Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?

By Martina McGrath, MD
July 18, 2018

Although the overall incidence of cervical cancer is decreasing, it is estimated that over 200,000 women are living with cervical cancer in the US, and it is expected to lead to over 4,000 deaths in 2018.1 Cervical cancer is predominantly caused by infection of the cervical mucosa with human papilloma virus (HPV), particularly by several pro-oncogenic subtypes. Multiple HPV genotypes can infect the genital tract mucosa, but types 16 and 18 are responsible for the majority of cervical cancers. HPV infection is highly prevalent in sexually active young woman, and the majority will clear the infection within 8–24 months.2 Although cleared, HPV infection can lie dormant for prolonged periods. It can recur and be detected again decades later, mandating the need for cervical screening throughout a patient’s lifetime.3 In addition, observational data indicates that the relative risk of abnormal cervical cytology is markedly increased in those with persistent HPV infection, particularly where infection is with a high-risk type of HPV.2 Continue reading “Cervical Cancer Screening Using HPV Testing Alone: Are We There Yet?”

Taking Personalized Medicine to a New Level: CAR-T Cell Therapy

By Martina McGrath, MD
September 13, 2017

Each individual is estimated to have around 4 x 1011 T cells, comprising many millions of T cell clones,1 each randomly produced in the thymus with a unique T cell receptor (TCR) specific for a given antigen. This massive diversity in T cell repertoire gives our immune systems the capacity to protect against the incredible array of bacteria, viruses and fungi that assail us on a constant basis. Continue reading “Taking Personalized Medicine to a New Level: CAR-T Cell Therapy”

Results of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia

By Charbel C. Khoury, MD
August 8, 2015

Being diagnosed with cancer can be devastating and life-changing. Furthermore, the side effects of chemotherapy are often very distressing, and hair loss is one of the more feared complications. When a patient, and particularly a woman, loses her hair to chemotherapy, she is faced with the stigma of the disease, and may feel that she is losing her identity, femininity, and sexuality.1 Patients with chemotherapy-associated alopecia are confronted with the lethal nature of cancer, and a minority of patients even choose to avoid chemotherapy for fear of losing their hair. Continue reading “Results of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia”

IgG4-Related Disease: The Great Pretender

[Featured image of solid pseudopapillary tumor (SPT) of the pancreas.]

By Martina M. McGrath, MD
March 24, 2017

Retroperitoneal fibrosis, autoimmune pancreatitis, Reidel’s thyroiditis, sclerosing cholangitis and Mikulicz’s disease, sclerosing aortitis and periaortitis – what do all of these conditions have in common?

IgG4-related disease (IgG4-RD) is a chronic, fibro-inflammatory condition with a characteristic histological appearance including dense lymphoplasmacytic infiltration with large numbers of IgG4-positive plasma cells, storiform fibrosis, obliterative phlebitis,and eosinophil infiltration. 1 It is now recognized as the cause of a large number of chronic inflammatory conditions, previously considered idiopathic, including those listed above. IgG4-RD is the most common cause of Type I autoimmune pancreatitis. 2 Continue reading “IgG4-Related Disease: The Great Pretender”

Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis

By Martina M. McGrath, MD
March 2, 2017

Publication of the RAVE and Rituxivas trials ushered in a new era of treatment of antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). Previously, cyclophosphamide was first-line therapy, but treatment was commonly complicated by infection and malignancy, leading to the search for less toxic alternative regimens. RAVE and Rituxivas demonstrated equivalent efficacy in treatment of AAV with either cyclophosphamide or rituximab, with similar numbers of adverse events.1,2 Unexpectedly, more malignancies were observed in rituximab-treated patients in both studies. However, absolute numbers were small, and the significance of this finding was unclear. Follow-up data and clinical experience would suggest that rituximab is well tolerated for treatment of AAV, including when used as maintenance therapy.3,4 Continue reading “Treatment Choice Influences Malignancy Risk in Patients with ANCA Vasculitis”

Immune Checkpoint Inhibitors: Collateral Damage and Organ Toxicities

By Martina M. McGrath, MD
February 3, 2017

Cancer immunotherapy has led to a paradigm shift in the treatment of a range of malignancies. Recently developed, immune checkpoint inhibitors (ICPI) are monoclonal antibodies, which specifically block immunological pathways involved in the control of T cell-mediated immune responses. Anti-CTLA4 (ipilimumab) blocks the interaction of CTLA-4, expressed by regulatory T cells, with its ligand, B7, allowing for increased T cell activation via CD28-B7 signalling. Similarly anti-PD-1 (nivolumab, pembrolizumab, pidilizumab) prevents interaction between PD-1 and its ligand PD-L1, another critical negative T cell costimulatory pathway. By ‘removing the brake’ for T cell activation, these agents increase anti-tumor immunity and overcome some of the mechanisms by which tumors evade the immune response. Management of diseases such as metastatic melanoma have been transformed by the availability of these agents and studies continue to show benefit in an increasing number of malignancies. Continue reading “Immune Checkpoint Inhibitors: Collateral Damage and Organ Toxicities”