Assistant Professor at Wayne State University. Head & Neck Oncologic Surgeon. Health services, quality improvement & outcomes researcher. All opinions my own.
Detroit, MI
Joined June 2009
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First-in-human circular RNA therapy lands in our field. circRNA encoding AQP1 injected into parotid in 6 patients with radiation-induced xerostomia. Restored flow up by day 7 and held to day 90. Small, uncontrolled, duration unknown. Still, congrats
nejm.org/doi/full/10.1056/NE…
Worth reading alongside it, same target, different vector. AAV2-hAQP1 for radiation induced xerostomia. 24 patients, 12 mo follow-up. XQ improved 39.5%, 67% responders, median unstimulated flow increased sciencedirect.com/science/ar…
John Cramer, MD retweeted
In a phase 1 study, RXRG001, a circular RNA encoding aquaporin-1, was administered to six patients with radiation-induced xerostomia. Measures of salivary flow improved, and adverse events were of grade 1 or 2 and transient. Full study results: nej.md/4BiCyUy
ALT A graph shows scores on the Xerostomia Questionnaire, a validated eight-item instrument for assessing the severity and effect of dry mouth on daily life as reported by the patient.
John Cramer, MD retweeted
Superstar Kevin Harrington joins us to discuss conference updates galore it’s a great summary of all the hot topics!
@DavidSherMD @drdavidpalma @HNSurgeon please RT and share! #hn #headandneck #hncsm
open.spotify.com/episode/1cA…
Tobacco, alcohol, HPV. Air pollution rarely makes our list of head and neck cancer risk factors. Our new paper in Laryngoscope adds to evidence that it should: each extra wildfire smoke day/yr was associated with higher 10-yr HNC incidence (RR 1.06) doi.org/10.1002/lary.70874
John Cramer, MD retweeted
NEW: Clinical Practice Guideline Update on Tinnitus gives clinicians evidence-based tools for diagnosis and treatment, built on a decade of new research.
About 50% of adults with #tinnitus talk to a clinician, but only 20% seek treatment.
Explore the CPG: hubs.ly/Q04B0_kK0
1/ REMATCH: neoadjuvant PD1 + chemo had a 94% ORR in LA-HNSCC (n=50). Responders got response adapted operations, with 90% 2-yr DFS. Congrats to the authors. #HNSCC aacrjournals.org/clincancerr…
Really impressive work in @NEJM: bilateral laryngeal pacing for bilateral vocal fold paralysis. Both trach-dependent patients were decannulated, airflow improved & voice & swallowing preserved. Only 4 patients, but I'd love to see this move into practice.
nejm.org/doi/full/10.1056/NE…
The ctHPV DNA draw I'd keep: 1 month after treatment. Positive then: HR 19.1 for OS. Still positive at 3 months: all 10 failed treatment or recurred. Serial testing for years? Less convinced. #HNSCC sciencedirect.com/science/ar…
John Cramer, MD retweeted
Big melanoma data in @NatureMedicine 👇
A pooled analysis of 1,038 patients with resectable melanoma treated before surgery. Among the 735 who received immunotherapy, 58% had little or no viable tumor left at surgery.
Those patients? ~98% alive at 5 years.
And their 5-year recurrence-free survival was similar with or without additional immunotherapy after surgery (90.8% vs 90.6%).
So if treatment already worked this well, do patients need more?
Not randomized, so prospective trials are needed. But very encouraging.
John Cramer, MD retweeted
Exciting progress in bilateral vocal-fold paralysis! We show that bilateral neuromuscular laryngeal pacing can improve fbreathing, while preserving voice and swallowing. This reversible alternative t could be a game-changer for this disease #MedTwitter #LaryngealPacing #NEJM
Do CPS <1 R/M #HNSCC patients benefit from checkpoint inhibitors? A new JAMA Oncol meta-analysis puts the probability that OS favors control at 95.6% (HR 1.42). Pembro monotherapy response rates are 4% in this group. I'm struggling to see the benefit. jamanetwork.com/journals/jam…
John Cramer, MD retweeted
Topical Antiseptic or Antimicrobial Preparation for Oral Cavity Surgery: Is It Necessary and Does It Help? Read more in this Trio Best Practice: doi.org/10.1002/lary.70273
#ENTSurgery
John Cramer, MD retweeted
🌎👋@NRGonc #HN009 p16-neg #ASTRO26; Dr. Paul Harari @UWMadison
➡️Diff AE profiles b/w Q1 vs Q3
➡️6 mo LRF diff 5% (Q1 9.6% & Q3 4.6%; 95%CI 1.0-8.9) Longer FU needed.
@DanielMaMD @quyhnhi99 @imrtlee @JamesBatesMD
@JJCaudell @drlorenmell @seanmmcbride @xrtGenomics
@ASTRO_org
SOAR-HN phase II RCT: SBRT reirradiation looks safer than conventional reRT for unresectable HNSCC (2-yr G3+ AEs 6.7% vs 23.9%). Caveat: 59% of conventional-arm patients crossed over to SBRT, limiting survival comparisons. #ASTRO26 sciencedirect.com/science/ar…
1/ Tomorrow (9/23) the FDA panel reviews GRAIL's Galleri MCED test, and for the first time the packet gives head and neck performance. Prior conference talks gave essentially none. In PATHFINDER 2, HNC was the single largest contributor to the stage I-II cancers Galleri caught
4/ Once you get to the actual screening data, HNC gets shaky. The FDA doc has it at 81.2% (13/16) in PATHFINDER 2 but only 42.9% (9/21) in NHS-Galleri. Those are tiny numbers and its retrospective analysis, and NHS-Galleri missed its primary endpoint. Hard to know what to trust.
5/ So where does that leave us? On biology and stage, HNC is one of the more compelling stories in the packet: often caught early, for a cancer we otherwise pick up symptomatically and late. Whether any of that saves lives is the question for the panel and future RCTs. #HNSCC