Epstein-Barr Virus (EBV) is a common virus in the United States, however many people do not show symptoms throughout their lives. Although this virus does not directly cause cancer, infection with this common herpes virus increases risk of some cancers such as lymphomas. Furthermore, an increased risk of other types of cancer, including nasopharyngeal and stomach cancers, has been associated with EBV infections. A new drug was tested on mice which inhibited tumor development, thus it may be useful in treating malignancies in EBV-positive patients. In addition, in treated mice, the drug counteracted the cancer-promoting mechanisms by certain proteins. The drug has potential both as a single agent and in combination with other cancer therapies, such as immune system boosting therapies.
Researchers at Spain’s Universitat Politecnica de Valenicia studied the effects of lycopene in the body. Lycopene is an antioxidant found in several fruits and tomatoes, hence it is also found in ketchup. Researchers found that lycopene is more potent in the sauce rather than the fruits because it has been cooked down thus facilitation absorption in the body. This is relevant because previous studies have shown that the consumption of tomatoes inhibit cell growth which can help to guard off gastric cancer. Furthermore, increasing levels of healthy bacteria in the gut can decrease the risk of gastric cancer. Another recommendation is to eliminate the use of cigarettes as it can double the risk of gastric cancer. Lastly, lowering the consumption of salt is recommended as it can have negative effects to diets.
The RAINBOW study pre-treated patients with the doublet of fluoropyrimidine plus a platinum, and later gave paclitaxel plus or minus ramucirumab. Survival rates for this study increased to more than 2 months. Another second line study, REGARD lead by Charlie Fuchs, consisted of best supportive care plus a placebo or best supportive care plus ramucirumab. Looking at both studies together we can say that ramucirumab plus paclitaxel is fit for patients in the second line treatment given as the mean survival of the RAINBOW study was around 9 months for the combination.
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.