toxicity – Oral Cancer News

Treatment paradigms are shifting for locally advanced HPV-positive head and neck cancers

Source: www.onclive.com Authors: Kaveh Zakeri, MD, MAS, Nancy Y. Lee, MD The standard of care for patients with locally advanced head and neck squamous cell carcinomas does not substantially differ according to human papillomavirus (HPV) status in the National Comprehensive Cancer Network guidelines.1 Resectable tumors can be treated with surgery followed by adjuvant therapy. Alternatively, definitive chemoradiation therapy with cisplatin is the other dominant treatment paradigm. Incidence of HPV-associated oropharyngeal squamous cell carcinoma has increased rapidly and is associated with higher overall survival (OS) compared with cancers caused by smoking and alcohol.2,3 Given the unique biology of HPV-associated oropharyngeal disease, a separate staging system was developed for these tumors.4 HPV-associated oropharyngeal cancers are more radiosensitive and chemosensitive than cancers caused by smoking and alcohol, yet the traditional treatment paradigms—including high doses of radiation and chemotherapy—were developed prior to the epidemic of HPV-associated disease. De-escalation of therapy has been proposed for HPV-associated oropharyngeal cancer based on data demonstrating high OS and progression-free survival (PFS).5 De-escalation of therapy has been investigated for both definitive surgical and chemoradiation therapy paradigms. Most de-escalated approaches focus on selecting patients according to clinical features, such as disease stage and smoking status, whereas personalized de-escalation reduces treatment intensity for patients according to treatment response. Transoral Robotic Surgery Followed by Adjuvant Radiotherapy Transoral robotic surgery (TORS) is a minimally invasive approach that reduces morbidity compared with traditional, open surgery for patients with oropharyngeal cancers. TORS is a standard of care option for patients with resectable tonsil or base [...]

Oral Cancer Foundation News Team - A2021-11-23T08:16:08-07:00November, 2021|Oral Cancer News|

New treatment for HPV-associated oropharynx cancer leads to excellent disease control, less side effects

Source: www.news-medical.net Author: Emily Henderson, B.Sc., Mayo Clinic Mayo Clinic researchers have found that a new, shorter treatment for patients with HPV-associated oropharynx cancer leads to excellent disease control and fewer side effects, compared to standard treatment. The new treatment employs minimally invasive surgery and half the standard dose of radiation therapy, compared to current treatments. The new treatment also lasts for two weeks, rather than the standard six weeks. Results of a study of the new treatment were presented Tuesday, Oct. 20, at the American Society for Radiation Oncology's Annual Meeting. Dr. Ma says that while the standard treatment for this type of cancer leads to high cure rates, it may also result in many short-term and long-term treatment toxicities, including dry mouth, problems swallowing, neck stiffness and jawbone problems. "Many of these side effects are directly linked to the amount of radiation used for treatment," says Dr. Ma. Dr. Ma and his colleagues developed an initial clinical trial looking at a new treatment using minimally invasive surgery and half the standard dose of radiation. The initial clinical trial demonstrated that well-selected patients could have excellent disease control with much lower toxicity using the new treatment. "Our findings suggest that in select patients with HPV-associated oropharynx a shorter course treatment, compared to the standard of care, yields a similar result," says Dr. Ma. Based on these phase 3 results, Mayo Clinic has adopted this shorter course treatment as its standard of care for well-selected patients. Dr. Ma and his [...]

Oral Cancer Foundation News Team - A2021-10-27T20:21:27-07:00October, 2021|Oral Cancer News|

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 [...]

Oral Cancer Foundation News Team - A2016-04-19T14:49:31-07:00April, 2016|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 [...]

Oral Cancer Foundation News Team - A2015-12-13T09:06:40-07:00December, 2015|Oral Cancer News|

Less Is More for HPV Oropharyngeal Cancer Reduced-intensity regimen clears disease in 86% of cases

Source: www.medpagetoday.comAuthor: Charles Bankhead SAN ANTONIO -- Less intense treatment of low-risk human papillomavirus (HPV)-related oropharyngeal cancer achieved a high rate of pathologic complete response (pCR) and favorable patient-reported outcomes, a preliminary trial showed. Overall, 37 of 43 (86%) patients achieved pCR with deintensified chemoradiation, including all but one evaluable primary tumor. The pCR rate was virtually identical to historical rates achieved with standard regimens, according to Bhishamjit Chera, MD, of the University of North Carolina (UNC) at Chapel Hill, and colleagues. Selected patient-reported adverse events peaked during the first 6 to 8 weeks and then declined thereafter. About 40% of patients required feeding tubes for a median duration of 15 weeks, but no patients required permanent feeding tubes, they reported here at the American Society for Radiation Oncology meeting. The regimen consists of lower doses of radiotherapy and concurrent cisplatin, administered over 6 weeks. With high-dose therapy, the radiation protocol requires an additional week. "Though we have limited follow-up, the pathological complete response rate with this reduced-intensity chemoradiotherapy regimen is very high in patients with favorable-risk oropharyngeal squamous-cell carcinoma," Chera said. "The early quality-of-life measurements are encouraging, particularly the data on swallowing. We are optimistic that these results with reduced-intensity treatment will translate into good long-term disease control with less toxicity." The study reflects the current trend and momentum in the management of HPV-positive oropharyngeal cancer, said Zain Husain, MD, of Yale Cancer Center in New Haven, Conn. "This is the second study to show that de-escalation of therapy might [...]

Charlotte Parker2015-10-21T14:59:53-07:00October, 2015|Oral Cancer News|

An effective and well-tolerated strategy in recurrent and/or metastatic head and neck cancer: successive lines of active chemotherapeutic agents

Source: 7thspace.com Author: staff The combination platinum, 5-fluorouracil (5-FU) and cetuximab is the standard first-line regimen of recurrent and/or metastatic head and neck squamous cell carcinoma (HNSCC). Due to the toxicity of this treatment, alternative therapies are often offered to patients. The aim of this study was to evaluate the overall survival obtained with a first line chemotherapy adapted to patients functional status and the administration of all active drugs within successive lines of chemotherapy. Methods: This series included a total of 194 patients with recurrent and/or metastatic HNSCC treated from 2006 to 2011 in a single institution where the administration of successive lines of chemotherapies has been the standard clinical approach. Treatment was administered according to clinical practice guidelines. Results: Most patients received at least two treatment lines. Only 11 patients (6%) were treated with a combination of cisplatin, 5-FU and cetuximab in front line, but most patients received at least one platinum-based regimen (n = 154 patients, 78%); 162 (82%) received taxanes, 36 (18%) received 5-FU, 27 (14%) received capecitabine, 67 (34%) received methotrexate and 134 (68%) received cetuximab. The median overall survival was 9.8 months (95% CI: 8.1-11.4 months) and reached 13.1 months among the subgroup of 131 patients eligible for inclusion in a clinical trial. Conclusion: The survival outcomes of patients treated in the first-line setting with chemotherapy regimens adapted to their functional status, followed by several subsequent regimens were comparable with published outcomes of patients treated by platinum, 5-FU and cetuximab. Credits/Source: BMC Cancer 2014, [...]

Oral Cancer Foundation News Team - A2014-07-12T08:48:52-07:00July, 2014|Oral Cancer News|

Unilateral radiation benefited patients with advanced tonsil cancer

Source: www.healio.com Author: staff Unilateral radiotherapy was associated with effective regional control in patients with advanced tonsil cancer, according to study results presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Additionally, the results supported previous findings that suggest the primary tumor location, not the extent of ipsilateral neck lymph node involvement on the tumor side of the neck, governs the disease risk in the contralateral side of the neck. Researchers evaluated 153 consecutive patients diagnosed with squamous cell carcinoma of the tonsil who were treated with surgical removal and postoperative intensity-modulated radiation therapy. Forty-six of the patients underwent unilateral radiotherapy. Of these patients, 72% were male. The average patient age was 59 years. Current or former smokers comprised 61% of the study population. Lateralized primary tumors were confirmed in 40 (87%) of the patients. Two (4%) patients had non-lateralized tumors. Lateralization could not be retrospectively ascertained in four patients (9%). The cancer stages for these patients were distributed as follows: TX, 2%; T1, 44%; T2, 41%; and T3, 13%. Lymph node involvement stages were as follows: N0, 11%; N1, 13%; and N2, 76%. The patients underwent radiation doses of 60 Gy to 66 Gy to the postoperative bed and involved neck, and 52 Gy to 54 Gy to the elective region in 30 to 33 fractions using a simultaneous integrated boost technique. Concurrent chemotherapy was administered to 30 of the 46 patients. The median follow-up period was 2.8 years (range, 0.4-8.7 years). Researchers reported no local or regional [...]

Oral Cancer Foundation News Team - A2014-03-26T16:02:26-07:00March, 2014|Oral Cancer News|

New drug combination could prevent head and neck cancer in high-risk patients

Source: www.sciencedaily.com Author: staff A new drug combination shows promise in reducing the risk for patients with advanced oral precancerous lesions to develop squamous cell carcinoma of the head and neck. The results of the study, which included preclinical and clinical analyses, were published in Clinical Cancer Research, a journal of the American Association for Cancer Research. "Squamous cell carcinoma of the head and neck (SCCHN) is the most common type of head and neck cancer," said Dong Moon Shin, M.D., professor of hematology, medical oncology and otolaryngology at Emory University School of Medicine, and director of the Cancer Chemoprevention Program at Winship Cancer Institute at Emory University in Atlanta, Ga. "The survival rate for patients with SCCHN is very poor. An effective prevention approach is desperately needed, especially since we can identify patients who are at extremely high risk: those with advanced oral precancerous lesions." Based on prior research suggesting a role for epidermal growth factor receptor (EGFR) and cyclooxygenase-2 (COX-2) in promoting SCCHN, Shin and colleagues believed combining an EGFR inhibitor and a COX-2 inhibitor could provide an effective chemopreventive approach. They found that the combination of the EGFR inhibitor erlotinib and the COX-2 inhibitor celecoxib was more effective for inhibiting the growth of human SCCHN cell lines compared with either drug alone. In addition, treating mice with the drug combination prior to transplanting them with human SCCHN cells more effectively suppressed cancer cell growth than did pretreating the mice with either drug alone. Based on these preclinical [...]

Oral Cancer Foundation News Team - A2013-02-20T07:38:26-07:00February, 2013|Oral Cancer News|

Radiotherapy technique significantly reduces irradiation of healthy tissue

Source: www.sciencecodex.com/ Author: staff Researchers at the University of Granada and the university hospital Virgen de las Nieves in Granada have developed a new radiotherapy technique that is much less toxic than that traditionally used and only targets cancerous tissue. This new protocol provides a less invasive but equally efficient cancer postoperative treatment for cases of cancer of the oral cavity and pharynx. The study -conducted between 2005 and 2008- included 80 patients diagnosed with epidermoid cancer of the oral cavity and pharynx, who had undergone lymph node removal. The affected nodes were located by the surgeon during the intervention and classified into different risk levels. Classification allowed physicians to target the areas at a higher risk of recurrence. This way, neck areas at a lower risk of containing residual cancer cells were not irradiated. Researchers achieved both to minimize the side effects of radiotherapy, and to reduce treatment discontinuation, thus achieving the therapy to be more effective. A Highly Toxic Treatment Over 70% of oral and pharynx cancer treated with surgery require supplementary treatment with radiotherapy occasionally associated to chemotherapy, because of the high risk for recurrence and spread through the lymph nodes. Radiotherapy and chemotherapy are highly toxic, mainly due to the ulceration of the mucous membranes lining the oral cavity; toxicity leads may patients to stop the treatment, which significantly reduces the chances of cure. By using the risk map obtained with the collaboration of the surgeon and the pathologist, an individualized treatment was designed and adapted [...]

Oral Cancer Foundation News Team - A2012-02-26T09:44:04-07:00February, 2012|Oral Cancer News|

Tumeric and Curcumin offer powerful anti-cancer health benefits naturally

Source: www.sacbee.com Author: staff Commonly used in many Eastern countries, tumeric has been found to suppress cancer growth and reduce brain tumors by an astounding 81% without evidence of toxicity. While the benefits of turmeric are just coming to light within the mainstream and alternative media, it has been known for quite some time that this inexpensive spice can profoundly improve biological function. Curcumin, a natural phenol and derivative of turmeric, may be responsible for many of these effects -- particularly the anti-cancer benefits. Used by ancient Chinese and Indian systems of medicine, curcumin has been shown to reduce brain tumor size by 81% in 9 out of 11 studies. With the research published in the July edition of the Journal of Nutritional Biochemistry, scientists found that curcumin dramatically decreased the size of brain tumors by 81% in 9 out of 11 studies without evidence of toxicity. Additional research has found that turmeric and curcumin also inhibit the spread of cancer by actually blocking a key enzyme responsible for its growth. Given chewable curcumin supplements containing 1,000 milligrams of curcumin each, 21 study participants with head and neck cancer experienced a halt in cancer spread after intake. Conducted by the UCLA, the results were examined by an independent lab in Maryland which confirmed that curcumin supplements ultimately stopped the spread of malignant cancer cells. Curcumin gives turmeric its unique color, and each 100 grams of turmeric contains 3 to 5 grams of the compound. Some health experts believe that turmeric [...]

Oral Cancer Foundation News Team - A2012-02-03T19:49:29-07:00February, 2012|Oral Cancer News|