Posts Tagged ‘baltimore’

Blood and saliva tests help predict return of HPV-linked oral cancers

“There is a window of opportunity in the year after initial therapy to take an aggressive approach to spotting recurrences and intensively addressing them while they are still highly treatable,” says Joseph Califano, M.D., professor of Otolaryngology — Head and Neck Surgery, member of the Johns Hopkins Kimmel Cancer Center, and medical director of the Milton J. Dance Jr. Head and Neck Center at the Greater Baltimore Medical Center. “Until now, there has been no reliable biological way to identify which patients are at higher risk for recurrence, so these tests should greatly help do so,” he adds.

Patients with HPV-associated oropharyngeal cancers are generally examined every one to three months in the first year after diagnosis. Recurrences are often found when patients report ulcers, pain or lumps in the neck. But imaging tests are unreliable in detecting cancer recurrence earlier, and the location of oropharyngeal cancers — in the tonsils, throat and base of the tongue — make it difficult for physicians to spot budding lesions.

Califano says survival rates for patients with early-stage, HPV-related oral cancers are as high as 90 percent within the first two years, and a study reported by Johns Hopkins experts in February showed that, even after recurrence, more than 50 percent of patients survive two years after their recurrence. The new blood and saliva tests have the potential to improve these rates, he adds.

For the study, the Johns Hopkins team analyzed blood and saliva samples from 93 oropharyngeal cancer patients who were treated with surgery, radiation alone, or combined chemotherapy and radiation at The Johns Hopkins Hospital or Greater Baltimore Medical Center. Samples were collected before and after treatment. Some 81 patients had HPV-positive tumors. The researchers selected patients with a variety of early-to-advanced stage cancers; none of the patients had distant metastasis.

The blood and saliva tests were performed using polymerase chain reaction, which amplifies certain portions of DNA and measures its amount.

The scientists found that HPV DNA detected in patients’ saliva after treatment was predictive for recurrence nearly 20 percent of the time in a subset of the patients. When the scientists looked for HPV DNA in the blood of another subset of patients, the accuracy of a recurrence prediction rose to more than 55 percent. In a third subset of patients, finding HPV DNA in both blood and saliva samples after treatment accurately predicted recurrence 70 percent of the time.

Despite the encouraging results, Califano says, further refinements are still badly needed to improve detection of possible recurrences because HPV is highly prevalent in our bodies, and “we can’t be sure our test results are cancer-specific and not due to other forms of HPV infection or exposure.”

His team is looking for other genomic biomarkers that would increase the specificity of HPV DNA testing in blood and saliva. Califano also cautioned that the current study was too small to link test results to the severity of recurrence.

Rates of HPV-related oropharyngeal cancer are on the rise in the United States, outpacing oropharyngeal cancers due to tobacco and alcohol use, according to Califano. Some 70 percent of nearly 30,000 oropharyngeal cancers diagnosed in the U.S. are caused by HPV.

Other Johns Hopkins scientists contributing to the research include Sun M. Ahn, M.D.; Jason Y. K. Chan, M.B.B.S., Zhe Zhang, M.S., Hao Wang, Ph.D., Zubair Khan, M.D., Justin A. Bishop, M.D., William Westra, M.D., and Wayne M. Koch, M.D.

Funding was provided by the National Institutes of Health’s National Cancer Institute/National Institute of Dental and Craniofacial Research (P50 CA19032).

source : http://www.sciencedaily.com/releases/2014/07/140731200954.htm

New program makes prostate cancer treatment decisions easier

A recent clinical study published in the New England Journal of Medicine showed that mortality rates for early stage prostate cancer were the same for men who choose active surveillance such as periodic PSA testing and biopsy, versus those who chose to treat their disease immediately with radiation or surgery. The research suggested that in cases of low-risk prostate cancer, aggressive treatment may not offer a long term survival benefit, and yet is associated with a number of side effects such as urinary incontinence and sexual problems. However, the vast majority of men diagnosed with low-risk cancer undergo aggressive treatment rather than active surveillance.

To ensure that patients make their treatment decisions based on the most current medical evidence and their own values and preferences, a research team at Thomas Jefferson University led by Ronald E. Myers, Ph.D., developed an online program called the Decision Counseling Program (DCP) to help patients clarify their treatment preference and discuss their options with the clinical team. This online program is unique to Jefferson.

First, patients are shown a printed summary of answers to frequently asked questions by treatment type. Some of the questions include: "What treatment option is best for long term survival?" and "What are the side effects." With the help of a nurse, the patient then identifies the top 3 reasons the patient may or may not want to initiate active surveillance (pros and cons). The patient then ranks those reasons by importance. The nurse enters the reasons and rankings into the online program and generates a 1-page summary report that helps patients visualize their preference to active surveillance versus aggressive treatment. A copy of the report is given to the patient and the clinical team. The report is used as a point of discussion during the patient’s clinical visit with an urologist and radiologist.

The research team tested the program with 23 low-risk prostate cancer patients. After participating in the Decision Counseling Program and speaking with the clinical team, 83 percent of the patients decided on active surveillance, rather than aggressive treatment. In addition, says Dr. Myers, "patients were more knowledgeable, and reported feeling more informed, more supported and less conflicted in their decision after going through the program. They understood their options better, and felt like they were making a treatment decision that was right for them."

source : http://www.sciencedaily.com/releases/2013/10/131022101909.htm