Better prospects for people with head and neck cancer
Improving patients’ survival and quality of life is what drives Francesco Missale to do research. He is an ear, nose and throat (ENT) surgeon and researcher at GROW. Here, Francesco conducts research into the diagnosis, treatment and monitoring of head and neck cancer and how these can be improved: from new microscopes and immunotherapy to tumour markers.
Francesco is from Brescia, Italy. “That is where I studied medicine and discovered my passion for doing research. Later I moved to Genoa for my training as a medical specialist and ENT surgeon. I developed my interest in oncological surgery in the head and neck area there. Inspired by a colleague, I did the Head and Neck Oncology training fellowship at the Netherlands Cancer Institute in Amsterdam, during my PhD. This was an intensive period of surgical exposure to learn how to operate on patients affected by head and neck cancer, so with tumours of the mouth, throat, vocal cords, salivary glands, or skin. That was the beginning of my connection to the Netherlands.”
Intense
“It was a tough period: I needed to continue my PhD, learn about the surgeries and learn a new language, because I speak Dutch with my patients. It was very intense, especially as it took place during the COVID-19 pandemic and I needed to go back to the lab in Italy regularly, but I managed and completed my fellowship and PhD. After two years of being part of the ENT staff here in Maastricht UMC+, I got the opportunity to become part of GROW. Now I have been here for a year and I am setting up research projects. One of them came from the GROW Young Investigator group, where I met Anna Schüth. Together we are starting a project to improve the diagnostic process around head and neck cancer with a new microscope that analyses tumours as a whole.”
Attacking cancer cells
Another research project is focused on oral cavity cancer, which often manifests itself as mouth or tongue tumours. “Treatment consists of surgery and radiotherapy, and is quite intensive,” Francesco explains. “It also has severe consequences, not only because of risk of progression of the disease but also regarding quality of life, if for example a piece of the tongue has to be removed.”
“A researcher in the past used immunotherapy for skin tumours. Immunotherapy uses the body’s immune system to find and attack cancer cells. This researcher found that some patients responded very well to it. Therefore, we are now investigating if we can use this therapy for oral cavity tumours as well, so we can avoid the intensive treatment and improve quality of life. This study is led by a senior researcher at the Netherlands Cancer Institute and most academic centres in the Netherlands are participating. Maastricht UMC+ is too, I am the principal investigator for the study here.”
If we better understand which patients are at risk, we can determine if a different kind of treatment is more suitable, or if patients with lower risk can receive less intensive treatment.
Markers in the blood
Last March, Francesco received a grant from the Maastricht UMC+ Academic Fund. “With this grant, I will hire a PhD student who will do a prospective study on surveillance testing. Surveillance is important, because there is a risk that a tumour comes back. For head and neck cancer, there is not enough evidence to suggest a specific surveillance test and to prove that they are useful, cost-effective, and change the clinical outcome. Researchers in Amsterdam were able to detect recurrence of cancer using tumour markers in the blood, which is quite inexpensive compared to using scans, for example. So I want to investigate if these markers are an alternative cost-effective way to detect recurrence earlier and potentially increase the chance of cure after detection. We will also include the patients’ experience, because deteriorating quality of life can be a signal that things are going wrong.”
Improving lives
With his research, Francesco’s aim is to improve survival and quality of life of patients. “If we better understand which patients are at risk, we can determine if a different kind of treatment is more suitable, or if patients with lower risk can receive less intensive treatment. I also want to look at tailoring treatment. At the moment, it is not really personalised. General guidelines exist, but things are still missing there. We have a nice head and neck community in the Netherlands, where a lot of nice collaborations come from. It is difficult to see if it will be achieved, but the end goal is improving patients’ lives.”
Want to know more about Francesco’s research? At the GROW Science Days, he will introduce himself and his work. Check the programme for more information.
Text and photo: Joëlle van Wissen
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