Treatment Delays Linked To High Mortality for Head and Neck Cancer

MedicalResearch.com Interview with:

Dr. Evan M. Graboyes is a otolaryngologist-head and neck surgeon with the Medical University of South Carolina. CREDIT Emma Vought, Medical University of South Carolina

Dr. Graboyes

Dr. Evan M. Graboyes MD
Otolaryngologist: Head and Neck Surgeon
Medical University of South Carolina

MedicalResearch.com: What is the background for this study?

Response: Unfortunately, there is no screening test for head and neck cancer like there is for colorectal, prostate, breast, lung, or cervical cancers. As a result, two-thirds of patients with head and neck cancer (HNC) present with loco-regionally advanced disease, making other aspects of timely treatment that much more critically important. We therefore sought to understand the association between treatment delay at different points along the cancer care continuum and oncologic outcomes for patients with head and neck cancer.

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Study Identifies Viral Protein That Allows HPV-Associated Head/Neck Cancers to Spread

MedicalResearch.com Interview with:

Manon Eckhardt, PhD Gladstone Institutes Quantitative BioSciences Institute University of California San Francisco 

Dr. Manon Eckhardt

Manon Eckhardt, PhD
Gladstone Institutes
The Quantitative Biosciences Institute
University of California San Francisco 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Infection with Human Papillomavirus (HPV) causes 5% of all cancers worldwide, including cervical cancer and an increasing number of head and neck cancers. Most cancers are caused by mutations in genes, leading to the production of malfunctioning proteins that result in unconstrained cell division. However, certain viruses like HPV can cause cancer without introducing mutations.

In this study, we compared cancers of the same type (i.e. head and neck) that are caused by either mutation or virus infection to identify important processes that are dysregulated in both subsets. We hypothesized that identifying which proteins the virus binds can lead the way to prioritize which of the proteins and cellular processes (pathways) that are affected in cancer cells are most important. To do this, we identified the complete set of human proteins that interact with HPV. We next determined genes that were more frequently mutated in non-viral cancers, and combined both data sets. The proteins we find to be both binding to HPV and mutated in non-viral cancers will be potential targets for new, more specific drug development, and help better understand the development of head and neck cancer.

From the many pathways we identified in this study, we highlighted two pathways with further mechanistic studies: the oxidative stress response, which helps cancer cells survive, as well as a pathway that allows the cancer to spread to other parts of the body. Continue reading

Access to Treatment for Head/Neck Cancer Patients Improved with Medicaid Expansion

MedicalResearch.com Interview with:

Richard B. Cannon, MD Division of Otolaryngology–Head and Neck Surgery School of Medicine University of Utah, Salt Lake City 

Dr. Cannon

Richard B. Cannon, MD
Division of Otolaryngology–Head and Neck Surgery
School of Medicine
University of Utah, Salt Lake City 

MedicalResearch.com: What is the background for this study? What are the main findings?

 Response: The Patient Protection and Affordable Care Act (ACA) is a nationwide effort to reduce the number of uninsured individuals in the United States and increase access to health care. This legislation is commonly debated and objective data is needed to evaluate its impact.  As a head and neck cancer surgeon, I sought to evaluate how the ACA had specifically influenced my patients.  Main findings below:    

MedicalResearch.com: What should readers take away from your report?

Response: This population-based study found an increase in the percentage of patients enrolled in Medicaid and private insurance and a large decrease in the rates of uninsured patients after implementation of the Patient Protection and Affordable Care Act (ACA).  This change was only seen in states that adopted the Medicaid expansion in 2014. The decrease in the rate of uninsured patients was significant, 6.2% before versus 3.0% after. Patients who were uninsured prior to the Patient Protection and Affordable Care Act had poorer survival outcomes.

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Head and Neck Cancer Survivors at Risk of Secondary Cancers, esp if They Smoke

MedicalResearch.com Interview with:

Eric Adjei Boakye, PhD, MA Saint Louis University Center for Health Outcomes Research (SLUCOR) St. Louis, Missouri

Dr. Boakye

Eric Adjei PhD, MA
Saint Louis University Center for Health Outcomes Research (SLUCOR)
St. Louis, Missouri 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Survivors of head and neck cancer (HNC) develop second primary cancers (SPCs) at a higher rate than most common cancers. This is concerning because the number of HNC survivors are increasing due to advancements in treatment and technology. Patients whose head and neck cancer was caused by smoking and alcohol are different than those whose HNC were caused by human papillomavirus (HPV). We therefore used data from 2000-2014 National Cancer Institute Surveillance, Epidemiology, and End Results (SEER) 18 database to examine if the incidence and the type of SPC that patients with smoking-related HNC develop were different from those from HPV-related head and neck cancer.

First, independent of group of HNC (HPV-related or not), we found that SPCs among survivors of head and neck cancer were high, with about 1-in-8 patients developing an SPC. Additionally, irrespective of whether the index . head and neck cancer was from smoking-related or HPV-related, the majority of SPCs were second malignancies in head and neck region (e.g. tongue, gum, mouth floor etc), lung and esophagus. However, we observed different incidence rates between the two groups. Patients with smoking-related head and neck cancer developed SPCs at a higher rate (14%) than those with HPV-related HNC (10%).

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Married Head/Neck Cancer Patients Less Likely To Smoke, More Likely To Live Longer

MedicalResearch.com Interview with:

Nosayaba Osazuwa-Peters, BDS, MPH, CHES Instructor, Department of Otolaryngology-Head and Neck Surgery Saint Louis University School of Medicine Member, Saint Louis University Cancer Center St Louis, Missouri

Nosayaba Osazuwa-Peters

Nosayaba Osazuwa-Peters, BDS, MPH, CHES
Instructor, Department of Otolaryngology-Head and Neck Surgery
Saint Louis University School of Medicine
Member, Saint Louis University Cancer Center
St Louis, Missouri 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Several studies have shown that there is an adverse effect of smoking on head and neck cancer survival; however, there are studies that show no effect between smoking and head and neck cancer. We wanted to investigate this problem using a single institution’s cancer dataset. Additionally, we wanted to understand the role of marital status in the smoking behavior of head and neck cancer patients, and to understand if smoking played any role in head and neck cancer survival.

Our study confirmed that head and neck cancer patients who were smokers at the time of diagnosis had lower survival rates than nonsmokers. We also found that married head and neck cancer patients were less likely to be smokers and more likely to survive longer than those unmarried.

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Pembrolizumab Reduces Death Rate in Head and Neck Squamous Cell Carcinoma

MedicalResearch.com Interview with:

Ezra Cohen, MD Associate Director, Moores Cancer Center Professor of Medicine Moores Cancer Center UC San Diego Health - La Jolla Moores Cancer Center La Jolla, CA  92093

Dr. Cohen

Ezra Cohen, MD
Associate Director, Moores Cancer Center
Professor of Medicine
Moores Cancer Center
UC San Diego Health – La Jolla
Moores Cancer Center
La Jolla, CA  92093

MedicalResearch.com: What is the background for this study?

Response: We have known for a couple of years that anti-PD1 therapy, and specifically pembrolizumab, is active in  head and neck squamous cell carcinoma (HNSCC). The KN40 trial now tested pembrolizuamb against standard of care in patients whose cancers progressed on platinum containing regimens.

MedicalResearch.com: What are the main findings?

Response: The main findings really supported what we know about pembrolizumab in this disease – it is active and effective with a favorable side effect profile. Pembrolizumab reduced the risk of death by 19% and was associated with a 14% response rate. The effect was even greater in tumors that expressed PDL1 and, in the highest expressing group, the benefit in reduction of risk of death was 46% with a 27% response rate.

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DNA Methylation Allows Head and Neck Tumors To Be SubClassified

MedicalResearch.com Interview with:

Jacek Majewski PhD Associate Professor Department of Human Genetics McGill University and Genome Quebec Innovation Centre Montreal, Canada

Dr. Jacek Majewski

Jacek Majewski PhD
Associate Professor
Department of Human Genetics
McGill University and Genome Quebec Innovation Centre
Montreal, Canada 

MedicalResearch.com: What is the background for this study?

Response: Our lab, in collaboration with Dr. Nada Jabado, has been investigating the molecular genetics of pediatric glioblastoma – a deadly brain cancer. Several years ago, in the majority of our patients’ tumors we discovered mutations in genes that encode histone proteins. Those mutations disrupt the epigenome – that is the way the DNA is modified, silenced, or activated in the cancer cells. It appears that epigenome-modifying mutations are particularly important in pediatric cancers, and our hypothesis is that they act by diverting the normal developmental pathways into unrestrained proliferation. Many other studies have highlighted the significance of epigenome disruption in a number of cancers.

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Nivolumab Extended Life in Subset of Head and Neck Cancer Patients

MedicalResearch.com Interview with:

Robert L. Ferris, M.D., Ph.D. UPMC Endowed Professor and Vice-Chair Chief, Division of Head and Neck Surgery University of Pittsburgh

Dr. Robert Ferris

Robert L. Ferris, M.D., Ph.D.
Robert L. Ferris, M.D., Ph.D.
UPMC Endowed Professor and Vice-Chair
Associate Director for Translational Research
Co-Leader, Cancer Immunology Program

MedicalResearch.com: What is the background for this study? What are the main findings?

Dr. Ferris: Investigators at the University of Pittsburgh Cancer Institute<http://upci.upmc.edu/> (UPCI) co-led CheckMate-141<https://clinicaltrials.gov/ct2/show/NCT02105636> a large, randomized international phase III clinical trial that enrolled 361 patients with recurrent or metastatic head and neck squamous cell carcinoma who had not responded to platinum-based chemotherapy, a rapidly progressing form of the disease with an especially poor prognosis. Patients were randomized to receive either nivolumab or a single type of standard chemotherapy until tumor progression was observed.

Nivolumab, which belongs to a class of drugs known as immunotherapeutics, enables the body’s immune system to destroy cancer cells. It currently is approved to treat certain types of cancers, including melanoma and lung cancer. The nivolumab group achieved better outcomes than the standard chemotherapy group by all accounts. After 12 months, 36 percent of the nivolumab group was alive, compared to just 17 percent of the standard chemotherapy group.

Nivolumab treatment also doubled the number of patients whose tumors shrunk, and the number whose disease had not progressed after six months of treatment. Importantly, these benefits were achieved with just one-third the rate of serious adverse events reported in the standard chemotherapy group. In addition, on average, patients receiving nivolumab reported that their quality of life remained stable or improved throughout the study, while those in the chemotherapy group reported a decline. The new trial was considered so successful that it was stopped early to allow patients in the comparison group to receive the new drug.

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Mouth and Throat Cancers Increasing in Frequency

MedicalResearch.com Interview with:

Adam S. Jacobson, MD Associate Professor, Department of Otolaryngology-Head and Neck Surgery Associate Director, Head and Neck Surgery NYU Langone Medical Center

Dr. Adam Jacobson

Adam S. Jacobson, MD
Associate Professor, Department of Otolaryngology-Head and Neck Surgery
Associate Director, Head and Neck Surgery
NYU Langone Medical Center and
Perlmutter Cancer Center

MedicalResearch.com Editor’s note: Dr. Jacobson is an Otolaryngologist, an Ear-Nose-Throat (ENT) physician specializing in the diagnosis of head and neck tumors and cancers, including cancers of the mouth and throat. Dr. Jacobson discussed oral (mouth) and pharyngeal (throat) cancers in recognition of Oral, Head and Neck Cancer Awareness Week.

MedicalResearch.com: How prevalent is the problem of Oral, Head and Neck Cancer?  Is this type of cancer becoming more frequent?

Dr. Jacobson: Oropharynx cancer is currently on the rise. 

MedicalResearch.com: Have HPV-induced cancers become more common?

(Note HPV or Human Papilloma Virus is a virus associated with various wart infections.)

Dr. Jacobson: Yes – Specifically tonsil and base of tongue cancer.
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Immunotherapy Shows Promise In Advanced Head and Neck Squamous Cell Cancer

Tanguy Seiwert, MD Assistant Professor, Dept. of Medicine Associate Director, Head and Neck Cancer Program Section of Hematology/Oncology Fellow, Institute for Genomics and Systems Biology Speciality Chief Editor, Frontiers in Head and Neck Cancer University of Chicago Chicago, IL 60637MedicalResearch.com Interview with:
Tanguy Seiwert, MD
Assistant Professor, Dept. of Medicine
Associate Director, Head and Neck Cancer Program
Section of Hematology/Oncology
Fellow, Institute for Genomics and Systems Biology
Speciality Chief Editor
Frontiers in Head and Neck Cancer
University of Chicago Chicago, IL 60637

Medical Research: What is the background for this study?

Dr. Seiwert: Recurrent/metastatic Head and Neck Squamous Cell Cancer (HNSCC) remains poorly treatable with a median OS of 10-13 months

There is evidence of a  prominent immune escape observed in squamous cell carcinoma of the head and neck (SCCHN) suggesting that anti-PD1 agents (similar to e.g. melanoma) may be active.

Medical Research: What are the main findings?

Dr. Seiwert:

  • One in four patients with Head/Neck cancer treated with pembrolizumab showed marked tumor shrinkage (so called – partial/complete responses), and 57% of patients experienced any decrease in the size of their tumors.
  • Pembrolizumab is broadly active in both HPV(-) and HPV(+) types of squamous cell carcinoma of the head and neck.
  • Pemborliuzmab treatment is active in heavily pretreated squamous cell carcinoma of the head and neck patients.
  • Responses seem to be durable è 86% of responding patients remain in response.

Treatment overall was well tolerated with less than 10% of patients experiencing severe side effects (≥Grade 3).

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Head & Neck Cancer: Biomarkers Predict Radiation Resistance

Jan Akervall, M.D., Ph.D. Co-director, Head and Neck Cancer Multidisciplinary Clinic Beaumont Hospital, Royal Oak Clinical Director of Beaumont’s BioBankMedicalResearch.com Interview with:
Jan Akervall, M.D., Ph.D.
Co-director, Head and Neck Cancer Multidisciplinary Clinic
Beaumont Hospital, Royal Oak
Clinical Director of Beaumont’s BioBank
MedicalResearch.com: What are the main findings of the study?

Dr. Akervall: We identified biomarkers that can predict who will have an unfavorable response from radiation for head and neck cancer. These can be analyzed using standard laboratory techniques on biopsies that routinely are taken for diagnosis.
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Squamous Cell Carcinoma of Head and Neck: Epigenetic Markers

MedicalResearch.com Interview with:
Dr. Muy-Teck Teh BSc, PhD
Centre for Clinical and Diagnostic Oral Sciences, Institute of Dentistry
Barts & The London School of Medicine and Dentistry
Queen Mary University of London, England, United Kingdom

MedicalResearch.com: What are the main findings of the study?

Answer: We found unique DNA markings (epigenetic methylation) on certain genes that may “predict” the risk of developing head and neck cancer. We identified certain DNA methylation marks unique to cancer cells and not found in normal healthy cells.

DNA methylation marks act as ‘switches’ that regulate the ‘on or off’ statuses of genes. Abnormal DNA methylation is known to precede cancer initiation. Hence, the presence of these abnormal DNA methylation marks in cells may be tell-tale signs of early cancer initiation. The chemically distinctive properties of methylated DNA provide ample opportunities for clinical exploitation as nucleic acid-based biomarkers potentially detectable in non-invasive samples such as blood, buccal scrapes, or even saliva.
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Dental Caries and Head and Neck Cancer

Mine Tezal, DDS, PhD Oral Biology University at Buffalo NYS Center of Excellence in Bioinformatics and Life SciencesMedicalResearch.com Interview with:
Mine Tezal, DDS, PhD
Oral Biology
University at Buffalo
NYS Center of Excellence in Bioinformatics and Life Sciences


MedicalResearch.com: What are the main findings of the study?  

Dr. Tezal: We observed an inverse association between dental caries and head and neck cancer (HNSCC), which persisted among never smokers and never drinkers. Besides untreated caries, two other objective measures of long-standing caries history (endodontic treatments and crowns) were also inversely associated with HNSCC with similar effect sizes, supporting the validity of the association.  Missing teeth was associated with increased risk of HNSCC in univariate analyses, but after adjustment for potential confounders, its effect was attenuated and was no longer statistically significant.

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