Type 2 diabetes drug could be beneficial for head and neck cancer patients

Source: www.eurekalert.org Author: press release Researchers at the University of Cincinnati (UC) College of Medicine have found that adding increasing doses of an approved Type 2 diabetes drug, metformin, to a chemotherapy and radiation treatment regimen in head and neck cancer patients is not well tolerated if escalated too quickly, but allowing slower escalation could be beneficial. These findings are being presented via poster June 4 at the 2016 American Society of Clinical Oncology (ASCO) Annual Meeting: Collective Wisdom, being held June 3-7 in Chicago. Trisha Wise-Draper, MD, PhD, assistant professor in the Division of Hematology Oncology at the UC College of Medicine, a member of both the Cincinnati Cancer Center and UC Cancer Institute and principal investigator on this study, says retrospective studies have shown improved outcomes in tumors treated with chemotherapy and radiation if they were also on metformin for diabetes. "In head and neck squamous cell carcinoma, which develops in the mucous membranes of the mouth, nose and throat, diabetic patients taking a medication called metformin had better overall survival compared to those not on metformin when also treated with chemotherapy and radiation," she says. "Additionally, pancreatic cancer patients treated with chemotherapy and metformin required higher doses of metformin--1,000 milligrams twice a day--to experience positive results. "In basic science studies, metformin has been shown to stop mTOR, a molecular pathway present and active in this type of head and neck cancer, and pretreatment with metformin resulted in a decrease in the occurrence of oral cavity tumors in [...]

Chemotherapy + radiation may improve survival for some elderly

Source: journals.lww.com Author: Carlson, Robert H., Oncology Times Because the toxicity of concurrent chemoradiation is greater than radiation therapy alone for definitive head and neck cancer treatment, many clinicians have reservations about offering chemoradiotherapy for elderly head and neck cancer patients. But a new study shows that combining chemotherapy with radiation therapy improves survival rates for those head and neck cancer patients ages 71 to 79 years who have low comorbidity scores and advanced disease stage, with survival rates similar to that of younger patients. The study, which used data from the National Cancer Data Base (NCDB), suggests elderly patients are being underrepresented in prospective clinical trials that have defined standards of care for head and neck cancer. “In the era of improved radiation techniques, improved systemic therapy, and better supportive care, we found that chemoradiotherapy does, in fact, improve survival for a large segment of this population,” said Sana Karam, MD, PhD, Assistant Professor of Radiation Oncology at the University of Colorado School of Medicine in Aurora, and senior author on the study.“ "These findings challenge historical data demonstrating no benefit of chemoradiotherapy for patients older than 70 years,” Karam said. The study was presented at the 2016 Multidisciplinary Head & Neck Cancer Symposium, sponsored by the American Society for Radiation Oncology (ASTRO) and the American Society of Clinical Oncology (ASCO). First author is Arya Amini, MD, a fourth-year resident in the Department of Radiation Oncology at the University of Colorado School of Medicine. Before the meeting, Karam discussed [...]

Study supports immunotherapy/radiation combo in head and neck cancer

Source: www.onclive.com Author: Laura Panjwani There may be potential synergy between radiation therapy, given with or without chemotherapy, and immune checkpoint inhibitors in patients with squamous cell carcinoma of the head and neck (SCCHN), according to results of a prospective study. The study, which was presented at the the 2016 Multidisciplinary Head and Neck Cancer Symposium in February 2016, examined blood samples from 16 consecutive patients with SCCHN undergoing curative-intent radiation therapies. Samples were obtained at week 1 and week 6 to 7. Patients received a median of 70 Gy for disease in the oropharynx (n = 12, 75%), nasopharynx (n = 2, 12%), larynx (n = 1, 6%), or oral cavity (n = 1, 6%). The majority of patients had stage IV disease that was metastatic to regional lymph nodes and received concurrent platinum-based chemotherapy. The analysis found that, during radiation treatment, circulating CD8-positive T-effector cells increased (P = .01), as did CD4-positive PD-1–positive cells (P = .02), CD8-positive LAG3-positive cells (P = .02), and regulatory T cells (P = .04). sPD-L1 levels also increased, mirroring increases in CD8-positive T cells over the course of therapy (P = .047). While the extent to which these systemic changes reflect changes in the tumor microenvironment is unknown, the study authors noted that these findings support the “complex immunologic effects of fractionated chemoradiation therapy and mechanisms for potential synergy between chemotherapy, radiation treatment, and immunotherapy in SCCHN.” To learn more about the impact of the research, OncLive spoke to one of the [...]

Forgotten patients: New guidelines help those with head-and-neck cancers

Source: www.fredhutch.org Author: Diane Mapes and Sabrina Richards Stigma, isolation and medical complexity may keep patients from getting all the care they need; recommendations aim to change that. Like many cancer patients, Jennifer Giesel has side effects from treatment. There’s the neuropathy in her hands, a holdover from chemo. There’s jaw stiffness from her multiple surgeries: an emergency intubation when she couldn’t breathe due to the golf ball-sized tumor on her larynx and two follow-up surgeries to remove the cancer. And then there’s hypothyroidism and xerostomia, or dry mouth, a result of the 35 radiation treatments that beat back the cancer but destroyed her salivary glands and thyroid. “I went to my primary care doctor a couple of times and mentioned the side effects,” said the 41-year-old laryngeal cancer patient from Cleveland, who was diagnosed two years ago. “She was great but she didn’t seem too knowledgeable about what I was telling her. She was like, ‘Oh really?’ It was more like she was learning from me.” Patients like Giesel should have an easier time communicating their unique treatment side effects to health care providers with the recent release of new head-and-neck cancer survivorship guidelines. Created by a team of experts in oncology, primary care, dentistry, psychology, speech pathology, physical therapy and rehabilitation (with input from patients and nurses), the guidelines are designed to help primary care physicians and other health practitioners without expertise in head-and-neck cancer better understand the common side effects resulting from its treatment. The goal is [...]

Patient survives stage IV, inoperable throat cancer in clinical trial

Source: medicalxpress.com Author: staff It took a white lie to get David Polisini, 79, to a doctor in 2004, after months of being unable to swallow. "Two of my daughters, Toni and Susie, showed up on my back porch and told me to put my jacket on," he says. "They told me we were just going for a ride, but the next thing I knew, we were pulling into the Clermont Mercy Hospital." Polisini says tests ordered in the emergency room uncovered a tumor in his throat. "It was the size of a golf ball," he says, adding that he then scheduled an appointment with his primary care physician, Francis Dumont, MD. "I was then referred to an ear, nose and throat physician within his group who said I needed to see someone at the University of Cincinnati (UC) Cancer Institute." A biopsy was performed, and a diagnosis was confirmed—it was Stage IV cancer. "I began seeing Dr. (Bill) Barrett who explained that I would need to go through very aggressive radiation along with chemotherapy five days a week for three months," he says. "I'd drive myself every day to every visit in my little Miata. The therapy really zapped my strength, but I'm here because of it. "I really don't think I realized how much trouble I was in with Stage IV inoperable cancer, but I knew I had to do what I had to do to get through it." The radiation and chemo regimen was a Phase III [...]

Immunotherapies gaining traction in head and neck cancers

Source: www.targetedonc.com Author: Greg Kennelty An explosion of immunotherapies is on the horizon for patients with metastatic head and neck cancer, specifically as phase III trials begin to report findings for PD-1 inhibitors. This upcoming wave of new therapies places importance on understanding optimal treatment settings and adverse events associated with these therapies. In late January, the phase III CheckMate-141 trial investigating the anti–PD-1 agent nivolumab was stopped early, due to a substantial improvement in the primary endpoint of overall survival (OS). The drug was put up against the investigator’s choice of cetuximab (Erbitux), methotrexate, or docetaxel following progression on a platinum-based therapy. At this time, data from the study have not yet been released but are being prepared for future presentation. Findings from the study are being discussed with the FDA and other health authorities. In addition to nivolumab, the PD-1 inhibitor pembrolizumab (Keytruda) demonstrated encouraging activity in patients with with advanced PD-L1–positive esophageal carcinoma during the phase Ib KEYNOTE-028 study. Additionally, the agent was effective for patients with squamous cell carcinoma of the head and neck in the phase I KEYNOTE-012 study. In the head and neck cancer population, the objective response rate with pembrolizumab was 24.8% in 117 evaluable patients. Tumor shrinkage was experienced by 56% of patients and another 25% had stable disease. The response rate seen with pembrolizumab was similar, regardless of HPV infection status. In those with HPV-positive disease, the ORR was 20.6% compared with 27.2% in the negative group. To gain further insight, [...]

2016-02-18T14:35:44-07:00February, 2016|Oral Cancer News|

Depressed Head and Neck Cancer Patients Have Lower Survival and Higher Recurrence Risk

Source: www.OncologyNurseAdvisor.comAuthor: Kathy Boltz, PhD Depression is a significant predictor of 5-year survival and recurrence in patients with head and neck cancer, according to a new study published in Pyschosomatic Medicine (doi: 10.1097/PSY.0000000000000256). These findings represent one of the largest studies to report on the impact of depression on cancer survival. Although depression can have obvious detrimental effects on a person's quality of life, its impact on cancer patients is more apparent, explained lead author Eileen Shinn, PhD, assistant professor of Behavioral Science at The University of Texas MD Anderson Cancer Center, in Houston. Increasing evidence shows modest associations between elevated symptoms of depression and greater risk for mortality among patients with lung, breast, ovarian, and kidney cancers. The research team sought to clarify the influence of depression on survival, focusing their analysis on a single cancer type. By limiting the sample set and adjusting for factors known to affect outcome, such as age, tumor size, and previous chemotherapy, they were able to uncover a more profound impact of depression. The researchers followed 130 patients at MD Anderson with newly diagnosed oropharyngeal squamous cell carcinoma (OSCC), a type of cancer in which the tumor originates at the back of the throat and base of the tongue. At the beginning of their radiation therapy, Patients completed a validated questionnaire at the beginning of their radiation therapy to identify symptoms of clinical depression. Researchers monitored the participants, all of whom completed treatment, until their last clinic visit or death, a median period of [...]

2015-12-30T18:15:58-07:00December, 2015|Oral Cancer News|

Poison’s Rikki Rockett Reveals He Is Battling Oral Cancer

Source: www.loudwire.comAuthor: Chad Childers Poison drummer Rikki Rockett revealed during an appearance on the Eddie Trunk Live radio show that he’s completed nine rounds of chemotherapy and seven weeks of radiation treatments after being diagnosed with oral cancer this past summer and that he’ll find out in February if the treatments were successful. Rockett told Trunk (as transcribed by Blabbermouth), “[In] June, I kind of got sick. I had this horrible cold, sore-throat thing, and they were scoping me and they were doing biopsies, and nothing was coming up. And finally a doctor at USC did a biopsy and took a look and he said, ‘I believe you have oral cancer.’ And what it was is a tumor at the base of my tongue … This is very similar to Bruce Dickinson, very similar to Michael Douglas, similar to Tom Hamilton, as far as I know; I don’t know the details of his. And two adjacent lymph nodes that it kind of … Normally, it does spread to the lymph nodes; that’s typical. That’s how you find out you have it ninety percent of the time.” According to the Rockett, his doctor told him that it was a very treatable cancer, but was “a son of a bitch to treat.” He was then told that he would either have to undergo radiation and chemotherapy at the same time or undergo surgery, but even if he chose the latter, he might still have to do radiation and chemotherapy. Rockett revealed that it [...]

2015-12-15T16:23:53-07:00December, 2015|Oral Cancer News|

Cetuximab plus RT linked with high toxicity in head and neck cancer

Source: www.cancernetwork.com Author: Anna Azvolinsky, PhD The combination of radiation therapy plus the EGFR inhibitor cetuximab had higher rates of acute toxicity among patients with locally advanced squamous cell carcinoma of the head and neck (SCCHN) compared with radiation therapy plus the chemotherapy cisplatin, according to results of a phase II trial based in Italy. Efficacy was similar with both combination therapies. According to Stefano Maria Magrini, MD, professor of radiotherapy at the Università degli Studi di Brescia in Italy, and colleagues, this is the first clinical trial to directly compare radiation therapy plus cetuximab to a chemoradiation regimen for SCCHN. The results of the randomized trial are published in the Journal of Clinical Oncology. Cetuximab was approved in combination with radiation therapy by the US Food and Drug Administration in 2006 for the treatment of unresectable SCCHN. Despite a goal of recruiting 130 patients, only 70 patients were recruited between 2011 and 2014. The 1- and 2-year overall survival rates were 75% and 68% in the cetuximab arm compared with 78% in the cisplatin arm. The 1- and 2-year local control rates were 64% and 53% in the cetuximab arm and 84% and 80% in the cisplatin arm, yet the differences between arms were not statistically significant (P = .073), reflecting the inadequate statistical power of the relatively small trial. Compliance in both treatment arms was relatively low. Only 28% of patients in the cetuximab arm and 20% of patients in the cisplatin arm received at least 7 cycles [...]

2015-12-13T09:06:40-07:00December, 2015|Oral Cancer News|

Head, Neck Cancer Patients May Be at Higher Risk for Suicide: Study

Source: www.health.usnews.comAuthor: Robert Preidt THURSDAY, Nov. 12, 2015 (HealthDay News) -- Head and neck cancer patients may be at raised risk for suicide, new research suggests. However, the overall risk is still small, the findings showed. The study included over 350,000 patients in the United States diagnosed with head and neck cancer between 1973 and 2011. Of those patients, 857 died by suicide. The investigators found that the suicide rate among head and neck cancer patients was three times higher than in the general population. And suicide rates were higher among patients treated with radiation alone compared to surgery alone. Suicide rates were highest among those with cancers of the lower part of the throat, including the larynx ("voice box") and hypopharynx, at five times and 12 times higher, respectively, than in the general population. "This may be linked to these anatomic sites' intimate relationship with the ability to speak and/or swallow. Loss of these functions can dramatically lower patients' quality of life," Dr. Richard Chan Woo Park, of Rutgers New Jersey Medical School, and colleagues wrote. "It is possible that the increased rates of tracheostomy [breathing tube] dependence and dysphagia [difficulty swallowing] and/or gastrostomy [feeding] tube dependence in these patients are . . . factors in the increased rate of suicide observed," the authors added. The study was published online Nov. 12 in the journal JAMA Otolaryngology--Head & Neck Surgery. "While there is a considerable body of research that examines survival outcomes for patients with head and neck cancer, additional [...]

2015-11-13T15:34:55-07:00November, 2015|Oral Cancer News|
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