Objectives. Salivary duct carcinoma (SDC) is a rare and aggressive malignancy with high mortality and poor response to treatment. A significant fraction of SDCs are HER2 positive. This retrospective review examines HER2 testing in SDC and the outcome of trastuzumab-based therapy in adjuvant and palliative settings. Methods. A total of 13 patients with SDC and HER2/neu expression by immunohistochemistry of 1-3ϩ were treated with trastuzumab in adjuvant (n ϭ 8) or palliative (n ϭ 5) setting. Adjuvant therapy consisted of concurrent radiation and chemotherapy with weekly paclitaxel, carboplatin, and trastuzumab (TCH) for 6 weeks followed by TCH for 12 weeks and trastuzumab alone for 1 year. Palliative treatment for metastatic disease consisted of TCH every 3 weeks for 6 cycles followed by trastuzumab for variable time periods with or without second-line chemotherapy for progression. All patients had fluorescence in situ hybridization testing for HER2/ neu gene amplification. Results. The median duration of follow-up was 27 months (range: 8 -48 months). In all, 62% of adjuvant patients (5/8) had no evidence of disease more than 2 years from completion of therapy. All patients with metastatic disease (5/5 patients) responded to treatment with TCH. One patient achieved a complete response and remains with no evidence of disease 52 months after initiation of TCH. The median duration of response was 18 months (range: 8 -52 months). Conclusion. HER2/neu positivity and treatment with trastuzumab correlated well with long-term survival and response in our patients. Based on this data, we propose that HER2/neu status be examined routinely in all patients with SDCs and the treatment be directed accordingly. The Oncologist 2013;18: 294 -300 Implications for Practice: Salivary duct carcinoma (SDC) is an extremely rare and aggressive type of salivary gland cancer with high morbidity and mortality. Current treatment options of surgery with or without radiation therapy provide limited benefit. Conventional chemotherapeutic agents have been utilized in the palliative setting with modest results. Randomized prospective clinical trials are difficult due to the rarity of the disease. Newer treatment strategies are needed to improve outcomes. At DanaFarber Cancer Institute, we treated HER2 positive SDCs with trastuzumab-based therapy with excellent results. Patients with HER2 positive SDC received a combination of paclitaxel, carboplatin and trastuzumab (TCH) in the palliative or adjuvant setting. Although the results below are from a small cohort of patients, treatment with trastuzumab correlated well with long-term survival and response to therapy. The unique application of this treatment in the adjuvant and palliative setting is practice changing and could have direct clinical implications.

Non-graft-versus-host disease (non-GVHD) ocular complications are generally uncommon after hematopoietic cell transplantation (HCT), but can cause prolonged morbidity affecting activities of daily living and quality of life. Here we provide an expert review of non-GVHD ocular complications in a collaboration between transplant physicians and ophthalmologists through the Late Effects and Quality of Life Working Committee of the Center for International Blood and Marrow Transplant Research and the Transplant Complications Working Party of the European Society of Blood and Marrow Transplantation. Complications discussed in this review include cataracts, glaucoma, ocular infections, ocular involvement with malignancy, ischemic microvascular retinopathy, central retinal vein occlusion, retinal hemorrhage, retinal detachment and ocular toxicities associated with medications. We have summarized incidence, risk factors, screening, prevention and treatment of individual complications and generated evidence-based recommendations. Baseline ocular evaluation before HCT should be considered in all patients who undergo HCT. Follow-up evaluations should be considered according to clinical symptoms, signs and risk factors. Better preventive strategies and treatments remain to be investigated for individual ocular complications after HCT. Both transplant physicians and ophthalmologists should be knowledgeable of non-GVHD ocular complications and provide comprehensive collaborative team care.

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