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|Year : 2020 | Volume
| Issue : 4 | Page : 507-509
News from the world of oncology
|Date of Submission||26-Sep-2020|
|Date of Decision||26-Sep-2020|
|Date of Acceptance||06-Oct-2020|
|Date of Web Publication||18-Oct-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. News from the world of oncology. Indian J Cancer 2020;57:507-9
| » COVID-19 Trials Versus Cancer Trials|| |
Coronavirus disease 2019 (COVID-19) has shaken the entire world in various aspects and oncology research is no exception. Minimal hospital visits and patient exposures are the new normal in the COVID era. Conventional clinical research practices require multiple patient visits to the hospitals for counseling, evaluation, examination, trial intervention, follow-ups, and many other trial formalities. The difficulties posed by COVID in continuing such practice include the need for social distancing, higher risk of infection and complications to immunocompromised comorbid patients, travel restrictions, compromised funding and availability of health care professionals, laboratory equipment, and infrastructure.
Considering these limitations, the unpredictable course of the pandemic trail, and changing methodologies or work-culture in every field, the oncology research community needs to reshape their mindsets, clinical practice, and trial protocols. This was highlighted in a recent article published in JAMA Oncology “The Day After COVID-19—Time to Rethink Oncology Clinical Research” on 3 September 2020 (Araujo et al. doi: 10.1001/jamaoncol. 2020.4240), where various practical solutions to hasten the dwindling research in COVID scenario have been suggested. The newly planned trials should adopt cost-efficient designs while focusing on only interventions with maximum potential for clinically relevant outcomes. The research on redundant drugs or combinations with minimal or borderline utility should be low in priority. Studies using cost, time, and resource and patient-visits consuming methods must be discouraged. Traditional practices like wet-ink signatures, repeated physical examinations, hospital-based blood sampling, treatment administration, and mandatory frequent patient visits should be vigilantly explored to be replaced by digital signatures, virtual platform examinations, home, or peripheral clinic-based sampling and treatment administration, telemedicine visits, etc. This will not only enhance the speed of work and reduce the cost but also enhance the geographical scope of studies and access of overseas patients to trials and newer drugs. Further stability of this decentralization process may be achieved by strengthening and equipping the peripheral services with tissue-based sampling, higher pathology expertise, and imaging infrastructure, reducing the need for long travels and crowding of tertiary care centers.
Dr. Purvish Parikh, (Medical Oncologist, Asian Cancer Institute, Mumbai, India) told this correspondent, “We actually did a survey that showed the impact on patient enrollment, travel and adherence to project timelines. However, many investigators had used technology innovatively to help patients remotely. Whether the COVID-19 pandemic is short-lived or not, it will leave a lasting effect on medical progress. Some ideas will never see the light of day. Data collected may not be robust to meet primary objective analysis. New innovative solutions and technology will emerge. Trial rules may also be rewritten, with some redundant ones finally eliminated”.
HS Darling, Bangalore
ORCID ID: https://orcid.org/0000-0001-7557-0292
| » Role of E-Cigarettes in Quitting the Smoking Habit|| |
Among the vast array of options provided to smokers to aid their attempts to quit smoking tobacco, recommended by the Food and Drug Administration (FDA) include nicotine patches, nicotine containing chewing gum, and anti-craving medications for tobacco products. However, the FDA has not yet approved e-cigarettes as a smoking cessation measure, although there is a potential role of e-cigarettes in quitting the tobacco habit. A randomized control trial in the United Kingdom showed an increased efficacy of e-cigarettes in tobacco cessation compared to the other tobacco cessation methods like nicotine replacement therapy.
JP Pierce et al. from the San Diego School of Medicine (University of California, USA) have evaluated the role of e-cigarettes and other methods in kicking the habit of cigarette and tobacco use. A cohort of about 2770 daily cigarette smokers was identified by the Population Assessment of Tobacco and Health study who had attempted to quit smoking within the first follow-up years, that is, 2014–2015 (Wave-2) and 2443 individuals who quit tobacco for more than 1 year in 2015–2016 (Wave-3). The findings from this study were recently published in PLOS One (Sep 2, 2020;15:9—e0237938).
The cohort was followed up annually to evaluate the abstinence rates from cigarettes, and other forms of tobacco among the individuals using one or more of the FDA approved methods of tobacco cessation. The study analysis, unlike other studies, had included only individuals who attempted quitting as recommended by the National Academies of Sciences, Engineering, and Medicine. The study had excluded individuals who were non-users of replacement therapy and the individuals who relapsed between the last follow-up and last quit attempt. The individuals who used e-cigarettes vis-a-vis individuals who used any or no product to quit smoking were compared using propensity score matching for the confounders in each group.
The rates of abstinence from smoking and other tobacco products using e-cigarettes were similar to other approved tobacco cessation aids for those followed up for 12 months or among those who quit tobacco for 30 days or more. The rates ranged to about 10% across all methods of tobacco cessation. There were no differences in the smoking rates, whether they used e-cigarettes or used any other or no product to quit smoking. However, the individuals who used e-cigarettes to quit, continued to use the e-cigarettes even after a year of quitting smoking, thus making e-cigarettes less helpful in aiding adults in quitting smoking.
Ankeeta Menona Jacob, Mangalore
ORCID ID: https://orcid.org/0000-0002-9839-3556
| » Using Tattoo Ink to Find Cancer|| |
That cancer, if detected early, can have better outcomes is common knowledge but few know that a common body art form where a design is made with ink, dye, or pigment into the dermis of the skin, could actually help achieve that. Researchers in the USC Viterbi's Department of Biomedical Engineering have used and shown, how commonly used coloring agents such as tattoo inks could help cancer detection of several kinds and be the gamechanger in our quest for developing methods for early detection. The study led by Cristina Zavaleta and her team attached these colorants to nanoparticles, preferentially taken up by cancer cells, thereby allowing medical professionals to differentiate between cancer and normal adjacent cells. This study was based on the tested observation that many of these FDA-approved dyes have interesting optical properties that could be exploited for imaging. This work has been published in Biomaterials Science 2020, Advance Article https://doi.org/10.1039/D0BM01099E.
Currently, only three dyes with fluorescent properties—methylene blue, indocyanine green, and fluorescein—are approved for human use by the USFDA and are used as optical imaging contrast agents. In this study, the researchers evaluated the optical properties of at least 30 approved food, drug, and cosmetic coloring dyes and tattoo ink pigments using a spectrophotometer measuring the intensity of light after it passes through a sample solution. Seven of the colorants displayed fluorescence properties that were comparable to or exceeded the three FDA-approved clinical dyes. The researchers also measured the Raman signatures to see how high the colors' unique signatures of light photon peaks were, with high peaks being indicative of usefulness in terms of multiplexing. Finally, they tested the best-performing dyes and pigments by injecting them as imaging agents in mice with cancerous tumors.
The study relied heavily on two optical properties of the inks, fluorescence and Raman properties. Fluorescence relates to a dye or pigment's capacity for absorption and emission of light, while Raman property indicates how light scatters; both these properties are utilized in imaging techniques in the cancer field. Highly fluorescent agents offer sensitivity in imaging i.e., very small amounts are needed for them to illuminate areas very brightly. Raman imaging, on the other hand, offers specificity by allowing multiplexing, or the ability to look at several processes happening inside the human body at once. These can help show whether cells or tissues are expressing multiple genes, or expressing a gene-product more in a particular cancer, such as human epidermal growth factor receptor 2 in breast cancer or a functional indicator such as estimated glomerular filtration rate raised in lung cancer. Each of the targets has different receptors that will be illuminated by different agents rendering more specificity.
A tattoo with unique spectral fingerprint carried by each color
Commenting on the impact of this study, Dr.PL Jyotsna, (Associate Professor of Pathology, Lady Hardinge Medical College and associated hospital, New Delhi, India) stated “Benign or malignant, diagnostic biopsies could be directed more accurately and this would also guide in appropriate surgical management without even the need for frozen sections. This is like bringing highly sensitive imaging to the microscopic level, a sort of a tissue diagnosis with colourful dyes in vivo.”
One of the safety challenges of imaging using nanoparticles is their prolonged retention in organs like the liver and the spleen, which normally break down the nanoparticle. Because of this major limitation, there are very few optical contrast agents approved for clinical use. Hence, it is crucial to consider biodegradable nanomaterials like liposomal nanoparticles, and materials with fatty skins similar to human body cells, that are already used in other targeted drug and nutrient delivery.
As per Dr. Satyavrat Verma (Consultant Nuclear Medicine at Dr. Ram Manohar Lohia Institute of Medical Sciences, Lucknow, India) “They will be more sensitive in some tumors and can be used with CT and MRI fusion for anatomic delineation in future. As with MRI contrast agents, these dyes will be able to detect tumors with leaky capillaries. Since they will be easier to visualize than normal MRI contrast, it will provide more confidence in detecting tumors. Tumor localization will be more precise and will help in equivocal cases.”
ORCID ID: https://orcid.org/0000-0001-8670-3556
| » Do Hair Dyes Increase the Risk of Cancer?|| |
A study published on September 2, 2020, in the BMJ, titled “Personal use of permanent hair dyes and cancer risk and mortality in US women: prospective cohort study. BMJ 2020;370:m2942” reports the relationship between hair dyes and risk of cancer. The study was led by E S Schernhammer and studied the age at first use, time since first use, duration, frequency, and integral use (cumulative dose calculated from duration and frequency) of permanent hair dyes.
In Europe and the United States of America, more than 10% of men and 50–80% of women over 40 years use hair dye. While the International Agency for Research on Cancer has classified occupational exposure to hair dyes as a probable carcinogen (group 2A) and the carcinogenicity resulting from personal use of hair dyes as not classifiable (group 3), the public has always been concerned about the carcinogenic potential of these dyes. A total of 1,17,200 women were enrolled in this study and were followed for 36 years. The questionnaires were sent to participants every 2–4 years and a response rate of greater than 90% was achieved for most follow-up cycles.
The main types of dyes that are used are oxidative (permanent) dye, direct (semi-permanent or temporary) dye, and natural dyes, of which permanent hair dye forms approximately 80% of the share of all dye users in the USA and Europe. Their proportion is even higher in Asia and hence this dye was supposed to pose the greatest risk of cancer. These permanent dyes consist of intermediates (para-substituted aromatic amines) and couplers (meta-substituted aromatic amines and other compounds). Chemical reactions in the presence of oxidants lead to the formation of pigments. The main route of entry of these dyes is via skin and airborne routes.
In this study, no positive association was found between the use of dyes and most solid cancers and hematopoietic cancers. The only cancers where the positive association was noted were increased risk of basal cell carcinoma, breast cancer, ovarian cancer, and Hodgkin lymphoma. The risk of basal cell carcinoma was higher in women with naturally light hair color while that of Hodgkin lymphoma was higher in women with naturally dark hair. The study could not attribute any significant increase of cancer in patients using hair dyes. One major drawback of this study was that it studied only women, hence, the association of hair dye use and cancer in men cannot be predicted by this study and would need separate evaluation.
Neha Chauhan, Bangalore
ORCID ID: https://orcid.org/0000-0003-4705-1959