Clinic Targets Oral Cancer at Early Stages

From OncoLog, October 2007, Vol. 52, No. 10

Clinic Targets Oral Cancer at Early Stages

by Dianne C. Witter

The Oral Cancer Prevention Clinic at M. D. Anderson has been established to provide early screening for premalignant lesions and oral cancers as part of the institution’s cancer prevention efforts.

The focus of the Oral Cancer Prevention Clinic is on patients who have a high risk of oral cancer: those who have precancerous conditions, such as erythroplakia, leukoplakia, or oral lichen planus; those who have previously had oral cancers; and those who use tobacco and alcohol, according to Ann Gillenwater, M.D., associate professor in the Department of Head and Neck Surgery.

Beyond offering referrals for the standard treatments of premalignant lesions (observation, surgical resection, and laser ablation), the clinic enables specialists to do longer-term observation and follow-up and to collaborate on disease management. Patients also have the opportunity to enroll in clinical research trials at M. D. Anderson—both diagnostic and chemoprevention trials.

“What we’re trying to do is put patients in one place where they can see the medical oncologist for cancer prevention, see a dentist for other oral pathology, have biopsies done, and if necessary, undergo treatment in one spot,” said Dr. Gillenwater. “We want to eventually be able to do treatment at the clinic, if the patient is not enrolled in one of the trials.”

The clinic’s co-directors are Dr. Gillenwater and Vassiliki Papadimitrakopoulou, M.D., associate professor in the Department of Thoracic/Head and Neck Medical Oncology. Jack Martin, D.D.S., professor of dental oncology in the Department of Head and Neck Surgery, contributes the important perspective of a dentist.

“This is the first time that a multidisciplinary approach to oral cancer prevention is taking place in the same space,” said Dr. Papadimitrakopoulou. “Dr. Gillenwater, Dr. Martin, and I are seeing patients at the same time and offering screening, biopsies, intervention, and participation in clinical trials to all appropriate patients.”

Clinical trials offer patients access to cancer prevention and treatments that are not available commercially. One such study, a phase II chemoprevention trial, is testing the efficacy of rosiglitazone in the prevention of oral cancer for patients with erythroplakia and leukoplakia. Another major research effort of the clinic is the Erlotinib Prevention of Oral Cancer (EPOC) study, a National Cancer Institute–funded study whose purpose is to determine whether erlotinib prevents oral cancer in those at high risk of developing the disease. The principal investigators are Dr. Papadimitrakopoulou and Scott Lippman, M.D., professor in and chair of the Department of Thoracic/Head and Neck Medical Oncology. “This trial is unique as it is the first trial to select patients based on a molecularly defined high risk of developing cancer,” said Dr. Papadimitrakopoulou.

The clinic also is evaluating new technologies to improve detection and diagnosis of oral dysplasia and early cancer, developed in collaboration with Rebecca Richards-Kortum, Ph.D., professor in and chair of the Department of Bioengineering at Rice University. Patients can enroll in several National Cancer Institute–funded trials investigating fluorescence imaging, spectroscopy, and other new methods to help clinicians identify changes associated with early cancer development.

Future plans call for an expansion of the clinic’s space and the involvement of the Department of Epidemiology and the Tobacco Treatment Program.

For more information on this topic or for questions about M. D. Anderson’s treatments, programs, or services, call askMDAnderson at (877) MDA-6789.

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