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 [...]

A new answer for helping patients with xerostomia

Source: www.dentistryiq.com Author: John Kringel Helping patients with xerostomia can be especially challenging. Set aside for a moment the dental complications that result, such as rampant caries and mucositis. Severe symptoms like difficulty swallowing, sleeping, and talking can ruin the sufferer’s daily quality of life at the most basic level. Yet the available interventions1 come down to lifestyle tips such as sucking on ice chips, chewing sugar-free gum, and using a humidifier at night. Dr. Jeffrey Cash, a dentist in Richmond, Virginia, has experienced the frustration of dealing with xerostomia from multiple perspectives. He was initially moved by his hospital-based residency working with head-and-neck cancer patients. “My conversations with patients who had tried the standard suggestions without finding relief generally went like this: ‘Can’t you do anything else for me? I'm miserable. I can't eat properly. I wake up four times a night because I can't breathe.’ My answer, which felt terrible, amounted to ‘welcome to the new normal.’ ” Within a year of graduation, Dr. Cash learned exactly what these patients had experienced when he underwent chemotherapy as a part of his own cancer treatment. “Shortly after starting chemo, I developed severe dryness which led to mucositis. It was so uncomfortable I didn’t want to swallow or eat anything that would scratch the tissue.” The combined experience as a dentist and a xerostomia sufferer started Dr. Cash on a decades-long mission to invent a new treatment option that would be immediate, continuous, and predictable. That aspiration became a reality [...]

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 [...]

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

Acupuncture prevents radiation induced dry mouth

Source: www.healthcmi.com/ Author: staff Acupuncture reduces the frequency and severity of xerostomia (dry mouth). University of Texas MD Anderson Cancer Center (Houston) and Fudan University Cancer Center (Shanghai) researchers conducted a randomized controlled clinical trial. The phase-three patient and assessor blinded investigation of acupuncture’s effects on head and neck cancer patients receiving radiation therapy demonstrated groundbreaking results. The researchers concluded that acupuncture “resulted in significantly fewer and less severe RIX [radiation-induced xerostomia] symptoms 1 year after treatment vs SCC [standard care control].” [1] Salivary glands may be temporarily or permanently damaged by radiation therapy. There is a high-incidence of RIX, which may lead to complications including difficult or painful swallowing, impairment of the sense of taste (dysgeusia), and dental problems. Other RIX complications may include insomnia and difficulty speaking. The study compared true acupuncture, sham acupuncture, and standard care control groups. True acupuncture produced significantly greater positive patient outcomes than the other groups. Outcome measures were based on a questionnaire, salivary flow, incidence of xerostomia, salivary contents, and quality of life scores. One year after completion of all acupuncture treatments, the true acupuncture group maintained significantly higher patient outcome rates over the standard care and sham groups. All acupuncture treatments were provided by credentialed acupuncturists. The researchers note that their findings are consistent with several prior investigations. True acupuncture patients that received acupuncture three times per week during their six to seven week course of radiation therapy had significantly less dry mouth a year after completion of treatments than standard [...]

2019-12-13T10:14:28-07:00December, 2019|Oral Cancer News|

Reducing RT toxicity in head and neck cancer: recent research context

Source: www.medpagetoday.com Author: Kristin Jenkins, contributing writer, MedPage Today In patients with head and neck malignancies, studies show that the significant acute and long-term toxicities and poor quality of life (QOL) associated with postoperative radiation therapy (PORT) can be improved by selectively reducing larger radiotherapy volumes. This includes treating just one side of the neck. In patients with locally advanced head and neck squamous cell carcinoma (HNSCC), however, locoregional failure rates with the omission of PORT to the pathologically uninvolved neck (PN0) have been less clear. As a result, PORT has historically been delivered to the PN0 neck, with several studies showing high rates of regional control ranging from 95% to 100%. Notably, consensus clinical practice guidelines continue to recommend the use of bilateral irradiation of node-negative necks. However, results from a prospective phase II study in 72 patients with primary HNSCC and high-risk pathology features now suggest that PORT to the PNo neck can be eliminated without sacrificing excellent disease control or QOL. At a median follow-up of 53 months, absolute regional control in the unirradiated neck was 97%, even though 67 patients (93%) had stage III/IV disease and 71% of tumors involved or crossed midline. No patient received contralateral neck PORT, and 17 patients (24%) were treated for the primary neck tumor only, said Wade Thorstad, MD, of Washington University in St. Louis, and colleagues. The 5-year rates of local control, regional control, progression-free survival, and overall survival (OS) were 84%, 93%, 60%, and 64%, respectively, they reported [...]

2019-11-21T12:57:43-07:00November, 2019|Oral Cancer News|

How dental professionals can help patients with xerostomia

Source: www.dentistryiq.com Author: Jennifer Pettit, CRDH Xerostomia affects up to 65% of the population, according to the American Academy of Oral Medicine.1 Many patients might experience dry mouth and accept it as a part of their life without seeking treatment or mentioning it to a health-care professional. It is important to recognize the signs of xerostomia to help reduce patients' symptoms and prevent the consequences it carries. Xerostomia is the reduction of salivary flow. The majority of saliva is produced by the parotid gland, followed by the lingual and submandibular glands. Saliva plays multiple roles in the oral cavity. It carries enzymes to help us digest food. It moistens food to create a bolus for easy passage through the esophagus. It also carries buffering agents to neutralize the pH of the oral environment, which can help prevent demineralization of tooth structure and caries lesions. It protects the oral mucosa and tongue from irritants such as bacteria and fungus. Lastly, it cleanses the teeth of small food particles.1 Hyposalivation is associated with many factors. According to the American Dental Association, more than 400 medications cause dry mouth as a side effect.2 The most well-known prescriptions to cause dry mouth are antipsychotics, anticonvulsants, bronchodilators, and certain hypertension medications.2 Other factors contributing to low saliva flow are aging, smoking, radiation therapy to the neck and head, and some diseases and conditions such as HIV/AIDS, diabetes, rheumatoid arthritis, thyroid dysfunctions, and Sjögren’s syndrome, just to mention a few.2 Oral manifestations of xerostomia include dry [...]

Ask the Dentist: Cancer patients should be aware how radiotherapy can affect saliva

Source: www.irishnews.com Author: Lucy Stock SALIVA – we normally give little thought to our spit but we definitely notice when it's not there. Every day in the UK 31 people are diagnosed with a head and neck cancer. With increasing numbers of people undergoing radiotherapy for head and neck cancers there are more people living with the side-effects of not having enough saliva. Dry mouth, termed xerostomia, is common after radiotherapy. It's not only extremely uncomfortable, it makes speaking and swallowing more difficult and alters how things taste. Food can taste saltier, metallic; you can lose your sense of taste totally; and perhaps even worse, foods can taste foul, like sour milk. Not being able to chew and swallow easily can reduce how much you eat and how well you eat, leading to weight loss and poor nourishment. Saliva performs numerous jobs. It starts digestion by breaking down food and flushes food particles from between the teeth. Crucially, saliva contains minerals such as calcium and phosphate that keep teeth strong. So no saliva means that teeth decay rapidly and extensively. Even voice quality can change. Without enough saliva, bacteria and other organisms in the mouth take the opportunity to grow uncontrollably. Nasty sores and mouth infections, including yeast thrush infections, are run-of-the-mill. Luckily a dry mouth is usually a temporary nuisance that clears up in about two to eight weeks but it can take six months or longer for the salivary glands to start producing saliva again after radiotherapy ends. [...]

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 [...]

Improving QOL in head and neck cancer as survival improves

Source: www.medscape.com Author: Zosia Chustecka In patients undergoing radiation treatment for head and neck cancer, reducing the radiation to organs not affected by cancer is key to improving quality of life post-treatment. Several studies presented here at the 2014 Multidisciplinary Head and Neck Cancer Symposium described new approaches to sparing radiation delivered to the salivary glands and to the voice box, without any loss of cancer control, but with a reported reduction in adverse effects, such as xerostomia (dry mouth), and an anticipated reduction in loss of voice and speech quality. Improvements in such outcomes are becoming increasingly important as the epidemiology of head and neck cancer is changing, and the increase in human papillomavirus-positive disease means that patients are being diagnosed their 50s and will, in many cases, go on to live for decades after their definitive cancer treatment, researchers commented at a press briefing. Xerostomia can make it difficult to speak, as well as chew and swallow, and can lead to dental problems. "Dry mouth might seem trivial, but it actually has a significant effect on quality of life," commented Tyler Robin, PhD, an MD candidate in his final year at the University of Colorado Medical School in Denver. To reduce this adverse effect, intensity-modulated radiation techniques are already directing the beam away from the parotid gland, which is responsible for stimulated saliva production, for example during eating. But for the rest of the time, saliva is produced unstimulated from the submandibular gland. "This gland actually produces the [...]

2014-02-28T14:23:04-07:00February, 2014|Oral Cancer News|

Effects of Chemoradiation on Voice and Speech Quality of H&N Cancer Patients

Source: Med Page TodayPublished: February 23, 2014By: Charles Bankhead   SCOTTSDALE, Ariz. -- Patients with oropharyngeal cancer reported significant voice and speech impairment for up to 2 years after chemoradiation therapy, but most of their doctors saw no evidence of it, data from a prospective study showed. Two years after treatment, a fourth of patients said their voice and speech remained below baseline levels, whereas none of their clinicians noted any impairment. At no time did as many as 10% of clinicians report patients with speech and voice issues, whereas the proportion of patients reporting problems ranged as high as 56%. The likelihood of patient-reported difficulties with oral communication increased with the radiation dose to the glottic larynx, reported Jeffrey M. Vainshtein, MD, and colleagues at the Multidisciplinary Head and Neck Cancer Symposium. "Our findings highlight the critical role of patient-reported outcomes in identifying areas of improvement of our current therapies, which may ultimately translate into improvements in quality of life for our patients," Vainshtein, of the University of Michigan in Ann Arbor, said during a press briefing. Dysphagia and xerostomia are recognized adverse effects of chemoradiation for head and neck cancer and have been studied extensively in recent years. In contrast, a paucity of information exists relative to the effects of chemoradiation on voice and speech quality, Vainshtein said. To examine the issue, investigators assessed voice and speech outcomes in 93 patients who underwent chemoradiation for oropharyngeal cancer, using intensity-modulated radiation therapy (IMRT). At baseline, and then every 3 to [...]

2014-02-24T17:36:33-07:00February, 2014|Oral Cancer News|
Go to Top