mg and follow it with methadone when needed,” he told Healio. “We’re having excellent results. Currently, we’re studying whether we can add something to the gabapentin to get narcotics even further out of the equation.”

Singh and study first author Gregory Hermann, MD, MPH, resident physician in radiation medicine at Roswell Park, have started to evaluate use of the antidepressant venlafaxine (Effexor, Pfizer), which was shown in a study conducted in Europe to enhance the effects of gabapentin.

“Venlafaxine is an SNRI [serotonin-norepinephrine reuptake inhibitor] that is similar to other drugs like duloxetine (Cymbalta, Eli Lilly) that have been used for neuropathic pain in diabetes. It’s a very common medication that is used in primary care,” Hermann told Healio. “At the end of the study, we’ll be able to say whether 3,600 mg is more effective than 2,700 mg and whether venlafaxine adds anything.”

Although opioid painkillers are known for their addictive potential, opioid abuse is less likely among patients with head and neck cancer, provided they are used properly, according to Heath Skinner, MD, PhD, associate professor of radiation oncology at UPMC Hillman Cancer Center. improve significantly within a few weeks of treatment completion,” Skinner told Healio. “In that situation, the goal is to manage pain to allow for eating and drinking as much as possible. Once the acute event leading to the pain is at least partially resolved, we start to wean those medications down. So, in the acute setting, I think these medications have a very limited addiction potential.”

However, if improperly prescribed for long-term use, opioid painkillers could become addictive, Skinner said. Moreover, narcotic painkillers are associated with significant toxicities for an already sick population.

“Constipation is a common effect with opioids and can be particularly challenging for [patients with head and neck cancer] because they’re not drinking a lot of fluids or eating much food,” Skinner told Healio. “That could exacerbate a problem known to happen with narcotic-based pain medications.”

Skinner said gabapentin is a promising alternative to opioids that is readily accessible to clinicians.

“It’s available in the setting of pain control and easily prescribed,” he said. “It’s not something that’s proprietary that a clinician couldn’t acquire. It’s nice to have another potential arrow in our quiver.” – by Jennifer Byrne

Reference:
Hermann GM, et al. Cancer. 2020;doi:10.1002/cncr.32676,

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