Paolo Bossi

Presentation
Chemotherapy (CT) and radiation therapy (RT)-related oral mucositis (OM) have a substantial effect on the oncological prognosis when scheduled treatment plans are changed, postponed, or stopped.

Even with new pharmaceutical treatments and better radiotherapy (RT) methods, patients still have both acute and long-term side effects. Of these, oral mucositis (OM) still has the most impact on quality of life (QoL). OM has a multifaceted basis, including direct effects, subsequent oxidative damage, elevation of immunologic components, and effects on oral flora, according to the more accurate pathophysiologic processes of CT and RT-induced OM that have been discovered.  A persistently elevated immune response associated with patient features may lead to more severe and protracted OM.

According to estimates, up to 100% of patients receiving RT may develop mucositis in the head and neck, with severe grades occurring in 45–65% of cases on average. OM incidence may be influenced by the tumour site, RT parameters such as type, dose, and schedule, RT field, and concurrent CT.  The incidence of severe OM can rise from 40% to 75% depending on the chemotherapeutic drug, dose, and timing (e.g., low-versus high-dose cisplatin added to RT).

The Multinational Supportive Care in Cancer (MASCC) recommendations state that there are a few preventative steps that may be taken both before and during radiation therapy, and that there aren’t many therapeutic options available, most of which are related to treating OM-related pain.  A few novel strategies to lessen the impact of OM have been explored in recent years.  Streptococcus salivaris K12 (SsK12) probiotics had a good safety profile while dramatically reducing the frequency, onset, and duration of OM in a prospective, randomised clinical research. One of the most intriguing strategies to lessen the occurrence and severity of OM is by microbiota modulation, which has a compelling biological justification.  Avasopasem (GC4419) is a potential new medication that mimics superoxide dismutase and is used to treat severe oral mucositis brought on by radiation therapy for head and neck cancer.  Finally, another strategy that has demonstrated potential in the prevention and treatment of oral mucositis and dermatitis in patients receiving radiation therapy is photobiomodulation (PBM) combined with low-level laser therapy (LLLT).  To be regarded as a state-of-the-art approach to OM prevention, however, wave length and method standardisation are required.  Preclinical and clinical research must work closely together to investigate novel strategies for preventing and treating this side effect, which is one of the most common toxicities seen by patients with head and neck cancer undergoing CTRT.

Bio
Associate Professor at Humanitas University and Chief of the Head and neck cancer Unit at Humanitas Cancer Center, Milan.
He is active member of ESMO, EORTC Head and Neck Group, IFHNOS, HNCIG and MASCC (chair of the Mucositis group). He is involved in all institutional and national/international research activities on head and neck cancer, from translational research (gene expression, next generation sequencing) to assessment of quality of life and value-based medicine. He is particularly dedicated to rare cancer among head and neck ones (nasopharyngeal cancer, paranasal sinus cancer, and salivary gland cancer). He has strong experience in conducting trials with targeted therapy and immunotherapy. He has a strong commitment to supportive care, both in clinical research and at education level, with a focus on treatment of elderly cancer patients and toxicities induced by immunotherapy. He is the Principal Investigator and co-investigator of several Italian and International trials on Head and Neck cancer. Authors of 350+ publications indexed on PubMed (H-Index 57)