Cancer-fighting drugs included in UN list of essential medicines

The UN health agency, WHO, has announced that dozens of new drugs have been added to the list of essential medicines that every country should have, including new cancer treatments that can be swallowed rather than injected.

More than 150 countries use the UN’s Essential Medicines List, which contains around 460 drugs deemed critical to treat public health needs. This latest update adds 28 products for adults and 23 for children, and specifies new uses for 26 already-listed products, based on value for money, evidence and health impact.

WHO said on Tuesday that the five cancer therapies added to the list are regarded as “the best in terms of survival rates” to treat melanoma, lung, blood and prostate cancers.

They include two recently developed immunotherapies - nivolumab and pembrolizumab - that have delivered up to 50 per cent survival rates for advanced melanoma, a skin cancer that, until recently, was incurable.

“The inclusion in this list of some of the newest and most advanced cancer drugs is a strong statement that everyone deserves access to these life-saving medicines, not just those who can afford them,” said WHO Director-General.

Other updates to the list include new oral anticoagulants to prevent stroke, as an alternative to warfarin treatment of deep vein thrombosis. These are “particularly advantageous” for low-income countries, according to WHO, because, unlike warfarin, they do not require regular monitoring.

In addition, the agency’s committee also advised that countries supply new products to treat chronic inflammatory conditions such as rheumatoid arthritis and inflammatory bowel diseases.

Life-threatening bleeding after childbirth was also addressed in this year’s Essential Medicines List update, with the proposal to use carbetocin rather than the currently used therapy, oxytocin.

“This new formulation has similar effects to oxytocin?but offers advantages for tropical countries as it does not require refrigeration,” WHO said in a statement.

UPDATES ON CRITICAL DIAGNOSES TOO

In a related development, the UN health agency also updated its Essential Diagnostics List, in recognition of the critical, life-saving importance of finding out what is wrong with patients before it is too late.

The first list, issued last year, concentrated on a limited number of priority diseases, such as HIV, malaria, tuberculosis, and hepatitis. This year’s list includes more non-communicable and communicable diseases. In all, WHO added 12 tests to the Essential Diagnostics List to detect a wide range of solid tumours such as colorectal, liver, cervical, prostate, breast and germ cell cancers, as well as leukemia and lymphomas.

The list focuses on additional infectious diseases prevalent in low- and middle-income countries such as cholera, and neglected diseases like leishmaniasis, schistosomiasis, dengue, and zika.

The list was also expanded to include additional general tests which address a range of different diseases and conditions, such as iron tests for anemia and tests to diagnose thyroid malfunction and sickle cell anaemia, which is very widely present in Sub-Saharan Africa.

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Tongue bacteria could help identify patients with early-stage pancreatic cancer

The different types of bacteria living on the tongue can distinguish patients with early pancreatic cancers from healthy individuals, according to results from a new study.

This is the first evidence that suggests changes to the bacteria in the tongue could be an early indicator of pancreatic cancer. If confirmed in larger studies, this could pave the way towards the development of new life-saving early detection or prevention tools for this highly aggressive disease.
Early diagnosis of pancreatic cancer can greatly improve chances of successful treatment – but this poses challenges for this disease as it grows deep inside the body and often shows few symptoms before it has already spread. As a result, most patients already have advanced disease by the time they seek medical help.

With researchers searching for biological changes that can accurately detect early signs of pancreatic cancer, a current hot topic is the potential role of the microbiome in the development of cancer. Previous studies have already seen dramatic disruptions to bacteria in saliva, intestinal and faecal samples collected from pancreatic cancer patients compared to healthy individuals.

In the first study to characterise the tongue coat microbiome of patients with pancreatic cancer, a team of researchers recruited a group of 30 patients with early-stage disease (diagnosed with a tumour positioned in the ‘head’ area of the pancreas) and a similar group of 25 healthy people.

Participants were all between 45 and 65 years in age, had no other diseases or oral health problems and had not taken any antibiotics or other drugs for the three months before the study.

The research team used gene sequencing technologies to examine the microbiome diversity of tongue coat samples and found that pancreatic cancer patients were colonised by remarkably different tongue coating microbiomes compared to healthy individuals.

Speaking about it, lead author said, “Although further confirmatory studies are needed, our results add to the growing evidence of an association between disruptions to the microbiome and pancreatic cancer.”

Notably, the abundance of four types of bacteria – low levels of Haemophilus and Porphyromonas and high levels of Leptotrichia and Fusobacterium – could distinguish pancreatic cancer patients from healthy individuals.

The research team hypothesises that the immune system is most likely a link between any confirmed shifts in the microbiome with pancreatic cancer. They theorise that disease development in the pancreas may influence the immune response in ways that favour the growth of certain bacteria – or vice versa. If proven, this could set the stage for the development of new treatment strategies involving antibiotics or immunotherapies – or potentially even probiotics that can help prevent pancreatic cancer in high-risk patients in the future.

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Study finds good gut bacteria improves cancer patient's response to immunotherapy

In a recent study, a group of researchers found a link between an individual's gut bacteria and their response to anticancer immune checkpoint inhibitor therapy (ICT).

The researchers analyzed the gut bacteria of 39 melanoma patients who were treated with immunotherapies and found a strong association between a good response and the presence of particular bacteria. While talking about the research, senior author  said, "Our research suggests there were certain good-guy bacteria that are needed to optimize the effectiveness of checkpoint inhibitors.
These bacteria somehow prime your immune system so that it's better able to attack cancer cells and kill them." Although ICT achieves durable remission in up to 50 percent of patients with metastatic melanoma, a significant proportion of patients fail to respond or experience severe autoimmune adverse effects, the researchers note.

A person with metastatic melanoma volunteered for the study to identify the link. The participant's metastatic melanoma was discovered on his lungs while he was fighting pneumonia. He was treated with an every-other-week infusion of nivolumab, an immunotherapy drug that acts by lifting a brake on the immune system, allowing the body's natural defenses to go into overdrive.

Researchers found he had the beneficial gut bacteria and suspect this microbiome contributed to the outcome. As a group, patients who responded well to the immunotherapy had three specific bacteria:
- Bacteroides thetaiotaomicron
- Faecalibacterium prausnitzii
- Holdemania filiformis
After identifying the link, scientists looked for a potential reason for the association between the helper bacteria and immunotherapy effectiveness. Dr. explained, "Is it something the bacteria are making? We examined metabolites in these subjects and found the strongest correlation between anacardic acid, present in cashews and mangoes, and the beneficial bacteria."

Now the researchers are planning to follow-up on the current study with larger clinical studies.

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World's tiniest hammer may help understand brain injuries

Researchers have created world's tiniest hammer to precisely measure how force affects brain cells, an advance that may pave the way for better treatments against traumatic brain injuries and diseases like Alzheimer's.

Researchers at University of California, Santa Barbara in the US have built a tiny machine called microHammer.

"Mechanical forces have been shown to impact cells a lot," said Kimberly Turner from UC Santa Barbara.

Far from being isolated units of life, cells - stem cells in particular - take cues from their environment that, for example, direct them to differentiate into one type of cell or another, or to start healing processes.

However a major limitation to understanding the reactions of individual neural cells to forces has been the inability to reliably apply impact or pressure to them.

MicroHammer, a cellular-scale machine built to tap, strike, squeeze and poke individual neural progenitors elicits responses that will then be studied and recorded to add to a body of knowledge that can help unlock the mysteries of the brain.

Modelled after cell-sorting technology used typically for medical diagnostics and immunotherapies, the MicroHammer flows individual cells through and subjects each of them to one of a variety of physical forces.

"This project will enable precision measurements of the physical, chemical and biological changes that occur when cells are subjected to mechanical loading, ranging from small perturbations to high-force, high-speed impacts," said Megan Valentine from UC Santa Barbara.

"Our technology will provide significantly higher forces and faster impact cycles than have previously been possible, and by building these tools onto microfluidic devices, we can leverage a host of other on-chip diagnostics and imaging tools and can collect the cells after testing for longer-term studies," said Valentine.

With the new devices and methods, Valentine said, the researchers expect to gain fundamentally new insight into the causes and progress of brain injuries due to trauma.

The MicroHammer is currently undergoing the process of characterisation, whereby the types and magnitudes of forces it can apply are being measured and recorded in anticipation of the first set of neuron-smashing experiments.

The knowledge gained by these experiments could pave the way toward a better understanding of neural conditions such as Alzheimer's disease as well as traumatic brain injury.

It may also lead to better prevention of such injuries by elucidating, for instance, what types of forces affect the neural cells most so helmets can be designed to buffer them.

It will have broad applications beyond brain cell research and help researchers gain insight on how forces affect other cells and tissue types.

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