Between relative newcomers like immunotherapy and robotic surgery along with the more traditional radiation, chemotherapy etc, it could be tempting to think cancer is on the run. It’s true the battle has heated up, but it will go on for a while yet and collateral damage is often extensive. However, as the stories below indicate, progress is being made.
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Novel approach Reduces Treatment Toxicities in Patients With HPV-Related Oropharyngeal Cancer
(U.S.) The incidence of mouth and throat cancer is on the rise due to transmission of the human papilloma virus (HPV), but physicians at Memorial Sloan Kettering (MSK) Cancer Center (original building pictured above) have managed to significantly reduce the intensity of treatment and improve quality of life for these patients.
The most common treatment modalities for oropharyngeal cancer (OPC) include concurrent chemoradiation therapy, robotic surgery with postoperative radiation or chemoradiation, and induction chemotherapy followed by chemoradiation therapy — a combination known as trimodality (using three modes of treatment) therapy. Trimodality therapy can leave patients with debilitating side effects, including long-term issues with speech and swallowing.
At MSK, fewer than 8% of oropharyngeal cancers are treated with trimodality therapy compared with the North American average of 41%.2
This massive decrease is due to a number of factors, but has occurred primarily because MSK employs a multidisciplinary approach to treatment planning as well as careful upfront patient selection for robotic surgery or nonsurgical treatment. Importantly, although HPV-related OPC is a “rapidly emerging disease,” HPV-positive status is associated with a more favorable prognosis compared with HPV-negative disease.
HPV-positive OPC shares histologic features with HPV-negative OPC, but there are fundamental biological differences. For example, HPV-positive OPC exhibits activated mutations of PIK3CA, a loss of TRAF3, and amplification of E2F1. 7 This has important implications for targeted therapy.
In 2014, MSK’s Head and Neck Service began convening surgery, radiation oncology, and medical oncology specialists for a weekly disease management team (DMT) review of every patient case involving a diagnosis of squamous cell carcinoma of the oropharynx. Pathology and radiology results are assessed prior to case review by a multidisciplinary tumor board, and an individualized treatment plan is designed for each patient by team consensus.
Robotic surgery now allows for tumors from the back of the throat to be surgically removed in a minimally invasive fashion with optimal visualization through the open-mouth transoral robotic surgery (TORS) system. At MSK, a formal radiology review is performed to identify factors that lead to postoperative chemoradiation, including extra capsular spread and being at high risk for positive margins.
Only specifically selected patients who meet these criteria are offered TORS.
Vaccine making medical history in Southampton
A POTENTIALLY life-saving cancer vaccine is being trialled for the first time in Southampton.
Michael Knowlton made medical history as the first person in the world to test a vaccine for his head and neck cancer, HPV 16, as part of an immunotherapy clinical trial by the University of Southampton.
It was an irritating cough which first prompted the 63-year-old, a company director, to visit his doctor in 2014, and tests later confirmed it was cancer. What followed was a procedure to remove the tumour from the back of his tongue which left him in intensive care.
At the end of gruelling rounds of chemo and radiotherapy he was told should the cancer return, his options for further treatment were limited.
It was then that Michael was referred to the clinical trial by the University of Southampton.
Michael took part in the first phase of the trial which recruited disease-free patients to see how they reacted to the vaccine in terms of side effects and to establish dose levels.
The trial was funded by Cancer Research UK. The vaccine ‘kick-starts’ the immune system to recognise the HPV16 cancer and destroy it before it has a chance to develop.
University of Southampton research sister Cristiana Goncalves said: “People like Michael are really special, these patients are all volunteers and Michael is currently disease-free. He doesn’t need to do this, it is purely for research which makes them even more special.”