Current research of esophagogastric cancer is heading toward building on the signals of activity seen for immunotherapy. Though phase I and phase II trials have given a mixed results, scientists are looking forward to the results of first line immunotherapy trials some of which involve the claudin protein in the body. This protein is overexpressed in most gastric cancers and it is a gap junction protein. Claudin protein combined with chemotherapy has shown great data for its phase II trials and will soon be undergoing phase III trials given improved overall survival of esophagogastric patients. We now know that VEGF-targeted drugs, HER-2 targeted agents, neoadjuvant chemotherapy and radiation added to surgery all improve outcomes in patients with esophagus and gastroesophageal cancers.
In a recent study, researchers found that MUC16 gene mutations in gastric cancer patients lead to higher mutational loads than patients who do not have these mutations. Furthermore, the researchers also found that MUC16 gene mutations affect the immune system and could in also be used to identify patients who could respond to immunotherapies. Of the samples tested in the study, MUC16 gene mutation samples show to have the highest mutation rates compared to those without MUC16. This phenomenon was attributed to tumor instability which is prevalent in gastric cancer. According to The Cancer Genome Atlas (TCGA) patients with MUC16 mutations survived a median 46.9 months, as compared to 26.7 months for those without. In addition, researchers reported MUC16 mutations appeared to influence expressions of other genes such as cell cycle checkpoints, DNA replication and repair, antiaging processing, and signaling pathways involved in the immune system. Lastly, MUC16 is known to modulate immune response to cancer thus patients with MUC16 mutations could benefit from treatments that boost the immune system.
The FDA recently granted an orphan drug designation to Alteogen Inc.’s ALT-P7 for the treatment of patients with gastric cancer. ALT-P7 is an antibody-drug that utilizes a trastuzumab variant form of antibody. This drug may accelerate the advancement of gastric cancer treatment in the United States. Currently in Korea, this drug is undergoing phase 1 clinical trial for the first time in humans. The phase 1 trial at the moment has an emphasis on the benefits of this drug for breast cancer. However, scientists believe ALT-P7 can be extremely helpful in the treatment of HER-2 overexpressing in gastric cancer.
Cancer treatments are typically prescribed for tumors specific to a region of the body. However, last May, the FDA approved the first cancer treatment that can be used for tumors located anywhere in the body, as long as it carries a specific type of genetic mutation: Keytruda (pembrolizab). It is an immune checkpoint inhibitor that can treat any solid tumor with a mismatch repair deficiency (the body cannot fix DNA damage to stop cancer growth). Another experimental drug that can cure tumors anywhere in the body is Larotrectinib. It inhibits tropomyosin receptor kinase (TRK) genes from activating cancer growth. TRK fusion mutations are found in only 1% of all cancers but are responsible for over 90% of some rare cancers. This approval is significant in that people with all types of cancer, not just those who have cancers common enough to have their own clinical trials, can try these new effective immunotherapies. Three out of four patients treated with Larotrectinib responded and over 90% of them were still doing well post-treatment.
Article Source: Highleyman, Liz. (2018). Treating Cancer Anywhere. Cancer Health, pp. 8.
Although green vegetables are great at preventing cancer, a new study published in the International Journal of Cancer states that in addition to cruciferous vegetables, orange vegetables also contribute to lowering risk of cancer. The reason behind this is not well understood yet, however, they are thought to have high micronutrients, antioxidants and fiber which can can prevent tumors in the genesis stage. Cruciferous vegetable such as cauliflower, cabbage and broccoli are known to be the best at lowering the risk of cancer. These types of vegetables have a high content of sulforaphane and are known to reduce the risk of breast cancer, prostate cancer and colorectal cancer. In addition to these, kale is also a great vegetable to prevent breast, lung, esophagus, bladder, mouth and other kinds of cancer. Moreover, tomatoes, peppers, white grapefruit and watermelons are rich in vitamin C which helps the immune system fight off cancerous cells and tomatoes also contain other carotenoids, such as lycopene, that help avoid cancer. Oranges, which are also rich in vitamin C, are very effective at preventing mouth, esophagus and stomach cancer by 50 percent. Finally, consuming carrots and beans can also be very beneficial in the fight against stomach cancer with carrots reducing the risk of this type of cancer by 26 percent and beans reducing the risk of colorectal tumors by 75 percent.
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Traditionally, preoperative chemotherapy without radiation is used following the standard Britsh regimen which combines epirubicin platinum and 5-FU (both drugs used for chemotherapy). However, recently the Germans developed the FLOT regimen which essentially is a modified FOLFOX with an addition of docetaxel. Following this development, they decided to compare their new regimen FLOT versus the old regimen ECF or ECX, with a primary focus on overall survival in over 700 patients with gastroesophageal junction and gastric cancers. The comparison was necessary to determine whether the new regimen could potentially replace the old as the standard regimen for preoperative chemotherapy without radiation. Moreover, the results from this comparison suggested that the overall survival of the participants was significantly improved from 18 to 30 months with FLOT. Ultimately in a patient who can tolerate 3-drug therapy, the FLOT regimen has become a new standard and for distal gastric patients, as Dr.David Ilson states, this should become the new standard of care as well given how successful it has been in the trials. Some adjustments must be made on the doses prescribed to each patient to avoid high levels of toxicity however, this should not compromise the efficacy of the regimen.
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John Hopkins Kimmel Cancer Center researchers developed a single blood test that can detect for eight common cancer types through assessment of the circulating proteins and mutations in cell-free DNA. The test, called CancerSEEK, is a unique noninvasive, multianalyte test that simultaneously evaluates levels of eight cancer proteins and the presence of cancer gene mutations from circulating DNA in the blood. The test was evaluated on 1,005 patients with nonmetastatic, stages I to III cancers of the ovary, liver, stomach, pancreas, esophagus, colorectum, lung or breast. For the five cancers that have no screening tests—ovarian, liver, stomach, pancreatic and esophageal cancers— the median overall sensitivity, or the ability to find cancer sensitivity ranged from 69 percent to 98 percent. The test had greater than 99 percent specificity for cancer.
The goal of this study was to test the effect of HIPEC (Hyperthermic Intraperitoneal Chemotherapy) on survival and postoperative outcomes after complete cytroreductive surgery compared with resection alone. At 3 years, HIPEC significantly improved overall survival with almost 26% of patients alive at 3 years compared with 13% of patients in the surgery alone group. The median overall survival was 18.8 months for patients treated with HIPEC compared to 12.1 months for surgery alone. Survival results at 5 years were consistent. About 20% of patients were still alive at 5 years, and 15% of patients were considered cured by HIPEC. In conclusion, cytoreductive surgery plus HIPEC improved overall survival compared with resection alone for patients with gastric cancer with peritoneal carcinomatosis.
Gastrointestinal toxicity is common during cancer therapy, and most treatment options are not helpful for the majority of patients. A recent study using a mixture of amino acids show decreases in mucositis and gastrointestinal toxicity following irradiation. This study was conducted in order to evaluate how the amino acid-based beverage benefited cancer patients receiving chemotherapy and/or radiation therapy. The use of the beverage was shown to reduce gastrointestinal toxicity in patients undergoing cancer treatment. There will be additional clinical studies to further effects of how this medical food to evaluate the benefits.
Medical marijuana can exist in a variety of formulations such as dried flowers, resins, extracts and oils. It’s legalization and use for medical purposes is still a developing issue and the perspectives of many health care providers is also following the same path. Medical marijuana can be used to ease chronic pain, chemotherapy-induced nausea and vomiting (CINV), sleeping disorders and certain anticancer agents. Overall, the evolution of medical marijuana is a conflict-ridden issue, but its efficacy has demonstrated as a possible method of treatment for a variety of conditions.