Alcohol a top cause of cancer says report
Australia
staff
www.abc.net.au
Four standard alcoholic drinks per day increases a man's risk of developing bowel cancer by 64 per cent, a new report says.
For women, just two standard drinks per day increases their risk of developing breast cancer by up to 22 per cent, according to study by the Cancer Institute NSW.
For both men and women, two standard drinks a day increases the risk of developing mouth cancer by 75 per cent.
NSW Assistant Health Minister Verity Firth, who will release the report today, says the alarming links to cancer have been generally ignored in community debate over alcohol consumption.
"In fact, alcohol consumption is a significant risk factor for a number of cancers, including those of the breast, bowel, throat and mouth," Ms Firth said in a statement today.
"(It) is one of the most well-established causes of cancer.
"Worryingly, a third of NSW adults actively reject the notion that drinking too much can cause cancer."
The report, entitled "Alcohol As A Cause Of Cancer", also found 12 per cent of all breast cancer cases in NSW could be directly linked to excessive consumption of alcohol.
Ms Firth said the World Health Organisation now listed alcohol as a top-rated Group 1 carcinogen.
The 2006 NSW Population Health Survey found 70 per cent of NSW adults drank alcohol, with 17.6 per cent drinking at risky or high-risk levels.
"Ultimately, we cannot police every person's drinking habits," Ms Firth said.
"But we want to make sure people have the information they need to make healthy choices about alcohol use for themselves."
Delays in starting radiotherapy can increase risk of cancer recurrence
Germany
staff
LifeGen.de
In both breast and head and neck cancers the risk of local recurrence increases with longer radiotherapy waiting times, finds a Canadian meta-analysis. The study, published in Radiotherapy and Oncology, concludes that delays in radiotherapy treatment should be kept to the minimum time possible. Waiting times for radiotherapy were first identified as cause for concern around 20 years ago. Treatment delays can be attributed to increasing demands for radiotherapy caused by the growing incidence of cancer due to an ageing population and the discovery and adoption of new indications for radiotherapy. “When the increasing demand is not matched by a commensurate increase in treatment capacity, waiting lists for RT become inevitable,” write the authors Zheng Chen and colleagues, from Queen’s Cancer Research Institute ( Kingston, Ontario, Canada) and Cross Cancer Institute ( Edmonton, Alta, Canada).
Experimental evidence has suggested that the probability of eradicating a tumour by radiotherapy can be inversely related to the number of clonogenic cells it contains, and there is also clinical evidence that the probability of local control in many different types of human cancer can be inversely related to the volume of the cancer. Two recent studies have demonstrated clear evidence of tumour progression in a high proportion of patients waiting to start radiotherapy for head and neck cancer.
In the current study, Chen and colleagues set about trying to provide direct evidence that waiting times for radiotherapy influence patient’s clinical outcomes. The study was initiated in response to a request from the Canadian government for assistance to provide “evidence-based benchmarks” for waiting times for selected procedures, including cancer treatment, cardiac surgery, joint replacements, cataract surgery and diagnostic imaging. Since it would be clearly unethical to perform a randomized trial exploring treatment delays, the investigators undertook a systematic literature to identify clinical studies published between 1975 and 2005 describing a relationship between waiting times and outcomes of radiotherapy. Altogether they identified 44 retrospective observational cohort studies, of which 20 met the high quality criteria for inclusion in the meta-analysis. High quality criteria included comparative groups being balanced with respect to relevant prognostic factors, and reported results being appropriately adjusted for differences in relevant prognostic factors.
For each cancer considered by the meta-analysis, the mean of the local recurrence rates reported in the groups with the shortest waiting time was used to estimate a baseline for local recurrence. For breast cancer the mean baseline rate of local recurrence following post-operative radiotherapy was 8.5 % (with a range of 2.0 to 13 %), with each month of delay in starting radiotherapy found to produce an absolute increase in the risk of recurrence of 1.0 %. For head and neck cancer, the mean baseline rate of local recurrence following post operative radiotherapy was 22.7 % (range 9.9 to 25.5%), with each month of delay found to produce an absolute increase in the risk of recurrence of 6.3 %. For head and neck cancer radiotherapy, taking place without an operation, the mean baseline rate of local recurrence was 24.7 % (range (9.0-27 %), with each month of delay found to translate into an absolute increase in the risk of recurrence of 3.7 % per month of delay.
In contrast, the study found little evidence of an association between delays in radiotherapy and the risk of distant metastasis. There is no evidence to suggest that the relationship between delay in radiotherapy and local recurrence is unique to these two cancer sites, write the authors. However, to date there have been no studies with sufficient power to show the presence of an association of similar magnitude in other cancer sites.
“Although the average increase in risk per month of delay in the individual patient is not large, it may have a very important detrimental effect on the overall value of a radiotherapy program because it potentially affects every patient who needs radiotherapy,” write the authors, adding that the negative effects of the prevailing delays in radiotherapy may be sufficient to cancel out the positive effects of many of the advances in radiotherapy over the last 20 years.
In head and neck cancer, tackling chronic waiting lists could deliver an absolute increase in local control of between 5 and 10 % simply by reducing radiotherapy waiting times by six weeks, calculate the authors.
“Given that there is no theoretical reason to believe that there is a threshold below which delay is safe, we believe that it is prudent to apply the principle that delays in RT should be as short as reasonably achievable,” conclude the authors.
Reference:
Chen Z, King W, Pearcey R, Kerba M, Mackillop W. The relationship between waiting time for radiotherapy and clinical outcomes: A systematic review of the literature. Radiotherapy and Oncology 2008, 87, 3-16
Note:
This summary is provided by the European School of Oncology''s Cancer Media Service
Cervical-cancer virus linked to cancers in men
Denver, CO
Katy Human
The Denver Post (www.denverpost.com0
A sexually transmitted virus that causes cervical cancer has been linked to cancers of the tonsil and tongue — diseases that have been on the rise in men for the past 30 years, according to a study by a Colorado Springs doctor and researcher.
Among Colorado men, such throat cancers have become 37 percent more common since 1980, compared with a national increase of 11 percent.
"Nobody knows that this is going on, and it's important to understand the risk," said Joel Ernster, a professor at the University of Colorado Denver School of Medicine and principal author of the study, which appeared in the journal Laryngoscope.
The trends point to oral sex as a likely mode of transmission and have prompted some to call for boys to be vaccinated against the human papilloma virus, Ernster said.
Girls can already receive a vaccine to prevent cervical cancer.
"Based on what they know right now, why the hell aren't they giving it to boys?" asked Jon Helander, 56, a patient of Ernster's in Colorado Springs.
Helander went through radiation and chemotherapy to fight a virus-related tongue cancer earlier this year and said he's frustrated that his son, 21, can't be vaccinated against the virus, as his daughter, 23, has been.
While the rate of tonsil and tongue cancer is lower in Colorado than nationally — about 3.47 cases per 100,000 people versus 4.81 — it is increasing more quickly, Ernster and his colleagues reported.
In Colorado, cases jumped from 2.54 per 100,000 to 3.47 in the past two decades, Ernster reported. Given the state's population growth, he said, that's an increase from about 50 cases per year in the 1980s to more than 100 today.
The researchers also found a steady increase since 1980 in the percentage of throat cancers in Colorado men testing positive for the human papilloma virus, from 33 percent in the 1980s to more than 80 percent today.
Sexual history possible factor
Ernster said he was trying to understand the shift he was seeing among throat cancer patients away from older, longtime smokers and drinkers to 45- to 55-year-old men married for 15 to 20 years.
"But if you ask what they did before that, they were promiscuous, had a lot of different encounters, and oral sex was part of their lives," Ernster said.
Helander, whose cancer tested positive for the human papilloma virus, said his history fits the pattern.
"Let's see — 20, 30 years takes me back to my years in the military," Ernster said. "So, yes, I know where it came from."
After Helander's cancer came back positive for the virus, he said, his ex-wife was tested. She was not infected.
Aimee Kreimer, an National Institutes of Health epidemiologist who has published research linking human papilloma virus to some throat cancers, said a variety of historic and social factors could explain Colorado's fast rate of increase among men.
Cancers related to the human papilloma virus have a long latency, she said, showing up 20 or more years after infection.
The sexual revolution of the '60s has certainly also contributed to the rise of viral-associated oral cancers, Kreimer said.
It's not clear why women aren't getting more of the cancers, she said.
Kreimer and Ernster said they worried that people are still underestimating the risks of oral sex, but both also said the human papilloma virus vaccine eventually could cut cancer rates.
Gardasil, manufactured by Merck & Co., can prevent HPV infection in girls, preventing cervical cancer.
"We're optimistic it will protect from infection at other anatomical sites too," Kreimer said.
Merck spokeswoman Jennifer Allen said the company does not yet have plans to test the vaccine's ability to prevent oral cancers in boys or men.
"It's all still new," Allen said.
"Who cares?" Helander said. "Gender's not going to make a difference. Just give it to my son."
Lasers May Treat Cancers of the Larynx
New York, NY
Lawrence K. Altman M.D.
New York Times (nytimes.com)
For people with early cancer of the larynx, the standard treatment can be grueling: a biopsy in an operating room followed by a six-week course of radiation that may lead to permanent hoarseness or speech impairment.
But a team of Harvard doctors is reporting that a new outpatient laser procedure promises to eliminate the need for radiation, preserve speech, shorten treatment time and significantly improve care in other ways for many patients whose cancer is diagnosed early.
The therapy, which uses heat from the laser to destroy the tumor’s blood supply and cancer cells, damages surrounding tissue far less than radiation and different types of lasers.
It has been tested in only 28 patients, all at Massachusetts General Hospital in Boston. Yet the initial findings hold promise because the laser was the patients’ only treatment and none have had a recurrence or needed surgery or radiation after a mean follow-up of 27 months, the team’s leader, Dr. Steven M. Zeitels, said in an interview. The longest is more than five years.
Other experts expressed cautious optimism about the findings from the pilot study, which the Harvard team reported May 1 at a meeting of the Broncho-Esophagological Association in Orlando. The scientific report involved the first 22 of the 28 patients.
The procedure “represents a radically new approach to treatment of these cancers,” said Dr. Gregory A. Grillone, an otolaryngologist at Boston University School of Medicine. Dr. Grillone, who directs the Center for Voice and Swallowing at Boston Medical Center, spoke in an interview after hearing Dr. Zeitels’s presentation at the meeting.
Dr. Zeitels agreed with Dr. Grillone and other experts who said the procedure must now be tested on more patients in other hospitals and monitored for a longer period before it could become a standard therapy. Longer studies comparing the new technique with standard therapy are needed to confirm that it is equally effective in curing the cancers.
Even then, only an estimated 2,000 of the 11,300 people, mostly men, who develop laryngeal cancer in this country each year seem likely to be candidates for the laser therapy.
Those eligible would be patients whose cancer was detected when the malignant growth was small and limited to one or both vocal cords in a form known as glottal cancer, which accounts for about 65 percent of new laryngeal cancers. An estimated one-third of glottal tumors are detected in an early stage, Dr. Zeitels said.
If studies confirm the early findings, then researchers must determine which kinds of laryngeal cancers and which patients are appropriate for the laser treatment, said Dr. Andrew Blitzer, a professor of otolaryngology at Columbia and director of the New York Center for Voice and Swallowing Disorders.
The initial clue to cancer of the vocal cords is often persistent hoarseness. The cancer most commonly develops among smokers, who are prone to developing additional types of cancer in the head and neck.
When radiation is used for laryngeal cancer, it cannot ordinarily be used again if other cancers develop nearby. So the laser procedure offers a strong additional advantage, Dr. Zeitels said — preserving radiation as a treatment option for laryngeal cancer patients who later develop head and neck cancers.
Treatment for laryngeal cancer has progressed slowly. Surgery was the only treatment until the advent of radiation in the early 20th century. In 1971, lasers began to be used for a noncancerous vocal cord problem, and different kinds of lasers have followed for vocal cord cancer.
The concept of the laser therapy derives from the work of the late Dr. Judah Folkman, the pioneering Harvard scientist who theorized that tumors could be starved by stopping angiogenesis — the process by which tumors stimulate formation of new blood vessels to feed themselves.
The new procedure relies on a type of laser called the pulsed photoangiolytic KTP. Its green light selectively destroys the blood vessels feeding the tumor without burning the vocal cords. “It’s like sandblasting the surface with light,” Dr. Zeitels said.
Vibration of the vocal cords is essential for good voice and speech. By preserving vocal cord function, the laser treatment allows the cords to vibrate, “not perfectly, but substantially better” than before patients had the procedure, Dr. Zeitels said.
“All the prior laser treatments would burn the vocal cords,” he said, “and when that happens they do not vibrate normally.”
Dr. Zeitels said his team had long used pulsed angiolytic lasers for a variety of benign laryngeal problems, including a precancerous condition called dysplasia.
The pulsed angiolytic laser has allowed ear, nose and throat specialists to treat most laryngeal dysplasias under local anesthesia in an office instead of general anesthesia in an operating room.
But “treating cancer is not the same as treating dysplasia,” he said, and he moved cautiously before using the laser for cancer.
One step was to alter the KTP laser to deliver the light in pulses to the soft tissue of the vocal cords, allowing the tissue to cool between bursts. The cooling prevented significant heat-induced scarring.
The first patient was John Ward, a professor at the Kellogg School of Management at Northwestern University. After several years in which he was hoarse and needed a microphone to give lectures, he said in a recent interview, doctors detected cancers on both vocal cords.
Dr. Ward read up on the disease and consulted with Dr. Zeitels and other specialists about his treatment options. Dr. Zeitels suggested the new laser therapy in extensive discussions, and Dr. Ward agreed.
The two tumors differed in size, so Dr. Zeitels said he aimed at preventing scars that might fuse the cords. He treated the larger cancer with a carbon dioxide laser and the smaller one with the angiolytic laser.
Six weeks later, both tumors had disappeared.
Dr. Ward said the treatment had saved his career — that he now had about 80 percent of his original quality of voice and 90 percent of its strength, and no longer needed a microphone to lecture.
Typically, patients are treated two to three times spaced six weeks apart to reduce the tumor’s size, Dr. Zeitels said. He added that it was generally safe to leave early vocal cord cancers in place for that period of time because they rarely spread at this stage.
Standard acoustic and other tests are performed in a sound-treated room before the procedure and monitored thereafter.
Urologists have used angiolytic lasers in a different way to burn prostate tissue, Dr. Zeitels said. For the vocal cords, “the procedure is dead-on easy” and could be performed by any ear, nose and throat specialist who learns to use the $70,000 laser, he said.
He also speculated that the angiolytic laser might eventually be adapted for treatment of cancers of the esophagus, bladder, cervix, windpipe and parts of the lungs.
Dr. Zeitels said that he had not received industry financial support for his research and that his team’s paper would be published in The Annals of Otology, Rhinology and Laryngology in July.
Most moms balk at HPV vaccine for young girls - Study
Chicgo, IL
Monifa Thomas
Chicago Sun-Times (www.suntimes.com)
Though there's now a vaccine against HPV, a sexually transmitted disease that can lead to cervical cancer, most moms aren't willing to get their daughters vaccinated at the age recommended by federal health authorities.
That's according to the first national study of mothers' attitudes toward the human papillomavirus vaccine, or HPV.
The vaccine is approved for females ages 9 to 26. But the Centers for Disease Control and Prevention recommend that it be given to girls at age 11 or 12, when they receive adolescent booster shots.
Sex discussion seen as barrier
According to a survey of more than 10,000 mothers, only 49 percent said they would vaccinate a daughter if she were 9 to 12 years old.
But moms were more willing to vaccinate a daughter who was 13 to 15 years old (68 percent) or 16 to 18 (86 percent).
Study author Dr. Jessica Kahn said it's not surprising that parents would feel more comfortable letting an older daughter get the vaccine.
"There's sort of an underlying assumption among some parents that recommending the vaccine means that someone, either a clinician or themselves, will have to have a discussion that HPV is ... transmitted sexually," said Kahn, a pediatrician at Cincinnati Children's Hospital Medical Center. "I think that's a barrier."
Parents and physicians also assume older girls have a higher risk of contracting HPV than preteens, so they may feel less urgency to vaccinate at a young age, Kahn said.
The problem with that logic, the CDC says, is the vaccine is most effective when it is given to a girl before she is exposed to HPV.
'It was more about the cancer'
A recent CDC study found that HPV is the most common sexually transmitted disease among teenage girls in the United States. Two strains of the virus are responsible for 70 percent of the approximately 10,000 new cervical cancer cases each year.
The vaccine, known as Gardasil, protects against these strains. But annual Pap smears are still recommended, the CDC says.
Since the vaccine went on the market in 2006, Merck has distributed nearly 16 million doses in the United States. A full vaccination is three doses of the drug.
Patti Smith, of Plainfield, got her daughter vaccinated at age 12.
"I don't see it as giving her permission to have sex any sooner," Smith said. "It was more about the cancer. It was one less thing to worry about for her."
Quackery in Head and Neck Cancer
Dublin, Ireland
M Amin et al.
Irish Medical Journal
Abstract
Most human beings will do almost anything to prolong their existence or to relieve the suffering of disease. Others will do anything to exploit these desires by selling what they claim to be pain killing remedies or life prolongation nostrums. We present three cases of head and neck cancer patients; two used complementary and alternative medicine (CAM) prior to presenting to our service and the third declined conventional treatment to seek CAM instead. We discuss here the diagnosis, the time delay between CAM and commencement of conventional treatment, and the outcome in each case. Our aim is to define Quacks and to heighten public awareness of the potential harm they can cause.
Introduction
In the face of the great leveller, Death, we are like children listening fearfully for the footsteps of doom, relieved only by the whisperings of hope. Quacks are peddlers of hope. Quackery is the promotion of false or unproven remedies for profit1. There is growing interest in complementary and alternative medicine at the present time; a significant number of cancer patients use complementary and alternative medicine (CAM) as adjunct therapies to their cancer treatment2,3. Eisenberg et al4 reported that one-third of the US population used some form of unconventional medicine and seventy-five percent of patients did not inform their physicians of this practice. Alternative therapies may include any unproven therapy or cure which is promoted as cancer treatment and is used in place of conventionally accepted oncological treatment. Complementary therapies are illustrated as adjuncts to mainstream cancer care for symptom management and to enhance quality of life5. Complementary and alternative medical practices include Traditional Chinese Medicine which includes acupuncture and herbs; homeopathy; naturopathy; herbal medicine; Ayurvedic medicine; mind-body medicine; massage and chiropractice.
Case Report 1
A 37 year old female presented to our department with a small T1N0 anterior tongue lesion which was virtually undetectable on MRI scan; biopsy confirmed squamous cell carcinoma. Unfortunately, the patient declined treatment by simple local excision. Instead, she went to the seventh son of a seventh son where she had topical poultice treatment, a paste of unknown substance that included plant extracts applied to the tongue lesion for one to two hours per day. She returned to our service several months later with a T3N2c lesion and underwent radical surgery. Unfortunately, she developed disseminated metastatic disease and passed away shortly afterwards.
Case Report 2
A 73 year old female presented to an alternative medical practitioner with a superficial skin lesion of the cheek. Over the next five years, he applied multiple poultices to this area. At initial presentation to our department five years later, she had a massive destructive squamous cell carcinoma which had extended medially and superiorly to include the maxilla and orbit. We carried out radical excision of cheek skin, maxilla and orbital exenteration, followed by radiotherapy. She remains disease free three years later.
Case Report 3
A 55 year old male presented to our service with a large preauricular mass, metastatic neck node and facial nerve palsy. He had been attending an alternative therapist for ten months and was treated with a herbal liquid drink taken once a day and also laying on of hands with prayers. Biopsy revealed a squamous cell carcinoma requiring excision of the ear and temporal bone with radial forearm flap reconstruction. He remains disease free three years later.
Discussion
A Medline search revealed only two dedicated reports of CAM used specifically in patients with head and neck cancer, one from Israel and one from USA6,7. The use of CAM among cancer patients varies depending on the type and site of the disease. In head and neck cancers, use of alternative therapies is reported to be around 15%8. Contrary to common perception, patients who pursue alternative therapies are likely to be well educated and from a higher socioeconomic group. This interest in CAM led the American Academy of Otolaryngology Head and Neck Surgery to establish a Committee on Alternative Medicine to serve as a resource for information regarding CAM practices that relate to otolaryngology and to make that information available to its members. The efficacy of CAM therapies remains questionable, in fact the research in these areas can be nonexistent or at best of poor quality. Patients seek CAM to address problems that may not be fully managed by conventional medicine (e.g. pain) or because CAM is often portrayed as having fewer side effects. Others may seek it for the holistic approach and the power of prayer or simply to feel that they are actively participating in controlling their disease process.
Head and neck cancer is unique in the way it debilitates patients and affects nutrition. It may also be associated with considerable morbidity, disfigurement and changes in facial features as part of the treatment process that may include tumour excision, flaps and radiotherapy. The prognosis for head and neck cancer remains poor (50% 5-year disease survival), despite advances in surgical technique, radiotherapy and chemotherapy7. Consequently, our patients are likely to seek alternative therapies that may appear to have fewer side effects9,10.
It is helpful to recognize warning signs of quackery which include claims of “miracle cures” and secret ingredients or processes7. Quack therapies may be categorized as those which cause direct harm, those which cause indirect harm by directing patients away from more effective therapies, and those which are harmless but economically fraudulent. Treatment delay associated with alternative medicine in Head and Neck cancer patients was first pointed out by Davis et al11 in 2006 and we can concur with these findings, as illustrated by the three cases presented. We believe that if medical advice had been sought initially or followed consequently, the likelihood of a positive outcome would have been much higher and in accordance with international survival rates.
Public interest in complementary and alternative medicine needs to be addressed seriously and statistics on the morbidity, mortality, incidence and prevalence of quackery in various specialities needs to be recorded and reported to a national system developed specifically to act against quackery. This may require the cooperation of the Irish Medicine Board, the Irish Medical Council, Department of Health, Department of Justice and Criminal Assets Bureau. We certainly have a moral and ethical obligation towards our patients and this may require us to spend more time communicating with them and exploring their concerns. We are currently instigating a national survey on the use of CAM among head and neck cancer patients in Ireland and we hope this will increase public awareness of the problem. It is also hoped that other specialties will provide their own perspective on the extent and magnitude of quackery in medicine.
References
1. Jarvis WT. Quackery: the National Council Against Health Fraud perspective. Rheum Dis Clin North Am. 1999; 25:805-814.
2. Jacobson JS & Verret WJ. Complementary and alternative therapy for breast cancer. The evidence so far. Cancer Practice 2001; 9:307-310.
3. Sparber A & Wootton JC. Surveys of complementary and alternative medicine: Part II. Use of alternative and complementary cancer therapies. Journal of Alternative and Complementary Medicine 2001;7:281-287.
4. Eisenberg DM, Kessler RC, Foster C, Norlock FE, Calkins DR, Delbanco TL. Unconventional medicine in the United States: prevalence, costs and patterns of use. N Engl J Med 1993;
328:246-252.
5. Cassileth BR. Complementary and alternative cancer medicine. J Clin Oncol 1999; 17:44-52.
6. Yoav P. Talmi et al. Limited Use of Complementary and Alternative Medicine in Israeli Head and Neck Cancer Patients. The Laryngoscope 2005; 115:1505-1508.
7. Benjamin F. Asher, Michael Seidman, Carl Snyderman. Complementary and Alternative Medicine in Otolaryngology. The Laryngoscope 2001; 111:1383-1389.
8. Ernst E, Cassileth BR. How useful are unconventional cancer treatments? Eur J Cancer 1999; 35:1608-1613.
9. Zeltzer L, Kellerman J, Ellenberg L, Dash J. Hypnosis for reduction of vomiting associated with chemotherapy and disease in adolescents with cancer. J Adolesc Health 1983; 4:77-84.
10. Baider L, Uziely B, De-Nour AK. Progressive muscle relaxation and guided imagery in cancer patients. Gen Hosp Psychiatry 1994; 16:34—347.
11. Davis GE, Bryson CL, Yueh B, McDonell MB, Micek MA, Fihn SD. Treatment delay associated with alternative medicine use among veterans with head and neck cancer. Head & Neck 2006; 28:926-931.
Authors’ Acknowledgement
We would like to thank Ms. M. Codd, Oncology Specialist Nurse at St. James’s Hospital, Dublin, for her contribution to this study.
Authors:
M Amin, J Hughes, C Timon, J Kinsella
Authors' affiliation:
Department of Otolaryngology, Head and Neck Cancer, St. James’s Hospital, James’s St, Dublin
Smokers squirming over graphic packs
Invercargill, New Zealand
Sean Gillespie
The Southland Times (www.stuff.co.nz)
Some smokers are changing cigarette brands to avoid the graphic health warnings that became compulsory in late February.
Faster selling brands tend only to be available with the anti-smoking graphics but some slower selling brands are still available without the pictures.
Invercargill tobacconist Paul McKinlay said this had caused some of his customers to change to a brand with non-graphic boxes still available.
"Most of them are disgusted by the images — they're very graphic." Retailers have been given until August 31 to sell any remaining stock that does not have the warning images.
Mr McKinlay said some customers were also choosing between disease warnings when they bought their cigarettes.
"They go `nah, I don't want the one with the pregnant lady; give me one with the toe tag'." There are seven images smokers can choose from, including warnings about blindness, gangrene, mouth cancer, lung cancers and heart attacks.
Some smokers have been avoiding the warnings by buying cigarette pack covers. Sales of the covers had skyrocketed since the graphic health warnings started two months ago, Mr McKinlay said.
Anti-smoking group Ash spokesman Michael Colhoun, in Wellington, said high sales of the covers were a positive sign.
"The sheer fact that they're using them means that the warnings are effective." The Ministry of Health said the aim of the warnings was to help prevent some of the 5000-odd smoking-related deaths that happen in New Zealand each year. Quitline spokesman Hayden Sanders said many more people had been calling its service since the introduction of the graphic warnings.
Rescue of salivary gland function after stem cell transplantation in irradiated glands
Groningen, The Netherlands
IM Lombaert et al.
PLoS ONE, January 1, 2008
Head and neck cancer is the fifth most common malignancy and accounts for 3% of all new cancer cases each year. Despite relatively high survival rates, the quality of life of these patients is severely compromised because of radiation-induced impairment of salivary gland function and consequential xerostomia (dry mouth syndrome).
In this study, a clinically applicable method for the restoration of radiation-impaired salivary gland function using salivary gland stem cell transplantation was developed. Salivary gland cells were isolated from murine submandibular glands and cultured in vitro as salispheres, which contained cells expressing the stem cell markers Sca-1, c-Kit and Musashi-1. In vitro, the cells differentiated into salivary gland duct cells and mucin and amylase producing acinar cells. Stem cell enrichment was performed by flow cytrometric selection using c-Kit as a marker. In vitro, the cells differentiated into amylase producing acinar cells.
In vivo, intra-glandular transplantation of a small number of c-Kit(+) cells resulted in long-term restoration of salivary gland morphology and function. Moreover, donor-derived stem cells could be isolated from primary recipients, cultured as secondary spheres and after re-transplantation ameliorate radiation damage. Our approach is the first proof for the potential use of stem cell transplantation to functionally rescue salivary gland deficiency.
Authors:
IM Lombaert, JF Brunsting, PK Wierenga, H Faber, MA Stokman, T Kok, WH Visser, HH Kampinga, G de Haan, and RP Coppes
Authors' affiliations:
Section Radiation and Stress Cell Biology, Department of Cell Biology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
Potential use of quantitative tissue phenotype to predict malignant risk for oral premalignant lesions
Vancouver, British Columbia, Canada
M Guillaud et al.
Cancer Res, May 1, 2008; 68(9): 3099-107
The importance of early diagnosis in improving mortality and morbidity rates of oral squamous cell carcinoma (SCC) has long been recognized. However, a major challenge for early diagnosis is our limited ability to differentiate oral premalignant lesions (OPL) at high risk of progressing into invasive SCC from those at low risk.
We investigated the potential of quantitative tissue phenotype (QTP), measured by high-resolution image analysis, to identify severe dysplasia/carcinoma in situ (CIS; known to have an increased risk of progression) and to predict progression to cancer within hyperplasia or mild/moderate dysplasia. We generated a nuclear phenotype score (NPS), a combination of five nuclear morphometric features that best discriminate 4,027 "normal" nuclei (selected from 29 normal oral biopsies) from 4,298 "abnormal" nuclei (selected from 30 SCC biopsies). This NPS was then determined for a set of 69 OPLs.
Severe dysplasia/CIS showed a significant increase in NPS compared with hyperplasia or mild/moderate dysplasia. However, within the latter group, elevated NPS was strongly associated with the presence of high-risk loss of heterozygosity (LOH) patterns. There was a statistical difference between NPS of hyperplasia or mild/moderate dysplasia that progressed to cancer and those that did not. Individuals with a high NPS had a 10-fold increase in relative risk of progression. In the multivariate Cox model, LOH and NPS together were the strongest predictors for cancer development.
These data suggest that QTP could be used to identify lesions that require molecular evaluation and should be integrated with such approaches to facilitate the identification of hyperplasia or mild/moderate dysplasia OPLs at high risk of progression.
Authors:
M Guillaud, L Zhang, C Poh, MP Rosin, and C MacAulay
Authors' affiliation:
British Columbia Cancer Agency/Cancer Research Center, University of British Columbia, Vancouver, British Columbia, Canada
Seeing Is Believing
United Kingdom
staff
Economist.com
The prospects for using genes as a therapy may be improving
For around 40 years scientists have understood how genes work. They have known the structure of genes, how they replicate, how they are controlled and expressed and, crucially, how to manipulate them. Such knowledge has been the basis of a genetic revolution that offers the power to rewrite the material from which all living organisms are made.
There has been great progress in realising some of this promise, in the form of genetically modified organisms. But ways to correct the genetic mistakes that cause many human diseases have been slower to arrive. Gene therapy has been plagued with problems—naivety, false promises, over-optimism and fatalities. Although thousands of patients have received gene therapy for a variety of conditions, only a few have shown any clinical benefit.
Could that be about to change? There was news this week of a successful attempt to correct a faulty gene that leads to blindness. An international team of scientists, led by a group at the University of Pennsylvania, used a genetically engineered virus to introduce the correct version of a gene called RPE65 into six people suffering from a retinal disease known as Leber's congenital amaurosis. In four patients vision improved. Earlier work with the same technique on dogs suffering from a naturally occurring form of blindness has also been successful.
Katherine High, of the Howard Hughes Medical Institute in Maryland, and one of the directors of the study, reported in The New England Journal of Medicine, reckons the treatment could be used more widely. It offers hope for correcting any of the ten genetic defects that can cause Leber's, as well as some forms of retinitis pigmentosa, a group of genetic eye conditions.
More importantly, though, it adds to the rather small number of human successes with gene therapy. The first human gene-therapy trial was in 1990, on a rare and severe immunodeficiency disease known as SCID. Although questions remain about whether the first examples were as successful as claimed, the treatment has since been used successfully on over two dozen patients around the world.
The clinical approach
Work on gene therapy for other conditions is proceeding. For diseases such as cystic fibrosis or muscular dystrophy, which involve one or a few inherited genetic changes, clinical trials are attempting to introduce the correct versions of faulty genes into patients. For acquired diseases, such as cancer, gene-therapy trials are introducing genes that are intended to kill cancerous cells. Len Seymour, a researcher at Oxford University, likens this approach to using DNA as a drug.
In the early days, says Dr Seymour, people wrongly thought that it would be easy to introduce genetic material into diseased cells. He likens attempts by researchers to introduce genes to “throwing a carburettor on to the passenger seat of a car and expecting the car to go”.
The most notable successes, so far, have been with diseases where it is relatively easy to introduce genes. In SCID, for example, bone-marrow precursor cells can be removed, treated and then injected back into place. In the case of Leber's congenital amaurosis, viruses carrying the correct gene can be injected directly into the retina where they will infect retinal cells. Direct injection is also being used in gene-therapy trials on patients with Parkinson's and on those with muscular dystrophy.
Many of gene therapy's other problems have been with the vector that carries the gene, usually a virus. Sometimes these viruses have provoked strong immune reactions—which is what caused the death of Jesse Gelsinger, an 18-year-old American who had a damaged gene that prevented his liver from making an enzyme to break down ammonia. In 1999 he was the first person to be publicly identified as having died in a clinical trial for gene therapy.
Viruses can also cause genetic mutations when they integrate themselves into human DNA. Of the 27 people treated for SCID worldwide, four have developed leukaemia and one has died, says Dr Seymour, though this needs to be balanced against the fact that most children with SCID are completely lacking a normal immune system and die in early childhood.
Hence, research is focused on improving the viral vectors. One way of doing this is to create viruses that lose their ability to activate local genes when they are integrated into their host's genome. Another route, used in the recent Pennsylvania trial, is to use viruses that integrate themselves only into the cell, rather than the cell's DNA. And at Oxford Dr Seymour is working on “stealth viruses”, which are coated in a polymer that hides the virus from the immune system. This allows the modified virus to circulate for longer in a patient's blood stream and thus have a better chance of getting to tumours disseminated around the body. Across the world a number of groups are trying to develop synthetic polymers to deliver genes, entirely removing the need to use viruses.
Most work in gene therapy is centred on cancer. One approach, used by Shenzhen SiBiono GeneTech, a Chinese company, is to replace broken tumour-suppressor genes with the correct version. In 2003 the company's treatment for head and neck cancer, which accounts for about 10% of the 2.5m new cancer patients in China every year, gained the first commercial approval of a gene-therapy treatment. Yet many outside China have been dismissive of the quality of the data used to support this therapy, although Dr Seymour says that when used with chemotherapy in some situations, it can be good.
Another promising strategy, one that is on the fringes of what strictly you would call gene therapy, is “virotherapy”. This uses viruses selectively to attack only cancerous cells. There are about a dozen trials in this area. In 2006 researchers from the Hebrew University in Israel isolated a variant of the virus that causes Newcastle disease, a highly contagious disease in birds that can kill. This variant was able to target selectively cancer cells in humans. Trials on a form of aggressive primary brain tumour have shown one complete regression out of 14 treated patients.
Despite the slow progress, Dr High says she is optimistic about the future of gene therapy. She argues that treatments only really got going 15 years ago (when the SCID trials began). This, she adds, should be put into context: the development of bone-marrow transplantation or monoclonal-antibody treatments both took several decades. Drugs that are “biologics”, such as vaccines, monoclonal antibodies and gene therapy, are derived from biological processes and are inherently more complicated than the chemicals that have traditionally been the mainstay of the pharmacological arsenal.
Gene therapy could be the most complex biologic of all, reckons Dr High. The work carried out so far gives scientists a reasonably complete list of things that can go wrong. Dr High warns that researchers are still at the bottom of a tall ladder, though she expects quicker progress in the future. “We have our foot on the rung, and it's not giving way.”
Super health benefits of strawberries
Scottsdale, AZ
Michele Thompson, MS
SheKnows.com
Red, juicy, delicious strawberries are one of the healthiest fruits to include in your diet. Strawberries are chockfull of antioxidants and other essential nutrients that can flavorfully help you reduce your risk of cancer, heart disease, inflammatory diseases, and birth defects as well as mouthwateringly manage your weight. Here are the bountiful health benefits of strawberries.
Strawberries help fight cancer
Dozens of studies over the past 20 years have associated diets high in fruit and vegetables with reduced risk of cancer. Recently, researchers have been testing individual foods for their cancer-fighting ability.
Studies examining the freeze-dried strawberries and strawberry extracts indicate that strawberries can fight breast, cervical and esophageal cancers. The compounds – such as antioxidants and other phytonutrients – found in strawberries (and other fruit and vegetables) are credited with health-protecting effects. Strawberries are a rich source of these antioxidants (vitamin C in particularly), flavonoids, and ellagic acid.
According to the California Strawberry Commission, a serving of strawberries (about 8 strawberries) provides 160 percent of the recommended daily intake for vitamin C. Further, vitamin C has been associated with reduced rates of stomach, cervical, breast and non-hormone-dependent cancers.
The flavonoids, such as anthocyanins, quercetin and kaempferol, exhibit antioxidant properties that have been proven beneficial in suppressing colon cancer cells, inhibiting prostate and breast cancer cancer cells, and inhibiting chemically-induced cancers of the lung, tongue, mouth, mammary and colon.
The antioxidant power of strawberries has been measured and scored by researchers of the United States Department of Agriculture (USDA) using the ORAC method. Strawberries score in the fruit group with the highest antioxidant values, or highest ORAC values. Strawberries are certifiably a super food!
In addition, strawberries contain folate, a B vitamin that has been associated with reduced risk of several cancers as well as a decreased risk for birth defects, such as spina bifida.
Strawberries for heart health
A new analysis of data from the Harvard Women’s Health Study offers another potential link between strawberries and heart health. Researchers found that women with high strawberry consumption were more likely to also lead a healthy lifestyle.
The heart-health benefits of strawberries are attributed to their high levels of key nutrients. Vitamin C is an important antioxidant that has been correlated with lower death rates from cardiovascular disease, lower prevalence of cardiovascular disease and reduced risk of angina. Further, supplementation with vitamin C has been shown to reduce serum levels of C-reactive protein (a substance in the body that indicates the presence of injury or inflammation).
Folate is another nutrient in promoting heart-health – lower folate concentrations have been associated with increased coronary disease risk and increased fatal coronary events. In addition to folate, strawberries are high in fiber and potassium, both associated with heart health benefits, such as lower cholesterol and blood pressure, respectively.
Maybe there is something truly fitting about heart-healthy strawberries being the preferred fruit for Valentine’s Day and other romantic encounters!
The direction of current research suggests that eating just eight strawberries a day can improve heart health, lower blood pressure, reduce inflammation, reduce the risk of cancers and even improve cognitive function. There is no reason not to eat strawberries as part of a healthy lifestyle. Strawberries are available nearly year round, ripe for you to take advantage of the health benefits of this luscious, juicy fruit.
Visit the California Strawberry Commission for abstracts and full text versions of the studies on strawberries as well as additional nutritional information and delectable recipes.
BSD Medical to Present Its Cancer Therapy Systems at the 2008 World Congress of Brachytherapy
Salt Lake City, UT
press release
BusinessWire.com
BSD Medical Corporation announced today that the company will present its systems for cancer therapy at the 2008 World Congress of Brachytherapy (the annual meeting of the American Brachytherapy Society or ABS) from May 4-6, 2008, in Boston, Massachusetts. The company’s objective at ABS is to leverage the growing clinical interest in the use of hyperthermia therapy with brachytherapy.
The ABS organization consists of BSD Medical’s primary customers, including oncologists, physicists and other health care providers practicing brachytherapy. A wide variety of national and international speakers have been invited to present data at the meeting. Founded in 1978, the American Brachytherapy Society is a nonprofit organization that seeks to provide insight and research into the use of brachytherapy in malignant and benign conditions.
Clinical studies have shown hyperthermia to be a safe and well tolerated therapy when combined with brachytherapy for the treatment of certain types of locally advanced cancer. Brachytherapy is a form of radiation therapy where radioactive sources are placed inside or next to the area requiring treatment. BSD Medical systems deliver hyperthermia for use in combination with brachytherapy through small, interstitial microwave antennae that are inserted through the same catheters used to place the radioactive sources.
Because it is less invasive than surgery and less disruptive to the patient, brachytherapy offers appropriate patients an effective alternative cancer treatment. Brachytherapy is used with hyperthermia to treat advanced localized prostate cancer, breast cancer, cervical cancer and cancers of the head and neck.
After Cancer, Hope for Devastating Side Effect
New York, NY
Tara Parker-Hope
New York Times (nytimes.com)
Cancer patients and their doctors often focus on beating the disease first. But new research shows they also benefit by early monitoring for lymphedema, a devastating side effect of cancer treatment that can show up years later.
Lymphedema is a painful swelling of an arm or leg that can occur months or even years after cancer treatment. Breast cancer patients, who often have lymph nodes removed during diagnosis and treatment, are particularly susceptible. But any cancer patient whose lymphatic system has been damaged by radiation or the removal of lymph nodes is vulnerable. That includes patients treated for prostate and gynecological cancers, head and neck cancers, testicular cancer, bladder cancer, colon cancer and melanoma.
The lymphatic system normally helps transport body fluids, but in someone with a compromised system, fluid can build up in an arm or leg, depending on where the lymph nodes were removed. If lymphedema sets in, a limb can swell far out of proportion to the rest of the body, and if not treated quickly, the condition can be irreversible.
But an important new study conducted by the National Institutes of Health and the National Naval Medical Center shows that cancer patients benefit if their treatment plans include early interventions to monitor risk for lymphedema. During the five-year study, researchers measured the upper limb volume of 196 newly diagnosed breast cancer patients to establish a baseline before they had surgery.
After surgery, doctors developed a lymphedema surveillance method in which they continued to measure upper limb volume. In the study, 43 women, or 22 percent, developed “subclinical” lymphedema, which means it typically would not be detected in a routine exam. The women were quickly prescribed pressure garments, which are tightly worn around the affected limb. All of them showed improvement that put them at or close to the presurgical “normal” state. The study was published in the online edition of the journal Cancer.
The study suggests there’s a benefit to using more sophisticated tools to track lymphedema, such as devices that use electrical signals to assess fluid changes in the body. Most physicians currently rely on tape measures to track changes in limb circumference and size or wait for a patient to report a loss of mobility or swelling in an arm.
Dr. Steven Schonholz,, a breast surgeon and medical director of the Breast Cancer Center at Mercy Medical Center in Springfield, Mass., says that by using better tools to measure limb volume, doctors can now identify lymphedema in its earliest stages, long before a patient is even aware of the problem.
“If patients aren’t treated at the earliest possible indication of lymphedema, it is less likely to be effectively treated,'’ Dr. Schonhlz said. “The condition may require lifelong costly treatment and, more importantly, have an enormous impact on a woman’s self-esteem, function and quality of life.”
Every cancer patient should talk to his or her doctor about lymphedema, and ask about monitoring and early detection, as well as baseline measurements of limb volume before treatment. In addition to being monitored for lymphedema, patients need to know that even minor overuse of an affected limb, such as carrying a heavy bag or typing for hours on a keyboard, can trigger the swelling.
Phase I Clinical Trial of Photodynamic Therapy Underway for Potential New Treatment of Oral Precancerous Lesions
web-based article
staff
money.cnn.com
A Phase I clinical trial, using a DUSA Pharmaceuticals, Inc. product, has been launched by the National Cancer Institute (NCI) to study an entirely new approach for the prevention of oral cancer, which may affect more than 30,000 Americans this year.(1) Chronic mouth lesions, the most common of which is a condition known as oral leukoplakia, are early indicators of oral cancer. There is currently no effective treatment for preventing the progression of oral leukoplakia to cancer. The long-term goal is to examine aminolevulinic acid (ALA) photodynamic (PDT) therapy as a preventive treatment for oral cancer by the selective removal of oral leukoplakia.
Oral leukoplakia is a condition involving the formation of white spots on the surfaces of the mouth and tongue. Previous studies have shown that ALA PDT may be used to identify and treat the condition.(2)(3)(4) ALA, the active ingredient in DUSA's product, Levulan®, is a chemical that is produced naturally at low levels in humans. If ALA is given to the body at higher levels, the drug can build up inside of pre-cancerous cells. When a laser light is pointed at a pre-cancerous cell, ALA may increase the effect of the laser causing the cell to die. This is called photodynamic therapy (PDT). The purpose of the present trial is to examine the safety and tolerability of orally administered ALA PDT and to determine the optimal dose of light therapy.
"The commencement of this trial is a critical first step towards identifying a novel therapeutic intervention that may prevent the progression of precancerous lesions into oral cancer," said Dr. Stuart J. Wong, Protocol Lead Investigator, Medical College of Wisconsin. "The data obtained from this study will be critical to the design of future trials that can examine the effectiveness of ALA PDT for the treatment of oral leukoplakia and/or prevention of oral cancer." Patient selection has begun at the Medical College of Wisconsin, with the University of Chicago to follow as a second site.
About the Study
During 2004, DUSA signed a clinical trial agreement with the National Cancer Institute (NCI) Division of Cancer Prevention (DCP), for the clinical development of Levulan® photodynamic therapy (PDT) for the treatment of oral leukoplakia. The NCI DCP will be responsible for the clinical trial costs, while DUSA will provide Levulan, laser light device(s) and the necessary training for the investigators involved in the studies. In the study, the same dose of ALA will be administered orally to six groups of patients with oral leukoplakia. The oral dose will be followed in three to four hours by laser light treatment (PDT), with the first group getting the lowest light dose and increasing the light dose for each new group. Safety evaluations will be performed following treatment of each group. Biopsies of target oral lesions and/or tissue where oral lesions previously existed will be performed at registration and completion to evaluate treatment.
"DUSA is pleased to support the National Cancer Institute in the development and initiation of this pilot clinical protocol, which presents a unique opportunity to use Levulan PDT as a new treatment for oral leukoplakia, a condition for which there is no standard therapy," said Bob Doman, President and CEO of DUSA. "The launch of this trial underscores DUSA's commitment to supporting studies that will examine the potential of Levulan PDT as a preventive cancer treatment across different patient populations."
Researchers anticipate that the study will be completed within 12-24 months and based on results, hope to move forward with a phase II trial. Visit http://clinicaltrials.gov for more information on the trial.
About DUSA Pharmaceuticals
DUSA Pharmaceuticals, Inc. is an integrated dermatology pharmaceutical company focused primarily on the development and marketing of its Levulan® Photodynamic Therapy (PDT) technology platform, and complementary dermatology products.
About Medical College of Wisconsin
The Medical College of Wisconsin in Milwaukee, www.mcw.edu, is a private, freestanding academic institution dedicated to leadership and excellence in advancing the prevention, diagnosis and treatment of disease and injury through education, discovery, patient care and community engagement. A major national research center and academic medical center, its faculty physicians and scientists direct or collaborate on more than 3,000 research studies, publish over 1,400 peer-reviewed scientific papers, and provide care in virtually every specialty of medicine to approximately 297,000 patients annually.
About The National Cancer Institute
The National Cancer Institute (NCI) is a component of the National Institutes of Health (NIH), one of eight agencies that compose the Public Health Service (PHS) in the Department of Health and Human Services (DHHS). The NCI, established under the National Cancer Institute Act of 1937, is the Federal Government's principal agency for cancer research and training. The National Cancer Act of 1971 broadened the scope and responsibilities of the NCI and created the National Cancer Program. The NCI coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.
Mouth cancer drug gets NICE thumbs up
web-based article
staff
dentistry.co.uk
The National Institute for Health and Clinical Excellence (NICE) has today issued a Final Appraisal Determination (FAD) recommending the use of cetuximab (Erbitux®) in combination with radiotherapy for the treatment of locally advanced head and neck cancer in patients for whom platinum-based chemoradiotheraphy is inappropriate.
Cetuximab is the first new treatment in more than 40 years that significantly prolongs patient's survival and control of the disease.
This news follows the Mouth Cancer Foundation's successful appeal last year to the Appeal Panel of NICE to ask its Appraisal Committee's to reverse its previous appraisal decision not to recommend the drug for head and neck cancer patients in England and Wales in May 2007.
The Appraisal Committee accepted that cetuximab plus radiotherapy caused less severe adverse effects than the chemoradiotherapy regimens.
This announcement means that patients with head and neck cancer in England and Wales will soon have access to this life-saving treatment like patients in Scotland already do.
Once the full guidance has been published, expected on 29 May 2008, it will be available across the NHS within three months.
Dr Vinod Joshi of the Mouth Cancer Foundation said: ‘The Mouth Cancer Foundation welcomes NICE's decision.
"It is something that oncologists and patients alike have been fighting for. It will go a long way to correcting the present postcode lottery in head and neck cancer for patients in the UK."
New Surgery Improves Head & Neck Cancer Treatment
Birmingham, AL
press release
www.newswise.com
A new surgical procedure for head and neck cancer at the University of Alabama at Birmingham offers improved accuracy for surgeons and reduced post-operative pain for patients.
The new procedure uses robotic surgery, and results have shown it lessens the scarring, breathing problems and damage to speech that can happen with treating head and neck cancers, said William Carroll, M.D., a scientist in the UAB Comprehensive Cancer Center.
Initial tests have shown the new procedure also shortens recovery times for cancer patients.
"This application takes robotic surgery to new places in the body," said Carroll, a head and neck surgeon within UAB's Division of Otolaryngology, and one of the first surgeons to begin using the procedure for head and neck cancers.
"There is an option for patients to have a more minimally invasive surgery, and one that could effectively remove the cancer while causing fewer side effects," he said.
Robotic surgery is an alternative to traditional open surgery and a refinement on the concept of laparoscopic surgery, Carroll said. The robot most commonly used in cancer treatment is called the da Vinci, which is sold by Intuitive Surgical.
UAB was the first medical center in Alabama and among the first in the United States to begin using the da Vinci for head and neck cancers more than a year ago. Since that time, 40 UAB patients have had the new operation.
Offering the new procedure to patients first involved adapting operating techniques and robot-arm positions, and continually refining those adaptations, Carroll said. The da Vinci was originally designed for operating on the lower and middle sections of the body, and not the narrow spaces inside the head and neck.
The increased surgical accuracy comes from tiny cameras attached to the end of the da Vinci instruments. Carroll said the magnified, 3-D image gives doctors a greater field of vision than conventional open or laparoscopic surgery.
This year more than 40,000 Americans will be diagnosed with head and neck cancer, and more than 7,500 will die from the disease, according to the American Cancer Society. The disease includes cancers of the oral cavity, and the larynx and pharynx.
The most effective prevention strategy remains stopping risky behaviors like smoking, chewing tobacco or drinking excessive alcohol, Carroll said.
Vaccine May Treat Lung Cancer
web-based article
Salynn Boyles
WebMD.com
An experimental vaccine that works by training the immune system to kill specific tumor cells is showing promise for the treatment of early lung cancer, researchers report. The immune-system-boosting vaccine targets a protein expressed in certain cancer cells, but not in normal cells, known as MAGE-A3.
About 35% of non-small-cell lung cancers (NSCLC) have this protein, which is also present in some melanomas and head and neck cancers.
In a trial of early-stage lung cancer patients whose tumors expressed MAGE-A3, treatment with the vaccine was shown to reduce the risk of relapse after surgery.
Long-term follow-up results from the early trial of the immunotherapy were presented at the 1st European Lung Cancer conference in Geneva, Switzerland.
"The principle behind this approach has potential for many different types of cancer," researcher Johan Vansteenkiste, MD, PhD, tells WebMD. "The principle is that you teach the patient's immune system to eliminate cancer cells that express certain proteins."
MAGE-A3 Vaccine
The vaccine therapy has not been compared head-to-head with chemotherapy, which is often given to surgically treated lung cancer patients to reduce their risk of relapse.
But Vansteenkiste says the immunotherapy-treated patients in the phase II study had outcomes similar to those seen among chemotherapy-treated patients, with almost no side effects.
"Many surgically treated lung cancer patients are not able to tolerate the side effects of chemotherapy, either because of their age or because of other health issues," he says. "This approach is a promising alternative."
A total of 182 patients with NSCLC were included in the early study, sponsored by drugmaker GlaxoSmithKline, which is developing the vaccine therapy. All the patients had cancers that expressed MAGE-A3.
After having surgery to remove their tumors, 122 patients were randomly assigned to treatment with the MAGE-A3-targeting vaccine and 60 patients got placebo vaccines.
The patients were given five injections every three weeks at the beginning of treatment and then eight injections every three months later on for a total of 27 months, Vansteenkiste says.
After 44 months of follow-up, 69 of the 182 patients had cancer recurrences, including 57 deaths. The researchers report that the treatment was well-tolerated. The MAGE-A3-treated patients seemed less likely to have recurrences and die from their disease than the placebo-treated patients, although this is being further evaluated in an ongoing phase III study for efficacy.
Immunotherapy vs. Chemotherapy
This year in the U.S., 215,000 new cases of lung cancer will be diagnosed and close to 162,000 people will die from the disease, according to National Cancer Institute projections.
Surgery is the standard treatment for patients with early-stage disease, but about 50% of patients who have surgery end up dying of their lung cancer, Vansteenkiste says.
He says adding chemotherapy to surgery boosts the survival rate by about 10%, a rate similar to that seen in the MAGE-A3 trial.
Last year, GlaxoSmithKline began recruitment for a phase III study of the cancer vaccine, which will include more than 2,000 patients whose cancers express MAGE-A3.
The placebo-controlled trial will include patients treated with the vaccine both instead of and in addition to chemotherapy.
"We want to see if there is an extra benefit to adding the immunotherapy to chemotherapy," he says.
Len Lichtenfeld, MD, of the American Cancer Center, tells WebMD that it remains to be seen if the MAGE-A3 vaccine will prove to be a useful treatment for lung cancer.
"The study suggests that there may be some benefit here, but clearly a larger trial will tell us more," he tells WebMD.
He adds that it will not be clear if the immunotherapy works as well as chemotherapy until the two treatments are compared head-to-head.
The role of PET in head and neck cancer
Heidleberg, Germany
LG Strauss and A Dimitrakopoulou-Strauss
Hell J Nucl Med, January 1, 2008; 11(1): 6-11
PET and PET/CT are the procedures of choice for molecular imaging in the head and neck area. The current data of the literature show, that functional imaging with fluorine-18-deoxyglucose ((18)F-FDG) provides the possibility to obtain information about the viability of malignant lesions.
The use of hybrid systems, PET/CT, enables physicians to assess both, morphology and function, and achieve a high diagnostic accuracy exceeding 90%. PET with (18)F-FDG is the most sensitive method to detect tumor recurrence. However, false positive results must be considered due to unspecific changes following treatment, especially radiotherapy.
The use of quantitative PET scans as well as the application of a second tracer, enhance the capability of PET to assess questionable masses more accurately. Follow up examinations with PET and (18)F-FDG provide data about early changes in the tumor metabolism due to chemotherapeutic treatment. Studies in patients undergoing surgery and radiotherapy demonstrated, that PET with (18)F-FDG can be used for the prediction of individual survival.
MR Imaging Criteria for the Prediction of Extranodal Spread of Metastatic Cancer in the Neck
Nagasaki, Japan
Y Kimura et al.
AJNR Am J Neuroradiol, April 10, 2008
Background and Purpose:
The presence of extranodal spread in metastatic nodes significantly affects treatment planning and prognosis of the patient with head and neck cancer. We attempted to evaluate the predictive capability of MR imaging for the extranodal spread in the neck. MATERIALS AND
Methods:
We retrospectively studied MR images from 109 patients with histologically proved metastatic nodes, of which 39 were positive for extranodal spread. We assessed 47 extranodal spread-positive and 130 extranodal spread-negative metastatic nodes by using the following MR imaging findings as the possible criteria for extranodal spread: 1) nodal size (short-axis diameter); 2) obliterated fat spaces between the metastatic node and adjacent tissues, such as the muscles and skin on T1-weighted images ("vanishing border" sign); 3) the presence of high-intensity signals in the interstitial tissues around and extending from a metastatic node on fat-suppressed T2-weighted images ("flare" sign); and 4) an irregular nodal margin on gadolinium-enhanced T1-weighted images ("shaggy margin"). Multivariate logistic regression analysis was conducted to identify independent predictive criteria for extranodal spread.
Results:
Nodal size, shaggy margin, and flare sign criteria were independent and significant MR imaging findings suggestive of extranodal spread in the metastatic nodes. We obtained 77% sensitivity and 93% specificity with the flare sign, 65% sensitivity and 99% specificity with the shaggy margin, and 80% sensitivity and 85% specificity with the size criterion (cutoff point = 16 mm).
Conclusion:
Fat-suppressed T2-weighted and gadolinium-enhanced T1-weighted images are useful for the detection of extranodal spread in metastatic nodes in the neck.
Authors:
Y Kimura, M Sumi, N Sakihama, F Tanaka, H Takahashi, and T Nakamura
Authors' affiliations:
Department of Radiology and Cancer Biology, Nagasaki University School of Dentistry, Nagasaki, Japan; and Department of Otolaryngology, Nagasaki University School of Medicine, Nagasaki, Japan
Possible Viral Links to Lung Cancer Risk Uncovered
Washington, D.C.
Alan Mozes
WashingtonPost.com
Although smoking is well-established as an independent risk factor for lung cancer, two new studies suggest that two different viral infections might boost a smoker's already substantial risk for developing the disease.
While the specific viruses at issue -- human papillomavirus (HPV) and measles -- may not directly cause lung cancer, they seem to aggravate the negative impact of tobacco, American and Israeli researchers say.
Both findings were presented Friday by separate research teams attending the European Lung Cancer Conference in Geneva.
"In terms of HPV, our finding is pretty controversial," said study author Dr. Arash Rezazadeh, a fellow of medical oncology and hematology at the University of Louisville in Kentucky. "And this is just the beginning of the road. There is much more work to be done. But it's important to know that being infected with this virus does appear to increase lung cancer risk."
As for the role of measles, the second study's lead author, Dr. Samuel Ariad, from the department of oncology at Soroka Medical Center in Beer Sheva, Israel, said that infection -- perhaps even asymptomatic infection -- seems to be associated with half of the lung cancer cases he tracked.
"Measles virus by itself is unlikely to be carcinogenic," he said. "[But] it probably modifies previous damage to DNA caused by smoking."
Both studies specifically focused on the viral impact on non-small cell lung cancer (NSCLC) risk. According to the American Cancer Society, 85 percent to 90 percent of all lung cancers are of this variety. Estimates regarding all forms of lung cancer indicate that 215,000 new cases will be diagnosed in the United States this year alone.
In the HPV study, Rezazadeh and his colleagues analyzed lung tissue samples taken from 23 lung cancer patients being treated in Kentucky. Kentucky, they noted, is the state with the highest rate of adult and teenage smoking in the United States, as well as the highest rate of NSCLC.
Among the patients -- all of whom were smokers -- five were found positive for infection with a variety of HPV strains.
The authors said this frequency of infection "supports the assumption that HPV contributes to the development of NSCLC." They point out that HPV is already known to be the cause of all cases of cervical cancer, a vaccine for which has recently become available. It has also recently been implicated as a possible cause for head and neck cancer.
Further studies are planned to look for signs of HPV infection in the respiratory tract of lung cancer patients and to explore the possibility for using HPV infection as a screening indicator for the disease.
In the measles study, Ariad and his team analyzed lung tissue samples taken from 65 Israeli lung cancer patients between the ages of 40 and 84. Ninety percent were smokers, and most were in the early stages of the disease.
The authors found evidence of measles infection in 54 percent of the patients. The likelihood of viral infection, they observed, went up with age.
They concluded that "a possible association" exists between measles and NSCLC.
Dr. Len Lichtenfeld, deputy chief medical officer of the American Cancer Society, described both research efforts as "interesting." But he cautioned that more research needs to be done on each front.
"The question I have for the measles association has to do with vaccination, since in the U.S., at least, we have near universal coverage," he noted. "So although the measles vaccine may lose some of its effectiveness over time, it would be interesting to know if this finding would apply to a country such as ours where most people are vaccinated."
"But I think the HPV study is the more interesting of the two," Lichtenfeld added, "since HPV is obviously already implicated in other cancers. But this is a small study, and it only suggests a possible link to lung cancer without answering a lot of questions. I would like to know, for example, whether patients who are not smokers but who develop lung cancer have a higher rate of HPV. But for now, I would not yet conclude that HPV increases risk, nor would I tie the HPV vaccine to any risk."
Sources:
Arash Rezazadeh, M.D., fellow, medical oncology and hematology, University of Louisville, Kentucky; Samuel Ariad, M.D., department of oncology, Soroka Medical Center, Beer Sheva, Israel; Len Lichtenfeld, M.D., deputy chief medical officer, American Cancer Society; April 25, 2008, presentation, European Lung Cancer Conference, Geneva
Hopkins Doctor Urges Early Diagnosis To Avoid Cancer’s Forgotten Killer
Baltimore, MD
staff
www.webwire.com
On average, two Marylanders each day are diagnosed with potentially fatal oral cancers that are often curable if identified and treated early. The Maryland Department of Health and Mental Hygiene’s Office of Oral Health reports that the state ranks in the country’s top 10 for number of deaths caused by oral cancers. Nationally, statistics show that the death rate from these cancers is higher than those of cervical cancer, Hodgkin’s lymphoma, testicular cancer, and thyroid and malignant melanoma.
A sore in the mouth that doesn’t heal could be a warning sign of oral cancer, which kills more than 8,000 people a year. Of the 34,000 Americans newly diagnosed with oral cancer annually, only half will be alive in five years. According to the American Dental Association, early diagnosis and treatment could boost that rate to 75 or 80 percent.
John O’Brien, 70, who had not smoked a cigarette in 33 years, was adamant about maintaining proper oral hygiene. But, in 2006, O’Brien, a national sales manager for an advertising agency, father of four and a grandfather of five, found a small lump that turned out to be a cancerous tumor at the base of his tongue. After 45 radiation treatments and six chemotherapy sessions, O’Brien says he is grateful to be alive. “I was just in disbelief. Nobody wants to hear that they have cancer,” says O’Brien. "But, for me I was lucky because the doctors caught it quickly.”
“Often, oral cancer is not diagnosed until it’s advanced because symptoms—sore throat, non-healing ulcer, white or red patches on the gums or tongue, or a neck mass—are easy to dismiss as something less serious,” says Christine G. Gourin, M.D., associate professor at the Johns Hopkins School of Medicine Department of Otolaryngology—Head and Neck Surgery and director of the clinical research program in head and neck cancer. “But oral cancer can be life threatening mostly due to the fact that it’s detected too late.”
According to Gourin, smokers and tobacco users are at the highest risk. “Smokers are six times more likely than non-smokers to develop oral cancer, and those who use chewing tobacco also increase the risks of cancers of their cheek, gums, and inner surfaces of the lip, by 50 percent,” Gourin adds. Gourin also warns that frequent alcohol consumption significantly increases the risk of oral cancer by a factor of four.
Gourin and other experts say that while oral cancer is mostly linked to tobacco and alcohol use, oral cancer in non-smokers is a growing problem as well. Sun exposure is another risk factor, with nearly a third of patients with cancer of the lips having a history of outdoor work and prolonged exposure to UV radiation.
The American Cancer Society recommends that adults, especially smokers, tobacco users or consumers of high amounts of alcohol, check their mouth, gums and tongue monthly as a way of prevention, self-care and catching oral cancers in the early stages. Gourin suggests all adults ask their physicians or dentists to perform a head and neck exam at least once a year, and to personally pay close attention for any unusual symptoms in the mouth, such as sores that do not heal; a lump or thickening in the cheek or lip; white or red patches on the gums, tongue, tonsil or lining of the mouth; chronic sore throat; difficulty in chewing or swallowing; or a lump or mass in the neck.
In recognition of Head, Neck and Oral Cancer week, Mon. Apr. 21 through Fri. Apr. 27, Johns Hopkins Hospital is holding an oral cancer screening on Thurs., April 24 from 10 a.m. to 4 p.m. at the 6th floor of the Johns Hopkins Outpatient Center located at 601 North Caroline St. The screening is FREE, but an appointment is necessary and can be made by calling 410-955-1080. No walk-ins accepted.
Opening up - Innovative physical therapy helps keep cancer survivor
Knoxville, TN
Kristi L. Nelson
knoxnews.com
A long, deep yawn.
A bite of a chocolate bar or crab meat.
A vigorous brushing and thorough flossing.
For 2 1/2 years, Esther Cahal has forgone these and other small pleasures most people take for granted.
An unusual complication from a rare form of particularly aggressive tongue cancer left Cahal's mouth locked shut, able to open barely wide enough to insert her little finger. She stays alive by hooking herself up to a feeding tube unit each night and sleeping in an upright position while she "eats" a liquid nutritional supplement for eight hours through a port in her stomach.
A little more than a year ago, Cahal, facing a recurrence of her cancer, "decided that before I die, I'm going to eat again," Cahal said. "If this cancer's going to kill me, at least I'm going to have something good down my throat."
But Cahal has had two "clear" scans for cancer - and now an innovative physical therapy treatment is helping open her up to experiencing food again.
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It started in February 2004, when Cahal's dentist found an ulcer on the right side of her tongue. She thought the skin was irritated by a tooth, but when the tooth was fixed, the ulcer still didn't heal. So she had a biopsy.
"It came back as extremely aggressive cancer," Cahal said. "It was a surprise for everybody, because I didn't have any risk factors."
The type of cancer Cahal had most commonly affects men older than 60 who drink alcohol, smoke or use oral tobacco products ("dip"). Not only did Cahal not have any of those habits, she had no family history of any type of cancer. In fact, she'd been out sick from work only two days in her then-22-year career as a physician's assistant.
Cahal had surgery to remove the cancer, followed by six weeks of weekly chemotherapy and seven weeks of daily radiation, a course designed to minimize the chance the rare cancer would come back.
The radiation burned her skin badly, and by the second week she couldn't swallow. That's not a common complication of radiation, and Cahal's doctors weren't sure why it happened. But by the fall of 2004, not only could Cahal still not swallow, she couldn't open her jaw because of scarring from the radiation, which badly burned her skin.
Then, almost a year to the day, her cancer came back. This time, surgeons removed a third of Cahal's tongue. She had eight more weeks of chemotherapy. A few months later, a test showed the cancer in her lymph nodes. She had all the nodes removed from her neck. Seven months of weekly chemotherapy followed, then Cahal finished up five more weeks of radiation to just her neck area in December 2006.
During the radiation treatments, Cahal was burned so badly that when she turned her head, the skin would crack and bleed all the way down her neck. Her daughter, now 11, was so distressed by her mother's appearance that Cahal sent her to stay with a friend for three weeks.
"She asked the really hard questions: 'Are you going to be there when I graduate from high school? Are you going to be there when I have my baby? Are you going to be there when I get married?'" remembered Cahal, who said she was always honest with her children. "I said: 'I don't know. I'm trying.' That's all I could tell her."
Cahal had PET scans in July and December 2007, and neither showed any cancer. It was the first time since diagnosis that she'd had two "clear" scans in a row.
But she couldn't open her mouth to shout for joy; her jaw was still locked tight.
Since moving to Knoxville from Johnson City, Cahal has been under the care of otolaryngologist Dr. Mark Overholt. Overholt recommended physical therapy to try to solve Cahal's problem; he even tried to manually force her jaw open when he was operating on her cancer. He had to stop for fear of breaking the jaw.
"We tried a lot of different things to treat Esther," Overholt said. "None of the things seemed to work very well."
Then last September a colleague in the neurosurgeon's office where Cahal works as a P.A. heard about a local seminar being given by Indiana physician Dr. Thomas Sevier, on a rehabilitation system, ASTYM, that he developed to treat chronic tendon disorders, scar tissue and fibrosis. Because Cahal couldn't attend, her co-worker brought her some material.
She contacted Sevier to ask him if he thought his system could help her. He'd not used it for her particular problem, he said, and told her, "'I don't know if you can swallow again, but I can probably get your jaw open,'" she said. "I said, 'Well, if you can get my jaw open, I'll be happy.'"
Cahal agreed to try 10 sessions of ASTYM, formerly called ASTM for "Augmented Soft Tissue Mobilization" (the "Y" was added later to aid with pronunciation). She made an appointment with physical therapist Susan Daugherty of Benchmark Physical Therapy in Farragut. Daugherty was the first of about 25 PTs in Benchmark's 55-clinic network to become ASTYM-certified. She'd enjoyed success using the method to treat patients with chronic tendinopathy, postoperative scarring, Achilles tendinitis, carpal tunnel syndrome and plantar fasciopathy, which is notoriously frustrating for both patients and PTs because of its difficulty to treat.
During the manual ASTYM treatment, a PT uses acrylic tools to locate and put pressure on scar tissue, increasing blood flow to the scar and ultimately helping the tissue heal, Daugherty said. The tools allow a PT to feel "bumpy" scar tissue more easily and to work on a larger area without tiring out, as happens when doing deep tissue massage with the hands alone. It works on patients who have immobility problems caused by scarring; patients whose problems are caused by inflammation won't benefit, she said.
Daugherty hadn't used the method on a patient's face, however, and Cahal had little confidence it would work for her. Still, she thought, "It can't hurt."
She was wrong. The therapy did hurt - a lot. Though Daugherty isn't pressing especially hard, Cahal's facial tissue is very tender.
"She's not gentle," Cahal said, laughing. After a session, "I look like I've been slapped around," because the increased blood flow to the scar tissue makes her skin red.
But it also worked. Within two weeks, Cahal was already seeing improvement. A visit to Overholt confirmed it: she could open her mouth wide enough that he could get his finger in the back of her throat.
By November, Cahal was able to eat her first food in more than two years. She had a bowl of vanilla pudding.
Cahal is now regularly eating soft foods, such as soups and mashed potatoes. She still has some trouble; enough of her tongue is missing that she can't move food around in her mouth, and she lacks sensation at the back of her throat. Daugherty also takes her through exercises to strengthen muscles she hasn't used in years. But she's not complaining.
"You don't realize until you lose the ability to eat, how social that is," said Cahal, who said waiters have asked her why she didn't like their restaurant's food, and people have accused her of being anorexic: "I was always having to explain why I wasn't eating."
She still has to supplement with her "liquid supper" at night, since she can't yet take in enough calories by mouth. But it's "a big breakthrough when you can't eat anything at all," said Overholt, adding, "Six to eight months ago, I thought she probably would be dependent on a feeding tube for the rest of her life. Now I'm optimistic that she won't."
Cahal's next goal is to be able to open wide enough to go to the dentist. A tooth that's been bothering her will now probably have to be removed, because her mouth has been closed too tightly even for pediatric dental instruments. She also hopes to be able to yawn, and to swallow a pill. Right now when she gets a headache, Cahal must either dissolve a pill, which takes about an hour, or have on hand specially ordered ibuprofen that has been compounded into liquid form at about $50 for 10 800-mg doses.
And maybe someday she'll be able to eat more of the foods she misses, like chocolate.
"I miss being able to bite a chocolate bar," Cahal said. "But if I can never eat regular food, that's fine. I never really thought I'd eat again."
Since the radiation also left Cahal's tongue scarred, her sense of taste is diminished. Daugherty has begun using the smallest ASTYM instrument to massage Cahal's tongue, on the off chance it might help bring some of that back.
"Her story is so inspiring," Daugherty said. "It makes you really glad for the profession you're in. … Really changing someone's life in big ways is just so awesome."
Cahal hopes others with similar problems will learn from her experience and start ASTYM treatment earlier; her scar tissue was already quite calcified when Daugherty began treating her. Had she known it would be so effective, she said, she would have started during radiation.
"I'm just glad she was willing to go off the road" of tried therapy to help, Cahal said.
Swedish tobacco tied to premature death
Gothenburg, Sweden,
staff
www.upi.com
A form of moist Swedish tobacco known as snus has been linked to premature death in users, a new longitudinal study has found.
Dr. Ann Roosaar at the Odontological Institute said the study found snus -- it rhymes with moose -- posed a significant health risk to those who used it even when compared to normal tobacco, the Swedish news agency TT reported Saturday.
"Even if smoking is without question a much greater threat to health than snus our research rejects the view that the use of Swedish snus is in principle without risk," the researcher said.
The study examined the use of snus in the Swedish municipalities of Enkoping and Habo during a 30-year period, along with residents' use of other tobacco products and alcohol.
Snus is generally used by placing a pinch of it inside the mouth under the upper lip. Inhabitants' mouths were examined prior to the study and its final results indicated that snus users were more likely to have mouth and throat cancers than non-snus users, the news agency said.
Understanding the biological basis of autofluorescence imaging for oral cancer detection
Austin, TX
I Pavlova et al.
Clin. Cancer Res., April 15, 2008; 14(8): 2396-404
Purpose:
Autofluorescence imaging is increasingly used to noninvasively identify neoplastic oral cavity lesions. Improving the diagnostic accuracy of these techniques requires a better understanding of the biological basis for optical changes associated with neoplastic transformation in oral tissue.
Experimental Design:
A total of 49 oral biopsies were considered in this study. The autofluorescence patterns of viable normal, benign, and neoplastic oral tissue were imaged using high-resolution confocal fluorescence microscopy.
Results:
The autofluorescence properties of oral tissue vary significantly based on anatomic site and pathologic diagnosis. In normal oral tissue, most of the epithelial autofluorescence originates from the cytoplasm of cells in the basal and intermediate regions, whereas structural fibers are responsible for most of the stromal fluorescence. A strongly fluorescent superficial layer was observed in tissues from the palate and the gingiva, which contrasts with the weakly fluorescent superficial layer found in other oral sites. Upon UV excitation, benign inflammation shows decreased epithelial fluorescence, whereas dysplasia displays increased epithelial fluorescence compared with normal oral tissue. Stromal fluorescence in both benign inflammation and dysplasia drops significantly at UV and 488 nm excitation.
Conclusion:
Imaging oral lesions with optical devices/probes that sample mostly stromal fluorescence may result in a similar loss of fluorescence intensity and may fail to distinguish benign from precancerous lesions. Improved diagnostic accuracy may be achieved by designing optical probes/devices that distinguish epithelial fluorescence from stromal fluorescence and by using excitation wavelengths in the UV range.
Authors:
I Pavlova, M Williams, A El-Naggar, R Richards-Kortum, and A Gillenwater
Authors' affiliations:
Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas.
Noninvasive Genetic Detection Of Head And Neck Squamous Cell Carcinoma
web-based article
staff
Medical News Today (www.medicalnewstoday.com)
Introgen Therapeutics phase 3 study of cancer drug confirms earlier findings
London, England
press release
CNNMoney.com
Introgen Therapeutics Inc. said Monday its Advexin phase three clinical trial data in patients with recurrent head and neck cancer has confirmed earlier phase two results of the drug's efficacy.
'Advexin provides therapeutic benefit by restoring p53 tumor suppressor function which is blocked in the majority of head and neck cancers,' Robert E. Sobol, senior vice president, medical and scientific affairs, Introgen said in a statement.
A comprehensive analysis of Introgen's phase three data and additional studies of Advexin will be presented at medical conferences later this year. These and other data will be the basis for regulatory submissions in the United States and in Europe as previously reported, the company said.
Qiagen keeps purchase powder dry for now
Hilden, Germany
Patricia Gugau and Mantik Kusjanto
www.guardian.uk
Qiagen plans to keep its powder dry for major acquisitions for now as it focuses on integrating its $1.6 billion purchase of rival Digene, its finance chief said.
"We still have sufficient firepower (for purchases)," Roland Sackers told Reuters in an interview.
But Qiagen first wanted to integrate Digene, which has made it the second-largest molecular diagnostics company in the world after Roche.
Digene helped boost cash flow at Qiagen, which has a high equity-to-assets ratio of 50 percent, he said. Qiagen also had a credit line for an undisclosed amount.
Digene's flagship product is a test for detecting human papilloma virus (HPV), the cause of almost all cervical cancers. The market for HPV testing is estimated at more than $1 billion.
In the HPV field, Digene is the market leader. Roche and smaller rival Third Wave Technologies are also tapping the lucrative and fast-growing market.
Digene shares were up 0.8 percent at 1240 GMT, compared with a 0.2 percent rise in pan-European DJ Stoxx drug index.
Sackers said the company was still in talks about payments from health authorities in Europe for its HPV test kits, which have proven to be more accurate than the traditional Pap smear test. Only private health insurers have been willing to pay for its HPV test kits in Europe.
"I believe there will be a breakthrough," he said.
Qiagen also dominates the genetic test kit industry. They are used to isolate nucleic acid -- building blocks of living organisms like DNA or RNA -- in biological samples for analysis.
Sackers added that he remained comfortable with the company's earnings guidance for this year.
The company expected revenue of $875-$905 million, a rise of up to 40 percent from 2007, and adjusted earnings per share of 76-80 cents.
"We are on track," Sackers said, adding the company is also looking to expand in Brazil, Mexico and India.
Asked whether the company could be a takeover target, Sackers said Qiagen could grow faster by staying independent than by being part of a bigger group.
"We are certainly growing by far the fastest and we are addressing one of the most attractive markets in the life science area," he said. "The speed at which we are growing could not be faster if Qiagen were part of a bigger organisation."
Qiagen, with a market value of around $4 billion, has not been the subject of any takeover speculation.
Morgan Stanley analysts said in a recent report that major drugmakers needed to reallocate capital into sustainable business areas like vaccines, molecular diagnostics and animal health to deal with structural problems facing conventional drug discovery.
Earlier this month, Swiss drugmaker Novartis said it would acquire Nestle's stakes in eye care company Alcon for $39 billion.
HPV-related oral cancers rise among younger men
Baltimore, MD
Stephanie Desmon
Baltimore Sun (www.baltimoresun.com)
The sexually transmitted virus that causes cervical cancer in women has now been linked to an uptick of throat, tonsil and tongue cancers - in a younger and healthier group of patients than doctors have ever seen before.
These head and neck cancers were once the scourge of older men - mostly the result of lifetimes of heavy smoking and drinking. The treatments often left victims disfigured.
But with those cases on the decline, doctors are seeing a new group of victims. They're men in their 40s, and even 30s, whose cancer is brought on by the increasingly common human papillomavirus (HPV). It's an infection that more than half of Americans will encounter during their lifetimes. And researchers now believe that the increase in certain oral cancers can be traced to the spread of the virus through oral sex.
New studies suggest that HPV-related oral cancer cases are on pace to eventually surpass cases of cervical cancer in the United States, which strikes about 11,000 women each year. And many doctors do not realize that they should be on the lookout for oral cancer in younger patients.
"It just kind of rocks the whole paradigm," said Dr. Maura Gillison, a Johns Hopkins oncologist who is credited with making the link between HPV and oral cancers. "Everyone thinks of the long-term smoker, the long-term drinker. Now we're seeing the movers and shakers in the prime of life."
Gillison and others say they hope an HPV vaccine designed to protect girls and young women against cervical cancer will be approved for boys and tested for head and neck cancers, which are more likely to affect men than women.
Researchers say changing sexual behavior probably accounts for the explosion of HPV-related oral cancers. In a study published last year in The New England Journal of Medicine, Gillison and colleagues found the strongest link in patients with larger numbers of lifetime sex partners.
The sexual revolution of the 1960s made it more acceptable to have more sex partners, she and others said. And, if the AIDS scare of the 1980s persuaded many to have safer sex, the caution didn't always extend to oral sex. The bottom line: more HPV-related oral cancers.
A reluctance to discuss oral sex may be why the public knows so little about the link between HPV and head and neck cancers.
There is plenty of open talk about preventing cervical cancer nowadays, including commercials that tout the blockbuster HPV vaccine with girls chanting about becoming "One Less." But there's still more of a taboo when it comes to talking about oral sex.
"The public is unaware of this," said Dr. Erich Sturgis, a head and neck surgeon at The University of Texas M.D. Anderson Cancer Center who has studied HPV. "It's just starting to filter out."
It doesn't even occur to some primary-care doctors that their patients younger than 60 might have developed oral cancer, but researchers say a lingering sore throat or a lump in the neck could be symptoms of the disease and should be checked out.
These cancers remain relatively rare, despite a 5 percent increase in cases each year since 2000. Estimates put cases of HPV-associated head and neck cancers at 6,000 per year - and cervical cancer cases at fewer than 11,000.
Debbie Roffman, a human sexuality educator at Park School and author of Sex and Sensibility: The Thinking Parent's Guide to Talking About Sex, discusses risky behaviors with her students, some of whom are in middle school. But sometimes it's hard to get the message through, especially when students are sure those behaviors won't hurt them.
"They're not going to be as focused on invisible things like germs and long-developing things like cancer that are way off in the future," she said.
Gillison said everyone involved - from pre-teens to primary-care doctors - must change their perception of who is at risk. Doctors taking medical histories typically ask about smoking- and alcohol-related behaviors, but she said they should ask about sexual history, too.
"Now most of us are at risk, because humans are sexual beings," she said.
The rise of HPV-related head and neck cancers is not just a U.S. phenomenon. Swedish researchers who re-examined samples from the 1970s have found that 28 percent of oral tumors were HPV-positive. In tumors from 2000 to 2002, HPV-positive samples jumped to 68 percent.
In a study by Gillison and others last year, 72 percent of certain oral cancers were HPV-positive.
HPV is typically spread through sexual contact. While many women will have HPV at some point in their lives, they frequently have no symptoms and the virus usually goes away on its own. Sometimes, HPV lingers and becomes cancer - a process that can take decades.
Doctors are familiar with this progression because pre-cancerous lesions are often caught during Pap tests. But they don't know much about how progression occurs in the throat and mouth.
Gillison and her colleagues say HPV-related oral cancers appear to be distinct from those not associated with the sexually transmitted infection and appear to respond differently to treatment.
Two years after diagnosis, 95 percent of those with HPV-positive head and neck cancers were alive compared with 62 percent with HPV-negative cancers, research shows.
Even so, the treatment can have serious and long-lasting side effects. Some patients end up disfigured; others have difficulty speaking or swallowing. Gillison said those with HPV-positive tumors might be able to survive with less-damaging treatments.
Meanwhile, the HPV vaccine has been a financial boon for Merck & Co., the maker of Gardasil, the three-dose vaccine approved in the United States in 2006 for females ages 9 through 26. Doctors recommend vaccinating girls before they become sexually active and can be exposed to the virus.
Merck sold $1.5 billion worth of Gardasil last year around the world. GlaxoSmithKline is seeking U.S. approval for a competing drug called Cervarix.
Neither vaccine is approved for males. Both companies are studying whether it is safe in boys and whether it would prevent genital warts and rare cancers of the penis and anus. But neither has plans to study whether the vaccine would play any role in the prevention of HPV-linked oral cancers.
"Cervical cancer is really the focus," said Liad Diamond, a GlaxoSmithKline spokeswoman.
Experts said they think researchers will find the vaccine works on HPV throughout the body.
"The way the vaccine works, there's no reason to think it wouldn't protect against oropharanyx [tonsil, tongue and throat] cancer as it does cervical cancer," Sturgis said.
Dr. Aimee Kreimer, an epidemiologist at the National Cancer Institute in Bethesda, said that, theoretically, the vaccine should work on HPV anywhere in the body but such discussion is premature.
"Before recommending the vaccine to men, it's crucial to determine if the vaccination works to prevent infection in men," she said.
Nuvelo Announces Preclinical Data for NU206 Demonstrating Potent Therapeutic Activity in Oral Mucositis Models
San Carlos, CA
press release
TheEarthTimes (www.earthtimes.org)
Nuvelo, Inc. today announced preclinical data demonstrating the mechanism of action and the potent therapeutic activity of NU206 (R-spondin1) in chemotherapy or radiation-induced oral mucositis models. The data were presented in a poster session yesterday at the 2008 American Association for Cancer Research (AACR) Annual Meeting in San Diego, CA.
The study, conducted in mouse models of oral mucositis, showed that NU206 regenerated basal layer epithelial cells and accelerated cell repair by stimulating the Wnt pathway, a signaling pathway that is critical for cell growth and differentiation during homeostasis and pathogenesis.
"This study reinforces our belief that NU206 is a potent regenerative agent," said Dr. Ted W. Love, chairman and chief executive officer of Nuvelo. "We are on track to begin a Phase 1 trial with NU206 in the second quarter of this year, and are also assessing the therapeutic potential of other secreted proteins in the R-spondin family through our Wnt therapeutics program, which targets a range of indications where cell regeneration and differentiation are important to disease processes, including gastrointestinal disease, bone disorders, wound healing and cancer."
About NU206 and R-Spondin secreted proteins
NU206 (R-spondin1) is a recombinant, secreted protein that acts as a highly specific regulator of the gastrointestinal epithelial cell function as demonstrated in early animal studies. Preclinical studies suggest it can promote growth and repair in animal models of radiation or cancer chemotherapy induced gastrointestinal injury, as well as in animal models of inflammatory bowel disease.
The R-spondin (Rspo) family of secreted proteins are the first biologic agents that can be used to enhance endogenous Wnt signaling in vivo, and provide therapeutic potential in diseases that are dependent on the Wnt pathway for maintenance of tissue integrity and tissue repair. Rspo proteins are novel regulators of the Wnt pathway and were first identified by Nuvelo as potent gastrointestinal mitogens in transgenic mice(1).
About Nuvelo
Nuvelo, Inc. is dedicated to improving the lives of patients through the discovery, development and commercialization of novel drugs for acute cardiovascular disease, cancer and other debilitating medical conditions. Nuvelo's development pipeline includes NU172, a direct thrombin inhibitor in Phase 1 development for use as a potential short-acting anticoagulant during medical or surgical procedures; and preclinical candidate NU206, a Wnt pathway modulator for the potential treatment of chemotherapy/radiation therapy-induced mucositis and inflammatory bowel disease. In addition, Nuvelo is pursuing research programs in leukemia and lymphoma therapeutic antibodies and Wnt signaling pathway therapeutics to further expand its pipeline and create additional partnering and licensing opportunities.
Note:
(1) Kim et al. (2005) Mitogenic influence of human R-spondin1 on the
intestinal epithelium. Science 309.
Providing early evidence of oral cancer
Buffalo, NY
Louis Baker
UB Reporter (www.buffalo.edu)
Epithelial cells of the mouth collected by a simple “swish and spit” method can be used to detect potential early evidence of oral cancer, a preliminary study conducted by researchers at UB and Roswell Park Cancer Institute has shown.
Results of the study were presented Friday at a poster session at the 2008 American Academy of Dental Research in Dallas.
More than 34,000 Americans will be diagnosed with oral or pharyngeal cancer in 2008 and only half of those will be alive in five years, according to the Oral Cancer Foundation. It is the sixth most common cancer worldwide, making early detection imperative.
The cancer marker studied is a fibrous protein molecule known as cytokeratin 8 (CK8). “This cytokeratin has emerged recently as a potential cellular marker of premalignant changes in oral epithelial cells and of increased risk of cancer development,” said Jennifer Frustino, a predoctoral student in the UB School of Dental Medicine and first author on the study.
“These markers are especially useful because they are abundant, stable and easily stained and detected,” she said. “Cytokeratin 8 expression is closely related to abnormalities of epithelial cells and shows a positive correlation with the development of head and neck squamous cell carcinoma.” Epithelial cells line all internal and external body surfaces.
Saliva samples were collected from eight subjects with oral cancer or a history of abnormal oral lesions and five healthy controls. Participants brushed and rinsed with saline before providing the saliva sample containing cheek cells.
Results showed that the percentage of cells with cytokeratin 8 was significantly higher in the cancer/abnormal samples than in samples from the normal controls.
“Early detection is critically important in diagnosing and managing oral cancer,” said Frustino, “and CK8 manifests as an early biomarker in malignancy. This marker may someday provide a focused target for early detection through a simple test done routinely in a dental office.
“This is the first study that detects CK8 as a biomarker through an easy collection method and simple analysis. The study is continuing and the results remain promising as more patients are enrolled.”
Note:
Contributors to the study from Roswell Park were Richard Cheney, Renee Sammarco, Mary Reid and Maureen Sullivan.
Lynn Solomon from Tufts University also contributed to the study.
Large Analysis Shows Quadrivalent Human Papillomavirus Vaccine Is Safe
Atlanta, GA
Désirée Lie, MD, MSEd
Medscape Today (www.medscape.com)
Quadrivalent human papillomavirus (HPV) vaccine (Gardasil; Merck & Co, Inc; Cervarix; GlaxoSmithKline) seems to be safe in a review of data involving more than 30,000 prelicensure and 12.4 million postlicensure doses of the vaccine, although vasovagal syncope may be a newly identified adverse event.
Senior author John Iskander, MD, MPH, acting director of the Immunization Safety Office, Centers for Disease Control and Prevention in Atlanta, Georgia, and colleagues reported these findings here at the International Conference on Emerging Infectious Diseases 2008.
The quadrivalent HPV vaccine, manufactured by Merck, was the first to be approved in the United States. The vaccine is active against HPV types 6, 11, 16, and 18 and is indicated in girls and women aged 9 to 26 years.
The researchers reviewed safety data of the vaccine from clinical trials and the US Vaccine Adverse Event Reporting System (VAERS).
In 7 clinical trials involving approximately 21,500 patients, injection site reactions were reported more frequently with vaccine vs placebo (82.9% vs 73.3%), although comparable rates of serious adverse events and deaths were noted. No deaths among prelicensure vaccine recipients were judged to be caused by the vaccine.
Congenital anomalies were also similar among pregnant women who received either the placebo or vaccine. Among patients vaccinated within 30 days of conception, 5 abnormalities in the vaccine group and none in the placebo group were noted, "but no pattern existed," the authors write in their abstract.
In the VAERS analysis, which included adverse events reported after licensure, approximately 2500 reports were made from June 2006 to July 2007 after an estimated 12.4 million doses of the vaccine had been distributed in the United States. Of those reports, 149 involved serious adverse events for a rate of 1.9 per 100,000 doses.
Vasovagal syncope was reported in 300 individuals involved in reports to VAERS. According to the researchers, this was a "newly identified" adverse event with the vaccine. Guillain-Barré syndrome was confirmed in 5 vaccinees. Among 3 confirmed deaths, none seemed to be vaccine related.
A pregnancy registry in the United States has been established to monitor pregnancy outcomes in women who have received the vaccine as well as a required phase 4 study. In addition, the Vaccine Safety Datalink is conducting an active surveillance study in a US managed care population. A long-term follow-up study in the Nordic countries, using their vaccination registries, is also underway.
"Our review provides reassuring evidence about the safety of [this vaccine]," Dr. Iskander told Medscape Infectious Diseases. "Most postlicensure safety reports have involved expected nonserious events, such as injection site pain," he added.
Regarding reports of Guillain-Barré syndrome, Dr. Iskander said that there is no evidence that the vaccine causes this adverse effect. "Among the small number of confirmed cases, most vaccinees also received meningococcal conjugate vaccine, which might rarely be associated with Guillain-Barré syndrome," he said. "There is also a baseline occurrence of [this disorder] among adolescents of about 1 to 2 per 100,000 persons per year."
He also pointed out that syncope often occurs with vaccinations. "Among young adults up to age 25, nearly half have experienced a syncopal episode, so there appears to be a high baseline risk for syncope among the target age groups for this vaccine," he said.
Dr. Iskander pointed out that both the Advisory Committee on Immunization Practices and the American Academy of Pediatrics Red Book Committee suggest a 15-minute waiting period after vaccination to prevent injuries that might occur from postvaccination syncope. "Clinicians should also report clinically significant adverse events that occur after immunization to VAERS at http://www.vaers.hhs.gov."
Margaret Stanley, MD, PhD, OBE, from University of Cambridge in Cambridge, United Kingdom, whose laboratory studies HPV, noted that the 2 HPV vaccines are very efficacious, achieving greater than 95% efficacy against precancerous HPV 16/18–related cervical disease. "No vaccine-related serious adverse events have been observed in the large phase 3 trials, and there is no evidence to date to suggest that there is a difference in the safety profiles of the 2 vaccines," she said.
Note:
The study was funded by the US government. The authors have disclosed no relevant financial relationships. Dr. Stanley is a paid consultant for Merck Research Laboratories, GlaxoSmithKline Biologicals, and Sanofi Pasteur MSD.
Source:
International Conference on Emerging Infectious Diseases 2008: Board 150. Presented March 18, 2008.
Luteolin Induces Apoptosis in Oral Squamous Cancer Cells
web-based article
S.-F. Yang et al.
J Dent Res 87(4):401-406, 2008
Oral squamous cell carcinoma is the most common malignancy of the oral cavity, and treatment approaches are inadequate. Luteolin, a natural flavonoid compound, has been shown to have anti-tumorigenic properties on various types of tumors. Therefore, we hypothesized that luteolin has anti-tumorigenic properties for oral squamous cell carcinoma, and may provide effective chemotherapy.
Results revealed that luteolin reduced the viability of SCC-4 cells and induced apoptosis by decreasing the expression of cyclin-dependent kinase (CDKs), cyclins, and phosphor- retinoblastoma (p-Rb) anti-apoptotic protein, but increased the expression of pro-apoptotic proteins and activated caspase 9 and 3, with a concomitant increase in the levels of cleaved poly-ADP-ribose polymerase (PARP). Combination treatment of luteolin with paclitaxel enhanced the cytotoxic effect of paclitaxel in SCC-4 cells, and continuous administration of luteolin suppressed the growth of xenograft tumors in nude mice. These results suggest that luteolin could be an effective chemotherapeutic agent for the treatment of oral squamous cell carcinoma.
Authors:
S.-F. Yang1, W.-E. Yang2, H.-R. Chang3, S.-C. Chu4, and Y.-S. Hsieh2
Authors' affiliations:
1 Institute of Medicine,
2 Institute of Biochemistry and Biotechnology, Chung Shan Medical University, Taichung 402, Taiwan;
3 Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan; and
4 Department of Food Science, Central Taiwan University of Science and Technology, Taichung 406, Taiwan
Zila in danger of stock delisting by Nasdaq
Phoenix, AZ
Angela Gonzales
Phoenix Business Journals (www.bizjournals.com/phoenix)
Zila Inc. is in danger of being delisted from The Nasdaq Stock Market.
Zila announced Wednesday it received a letter from Nasdaq warning it has failed to comply with the minimum bid price requirement for continued listing on the exchange. For the last 30 consecutive business days, the bid price of its common stock closed below $1 a share. Zila has 180 days, or until Sept. 16, to regain compliance.
The company's stock is trading around 23 cents a share, barely hovering over its 52-week low of 21 cents a share, and far from the 52-week high of $2.19 a share.
Zila reported a net loss of $9.6 million for the six months ended Jan. 31, on revenue of $21.9 million. That compares with a net loss of $6.4 million on revenue of $7.5 million during the same period a year earlier.
The company's only main product is ViziLite, being marketed to dentists as an oral cancer detection tool. Earlier this year, Zila pulled its clinical trials of another oral cancer tool called OraTest. In October 2006, the company sold its nutraceuticals business unit for $37.5 million to NBTY Inc., and in May 2007 sold its Peridex brand of prescription periodontal rinse for $9.5 million.
Focusing on its ViziLite suite of products, Zila recently was authorized to sell in Canada and plans to expand into the United Kingdom in May, according to its 10-Q filed March 11 with the U.S. Securities and Exchange Commission.
As of Jan. 31, Zila had $5.9 million in cash and cash equivalents, as well as $8.3 million of working capital.
Company officials warned in the 10-Q they may be "required to seek additional funds and/or restructure our senior convertible debt." If they can't raise more funds, Zila officials said they may have to lay off employees or scale back marketing efforts.
Smokeless tobacco associated with stomach cancer
web-based article
staff
TamilStar.com
The results of a study in the International Journal of Cancer confirm an association between smoking and cancers of the stomach and esophagus, and suggest that moist snuff, a popula