Molecular Markers and Chemotherapy for Advanced Salivary Cancer

Abstract

Recent advances in our understanding of the molecular biology of salivary gland neoplasms have yielded diagnostic targets and potential therapeutic targets that have started to change our approach and choice of treatment strategies. Currently, these options are mainly investigated in recurrent and metastatic salivary gland cancer (SGC). Although the results of both cytotoxic and targeted molecular biological systemic therapy for locoregional recurrence and distant spread of SGC remain largely unpredictable, targeted therapy can be the treatment of choice in selected cases today. Molecular analysis is required as part of the diagnostic workup to help select patients with recurrent and metastatic SGC who may benefit from targeted or standard treatment regimens.

Adenoid cystic carcinoma of the head and neck – An update

“…The role of palliative systemic therapies (including cytotoxic and targeted therapies) has recently been extensively reviewed [15]. Only level-3 evidence (case-control or cohort studies) exists, and the available trials have only involved small patient numbers with heterogeneity regarding histology, many having had prior systemic therapies and a proportion of patients with locoregional recurrence versus distant metastasis.…”

“…Chemotherapy (both cytotoxic chemotherapy and targeted molecular therapies) has been extensively studied in patients with advanced AdCC, but the rather indolent course of the disease makes it difficult to observe clinical responses [15].…”

Multidisciplinary Management of Salivary Gland Cancers

“…60 In the palliative setting, a wide array of conventional chemotherapeutic agents can be used (both singe-and poly-drug regimens); partial and complete response rates range from 25% to 60%. [60][61][62][63] These responses are also generally of a short duration, as demonstrated by a median 7-month partial response rate of 27% achieved in a single phase 2 trial of cisplatin, doxorubicin, and cyclophosphamide. 62,64 Because these study results are not promising for the palliative setting, conventional chemotherapeutic agents have not generally been considered for the adjuvant management of advanced salivary malignancies; however, the exception has been a group of exploratory studies that have employed concurrent chemoradiotherapy.…”

Patterns of care, toxicity and outcome in the treatment of salivary gland carcinomas: long-term experience from a tertiary cancer center

“…Seventy percent of SGC arise from the parotid gland, while 20–25% derive from the submandibular and sublingual glands. Whereas acinic cell carcinoma (ACC, 15–17%), adenoid cystic carcinoma (AdCC, 16–27%) and mucoepidermoid carcinoma (MEC, 15–38%) represent frequent histopathological entities in the paired, major salivary glands, AdCC and MEC are also common in the minor salivary glands of the oral cavity [ 3 ]. While ACC depicts a low-risk malignancy, other histopathological subtypes such as AdCC, salivary duct carcinoma (SDC), or adenocarcinoma—not otherwise specified (ACA) are high-risk tumors with different prognosis [ 1 ].…”