A Pilot Study of Head and Neck Cancer Patients Treated Daily with an Intraoral Photobiomodulation (PBM) Device while Undergoing IMRT Demonstrates Tolerability, Safety, and Preliminary Efficacy for Reducing the Impact of Oral Mucositis

Abstract

Radiotherapy (RT) when given for head and neck cancer (HNC) causes acute and chronic adverse events (AEs). Oral mucositis (OM) is a significant AE and can impact cancer treatment (interruptions and/or early termination), increase opioid usage, impact diet (dysgeusia, dysphagia, inadequate nutritional intake), and cause depression. Pharmacological options are limited; however supportive care treatment guidelines (MASCC, WALT) recommend photobiomodulation (PBM) therapy for the prevention/treatment of OM. PBM is the use of non-ionizing light in the visible and near-infrared light spectra to modulate biological systems, such as wound healing. Current PBM protocols for OM prevention involve laser-based treatments using spots that are technique sensitive and time consuming. The (Sponsor) Phototherapy System uses an LED-based intraoral mouthpiece to deliver a dosage of 6 J/cm2 to the entire oral cavity, soft palate, uvula, retromolar trigone, and portions of the oropharynx in a daily 10-minute treatment. Per sponsor protocol, this medical device is used daily in the radiation therapy clinic without proximate physician supervision. A pilot study was performed at 7 centers (5 academic) to assess feasibility. HNC participants receiving chemotherapy and IMRT with a minimum of 30Gy to greater than one oral site received a 10-min PBM treatment prior to daily RT. Pain medications and mouthwashes were permitted. PBM treatment was delivered at the radiation clinic throughout the entire duration of IMRT. Device safety (daily) and OM (weekly) evaluations were completed, and participant status was reviewed for primary and secondary outcomes at week six. OM was graded according to the Oral Mucositis Index (OMI), NCI, and RTOG scales. A total of 40 patients were enrolled, 3 withdrew consent and 3 did not complete 80% of PBM treatments. A total of 1227 of 1271 study treatments were completed in full and no device-related adverse events were reported. At week 6: Participants averaged of 8.74/60 on the OMI; NCI/RTOG grades ranged from 0-3. Grade distribution was 0 (1/1), 1 (5/5), 2 (9/8), 3 (19/20) respectively. A total of 52% of salivary flow was retained. Participants reported they could swallow solids for 24.3/30 treatments (avg). Thirteen of 34 patients retained the ability to swallow solids throughout. PBM has been recommended to prevent/treat OM; however, current options are technique sensitive and time consuming for physicians. The (Sponsor) Phototherapy System shows encouraging results in a pilot cohort, is well tolerated for daily treatments in a clinic setting and is safe without apparent device-related adverse events. This device presents a promising alternative for PBM delivery and is currently being evaluated for safety and efficacy in a double-blind randomized clinical trial (NCT03972527).