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Mitani Y, Lin SH, Pytynia KB, Ferrarotto R, El-Naggar AK. Reciprocal and Autonomous Glucocorticoid and Androgen Receptor Activation in Salivary Duct Carcinoma. Clin Cancer Res 2019; 26:1175-1184. [PMID: 31772120 DOI: 10.1158/1078-0432.ccr-19-1603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 10/01/2019] [Accepted: 11/22/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine the expression of glucocorticoid receptor (GR) and androgen receptor (AR) in salivary duct carcinoma (SDC) and to analyze the role of these proteins in the development and management of this disease entity. EXPERIMENTAL DESIGN We performed a phenotypic assessment of GR and AR localization and expression, and determined their association with clinicopathologic factors in 67 primary SDCs. In vitro functional and response analysis of SDC cell lines was also performed. RESULTS Of the 67 primary tumors, 12 (18%) overexpressed GR protein, 30 (45%) had constitutive expression, and 25 (37%) had complete loss of expression. Reciprocal GR and AR expression was found in 32 (48%) tumors, concurrent constitutive GR and AR expression in 23 (34%), and simultaneous loss of both receptors and high GR with AR expressions were found in 12 (18%). GR overexpression was significantly associated with worse clinical outcomes. In vitro ligand-independent AR activation was observed in both male- and female-derived cell lines. GR antagonist treatment resulted in decreased cell proliferation and survival in GR-overexpressing cells, irrespective of AR status. Reciprocal GR- and AR-knockdown experiments revealed an independent interaction. CONCLUSIONS Our study, for the first time, demonstrates differential GR and AR expressions, autonomous GR and AR activation, and ligand-independent AR expression and activation in SDC cells. The findings provide critical information on the roles of GR and AR steroid receptors in SDC tumorigenesis and development of biomarkers to guide targeted steroid receptor therapy trials in patients with these tumors.
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Affiliation(s)
- Yoshitsugu Mitani
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sue-Hwa Lin
- Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kristen B Pytynia
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Adel K El-Naggar
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas.
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102
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Advances and challenges in precision medicine in salivary gland cancer. Cancer Treat Rev 2019; 80:101906. [PMID: 31644971 DOI: 10.1016/j.ctrv.2019.101906] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/11/2019] [Accepted: 10/07/2019] [Indexed: 12/13/2022]
Abstract
Salivary gland cancer (SGC) is a rare malignancy consisting of 22 subtypes with different genetic, histological and clinical characteristics. This rarity and heterogeneity makes systemic treatment of recurrent or metastatic (R/M) disease challenging. Use of chemotherapy is scarcely studied and chemotherapy at best has moderate effects. New therapeutic strategies are therefore warranted, but advances made in SGC are lagging behind on advances made in more common cancers. By unraveling tumor characteristics of SGC, such as genetic alterations and protein expression profiles, therapeutic strategies tailored to the patient's tumor can be rationalized. This genomic profiling and mapping of immunohistochemical expression profiles is essential in the search for a suitable treatment approach. Thereby, it alleviates the paucity in systemic treatment options and can significantly alter the prognosis of patients with R/M SGC. This review aims to give a comprehensive overview of known genetic alterations and expression profiles amenable for targeted therapy in every histological subtype of SGC. We discuss the remaining knowledge gaps and the implications of these targets for future studies and personalized treatments, thereby aiding clinicians faced with this rare and heterogeneous type of cancer.
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103
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Elkrief A, Saleh R. Androgen deprivation therapy for metastatic salivary gland cancer. CMAJ 2019; 190:E985-E987. [PMID: 30127038 DOI: 10.1503/cmaj.180286] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Arielle Elkrief
- Internal Medicine (Saleh), McGill University; Internal Medicine (Elkrief), McGill University Health Centre
| | - Ramy Saleh
- Internal Medicine (Saleh), McGill University; Internal Medicine (Elkrief), McGill University Health Centre
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104
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Xu B, Dogan S, Haroon Al Rasheed MR, Ghossein R, Katabi N. Androgen receptor immunohistochemistry in salivary duct carcinoma: a retrospective study of 188 cases focusing on tumoral heterogeneity and temporal concordance. Hum Pathol 2019; 93:30-36. [PMID: 31430492 DOI: 10.1016/j.humpath.2019.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 07/25/2019] [Accepted: 08/07/2019] [Indexed: 12/16/2022]
Abstract
Salivary duct carcinoma (SDC) is a high-grade salivary gland carcinoma that is associated with frequent metastasis and poor outcome. Androgen receptor (AR) immunoexpression in SDC is reported in 69% to 100% of SDC. Androgen deprivation therapy (ADT) has shown a response rate of 18% to 42% in SDC. Therefore, AR immunoexpression may serve as a diagnostic and predictive marker for ADT response in SDC. We investigated AR immunopositivity and staining pattern in a large retrospective cohort of 188 SDCs from 163 patients, including 22 paired primary and metastatic SDCs from the same patients, focusing specifically on staining heterogeneity and concordance. A control cohort of 61 non-SDC salivary gland carcinomas was also included. AR immunopositivity defined as ≥1% of tumor cell nuclear staining was found in 94% (177/188) of SDCs, including 95% of primary tumors, 100% of regional metastases, and 90% of distant metastases. Most of the cases (75%, 86/114) showed homogeneous and diffuse AR positivity. However, a subset (25%) exhibited focal or heterogeneous AR staining pattern. Although most metastases (21/22, 95%) had concordant AR expression with the primary tumors, one treatment-naïve tumor (5%) had complete loss of AR immunoexpression in the metastasis without detectable molecular alterations in AR or AR co-regulators. AR positive staining in non-SDC salivary carcinomas was infrequent (15%, 9/61), and mostly heterogeneous or focal. AR immunoexpression is highly prevalent in SDC, in both primary (94%) and metastatic tumors (93%). The cumulative AR immunopositivity rate in SDC is 90% based on data from the current study and previous literature. A small subset may show intratumoral AR heterogeneity and discordant AR expression in metastasis. AR immunoexpression may be seen in non-SDC salivary gland carcinomas but it is uncommon and usually focal.
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Affiliation(s)
- Bin Xu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA, 10065
| | - Snjezana Dogan
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA, 10065
| | | | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA, 10065
| | - Nora Katabi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, USA, 10065.
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105
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Cappelletti V, Miodini P, Reduzzi C, Alfieri S, Daidone MG, Licitra L, Locati LD. Tailoring treatment of salivary duct carcinoma (SDC) by liquid biopsy: ARv7 expression in circulating tumor cells. Ann Oncol 2019; 29:1599-1601. [PMID: 29897400 DOI: 10.1093/annonc/mdy141] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- V Cappelletti
- Department of Applied Research and Technical Development, Istituto Nazionale dei Tumori, Milan, Italy
| | - P Miodini
- Department of Applied Research and Technical Development, Istituto Nazionale dei Tumori, Milan, Italy
| | - C Reduzzi
- Department of Applied Research and Technical Development, Istituto Nazionale dei Tumori, Milan, Italy
| | - S Alfieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - M G Daidone
- Department of Applied Research and Technical Development, Istituto Nazionale dei Tumori, Milan, Italy
| | - L Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy.,University of Milan, Milan, Italy
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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106
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Viscuse PV, Price KA, Garcia JJ, Schembri-Wismayer DJ, Chintakuntlawar AV. First Line Androgen Deprivation Therapy vs. Chemotherapy for Patients With Androgen Receptor Positive Recurrent or Metastatic Salivary Gland Carcinoma-A Retrospective Study. Front Oncol 2019; 9:701. [PMID: 31428578 PMCID: PMC6688187 DOI: 10.3389/fonc.2019.00701] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/15/2019] [Indexed: 12/18/2022] Open
Abstract
Objectives: There is a lack of effective therapy for recurrent or metastatic salivary gland carcinoma. Androgen deprivation therapy has demonstrated efficacy in cases of salivary duct carcinoma (SDC) and high-grade adenocarcinoma not otherwise specified (NOS) that express androgen receptor. Materials and Methods: We conducted a single institution retrospective cohort study examining patients treated for recurrent/metastatic SDC or high-grade adenocarcinoma NOS of the salivary gland. Survival analyses were performed to assess for efficacy of first-line androgen deprivation therapy (ADT) vs. first-line conventional cytotoxic chemotherapy. Efficacy of salvage ADT was also assessed. Results: Fifty-eight patients were reviewed. Thirty-five patients had recurrent/metastatic disease of which 28 had SDC (80%) and 7 had high-grade adenocarcinoma NOS (20%). Median overall survival for first-line ADT was 25 months compared to 25 months for first-line chemotherapy [RR 0.54 (0.23–1.28, p = 0.16)]. Patients treated with first-line ADT had a response rate of 45% (9/20) and patients treated with first-line chemotherapy had a response rate of 14% (2/14). Six patients received salvage ADT with 1 patient demonstrating complete response and 3 with stable disease as best response (clinical benefit rate 67%). Conclusion: Overall survival for first line ADT and first line cytotoxic chemotherapy was comparable but response rates to first-line ADT were higher than those with first-line chemotherapy. Salvage ADT is active in recurrent/metastatic salivary gland carcinoma.
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Affiliation(s)
- Paul V Viscuse
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Katharine A Price
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, United States
| | - Joaquin J Garcia
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, United States
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107
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van Boxtel W, van Herpen C. Improving survival in salivary duct cancer with adjuvant androgen deprivation therapy. Oncotarget 2019; 10:3833-3834. [PMID: 31231462 PMCID: PMC6570469 DOI: 10.18632/oncotarget.27004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 05/20/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Wim van Boxtel
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Carla van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
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108
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Okada T, Saotome T, Nagao T, Masubuchi T, Fushimi C, Matsuki T, Takahashi H, Miura K, Tsukahara K, Tada Y. Carboplatin and Docetaxel in Patients With Salivary Gland Carcinoma: A Retrospective Study. In Vivo 2019; 33:843-853. [PMID: 31028207 PMCID: PMC6559918 DOI: 10.21873/invivo.11549] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/28/2019] [Accepted: 03/01/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND/AIM The aim of this study was to evaluate the efficacy and safety of carboplatin/docetaxel combination therapy in patients with locally advanced and/or recurrent/metastatic (LA/RM) salivary gland carcinoma (SGC). MATERIALS AND METHODS This was a retrospective analysis of 24 patients that included six patients with AR-positive salivary duct carcinoma (SDC) after progressive disease treated with combined androgen blockade (CAB). Carboplatin (AUC5) and docetaxel (70 mg/m2) were administered for six courses every three weeks. RESULTS The overall response rate was 42%, the median progression-free survival was 8.4 months, and the median overall survival was 26.4 months. Among the six patients with CAB-resistant SDC, two achieved a partial response and two long-term stable disease. Grade 3/4 neutropenia and anemia were observed in 20-30% of the patients; all adverse events were manageable. CONCLUSION Carboplatin/docetaxel combination therapy may be a chemotherapeutic option for patients with LA/RM SGC, and a valuable second-line chemotherapy for CAB-resistant, AR-positive SDC.
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Affiliation(s)
- Takuro Okada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
- Department of Otolaryngology Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Takashi Saotome
- Division of Medical Oncology, Matsudo City Hospital, Chiba, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Tatsuo Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Chihiro Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Takashi Matsuki
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Hideaki Takahashi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kouki Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
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110
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Cavalieri S, Platini F, Bergamini C, Resteghini C, Galbiati D, Bossi P, Perrone F, Tamborini E, Quattrone P, Licitra L, Locati LD, Alfieri S. Genomics in non-adenoid cystic group of salivary gland cancers: one or more druggable entities? Expert Opin Investig Drugs 2019; 28:435-443. [DOI: 10.1080/13543784.2019.1598376] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Stefano Cavalieri
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Francesca Platini
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Cristiana Bergamini
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Carlo Resteghini
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Donata Galbiati
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Paolo Bossi
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Federica Perrone
- Pathology Department. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Elena Tamborini
- Pathology Department. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Pasquale Quattrone
- Pathology Department. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Lisa Licitra
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
- Department of Oncology, University of Milan, Milan, Italy
| | - Laura Deborah Locati
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
| | - Salvatore Alfieri
- Head and Neck Cancer Medical Oncology 3 Unit. Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
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111
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van Boxtel W, Locati LD, van Engen-van Grunsven ACH, Bergamini C, Jonker MA, Fiets E, Cavalieri S, Tooten S, Bos E, Quattrone P, Verhaegh GW, Schalken JA, Licitra L, van Herpen CML. Adjuvant androgen deprivation therapy for poor-risk, androgen receptor-positive salivary duct carcinoma. Eur J Cancer 2019; 110:62-70. [PMID: 30771738 DOI: 10.1016/j.ejca.2018.12.035] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 12/18/2018] [Accepted: 12/22/2018] [Indexed: 10/27/2022]
Abstract
AIM Salivary duct carcinoma (SDC), an aggressive subtype of salivary gland cancer, is androgen receptor (AR)-positive in 67-96% of cases. In patients with locally recurrent and metastatic (R/M) AR-positive SDC, androgen deprivation therapy (ADT) has an overall response rate of 18-64.7%. In this study, we describe the efficacy of adjuvant ADT in patients with poor-risk (stage 4a) AR-positive SDC. METHODS This is a retrospective cohort study in which patients with stage 4a AR-positive SDC were offered adjuvant ADT, i.e. bicalutamide, luteinizing hormone-releasing hormone (LHRH) analogue or a combination of these after tumour resection. In the control group, data were collected on patients with stage 4a SDC who underwent a tumour resection but did not receive adjuvant ADT. RESULTS Twenty-two AR-positive SDC patients were treated with adjuvant ADT for a median duration of 12 months. The control group consisted of 111 SDC patients. After a median follow-up of 20 months in the ADT-treated patients and 26 months in the control group, the 3-year disease-free survival (DFS) was estimated as 48.2% (95% confidence interval [CI] 14.0-82.4%) and 27.7% (95% CI 18.5-36.9%) (P = 0.037). Multivariable Cox regression analysis showed a hazard ratio of 0.138 (95% CI 0.025-0.751, P = 0.022) for DFS and 0.064 (95% CI 0.005-0.764, P = 0.030) for overall survival (OS) in favour of the ADT-treated patients. CONCLUSION Poor-risk, AR-positive SDC patients who received adjuvant ADT have a significantly longer DFS compared with patients in the control group, who did not receive adjuvant ADT. For OS, this was just below and above the significance level, in case there was or was no correction for confounders.
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Affiliation(s)
- W van Boxtel
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, the Netherlands
| | - L D Locati
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - A C H van Engen-van Grunsven
- Department of Pathology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - C Bergamini
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - M A Jonker
- Department for Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - E Fiets
- Department of Medical Oncology, Medical Center Leeuwarden, Henri Dunantweg 2, 8934 AD Leeuwarden, the Netherlands
| | - S Cavalieri
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - S Tooten
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, the Netherlands
| | - E Bos
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, the Netherlands
| | - P Quattrone
- Department of Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy
| | - G W Verhaegh
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - J A Schalken
- Department of Urology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, the Netherlands
| | - L Licitra
- Head and Neck Medical Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Via Giacomo Venezian 1, 20133 Milan, Italy; University of Milan, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - C M L van Herpen
- Department of Medical Oncology, Radboud University Medical Center, Geert Grooteplein Zuid 8, 6525 GA Nijmegen, the Netherlands.
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Viscuse PV, Price K. Marked responses to pemetrexed chemotherapy for metastatic adenocarcinoma of the parotid gland: Case series. Head Neck 2019; 41:E99-E103. [PMID: 30706564 DOI: 10.1002/hed.25658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 12/12/2018] [Accepted: 12/28/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND There are no proven systemic therapies for metastatic adenocarcinoma of the salivary glands. Pemetrexed use in adenocarcinoma of the salivary glands has not been previously described. METHODS Retrospective case reports and literature review. RESULTS Two patients with metastatic salivary gland adenocarcinoma were treated with single-agent pemetrexed with marked response and clinical benefit. Case 1 describes a sustained clinical response for 8 months after failing several lines of chemotherapy. Case 2 describes a marked interval response of diffuse metastatic disease at 2 months with resolution of bone pain and sustained response at 8 months. CONCLUSION To our knowledge, this is the first report of efficacy of single-agent pemetrexed for metastatic salivary gland adenocarcinoma. Given the significant and sustained responses in heavily pretreated patients, further investigation of pemetrexed for salivary cancer may be warranted.
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Affiliation(s)
- Paul V Viscuse
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Katharine Price
- Division of Medical Oncology, Mayo Clinic, Rochester, Minnesota
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113
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Schvartsman G, Pinto NA, Bell D, Ferrarotto R. Salivary gland tumors: Molecular characterization and therapeutic advances for metastatic disease. Head Neck 2018; 41:239-247. [PMID: 30552848 DOI: 10.1002/hed.25468] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/11/2018] [Accepted: 07/05/2018] [Indexed: 01/03/2023] Open
Abstract
Salivary gland cancers represent a rare group of tumors composed by over 20 histological subtypes. Initially treated as one single disease, its diagnosis, prognosis, and treatment are currently being stratified based on morphology. More recently, insight has been provided on the molecular characterization of each subtype, further improving diagnostic accuracy and paving the way for personalized therapy. In this article, we provide a comprehensive review of recent breakthroughs, preliminary results of novel therapy, and future directions on the treatment of these complex malignancies.
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Affiliation(s)
- Gustavo Schvartsman
- Department of Oncology, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | | | - Diana Bell
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Renata Ferrarotto
- Department of Thoracic/Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Di L, Qian K, Du C, Shen C, Zhai R, He X, Wang X, Xu T, Hu C, Ying H. Radiotherapy as salvage treatment of salivary duct carcinoma in major salivary glands without radical operations. Cancer Manag Res 2018; 10:6071-6078. [PMID: 30538556 PMCID: PMC6252779 DOI: 10.2147/cmar.s185542] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Background Salivary duct carcinoma (SDC) is an extremely rare and highly malignant carcinoma, and surgical radical resection is the most effective therapy. However, there were quite a proportion of patients receiving non-radical resections, and how to treat them remained controversial. Thus, the aim of this study is to evaluate whether postoperative radiotherapy could be a salvage treatment of SDC in major salivary glands without radical operations. Patients and methods We identified 40 pathologically diagnosed SDC patients who came to our hospital and did not receive radical operations. Thirty-three patients received at least one treatment (remedial operation, postoperative radiotherapy and chemotherapy), and seven patients only chose observation and received no further treatment. The prognostic indicators of the local-regional control (LRC) and distant disease-free survival were analyzed using the Kaplan-Meier methods and the Cox proportional hazards regression models. Results Thirteen patients experienced local-regional recurrence or local progression, and distant metastases were observed in 15 patients. Through multivariate analysis, we found that postoperative radiotherapy was associated with better LRC, but this kind of treatment did not show significant efficacy in the prevention of distant metastasis. Conclusion SDC is a rare, aggressive malignancy, and a substantial proportion of these patients experienced inadequate initial treatments. Although postoperative radiotherapy could not decrease distant metastases, it might help to improve LRC in patients with SDC.
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Affiliation(s)
- Lu Di
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, .,Department of Oncology, Liyang People's Hospital, Changzhou, Jiangsu 213000, China
| | - Kai Qian
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China, .,Department of Head and Neck Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China
| | - Chengrun Du
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Chunying Shen
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Ruiping Zhai
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Xiayun He
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Xiaoshen Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Tingting Xu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Chaosu Hu
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
| | - Hongmei Ying
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, Shanghai 200032, China, .,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China,
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Takahashi H, Tada Y, Saotome T, Akazawa K, Ojiri H, Fushimi C, Masubuchi T, Matsuki T, Tani K, Osamura RY, Hirai H, Yamada S, Kawakita D, Miura K, Kamata SE, Nagao T. Phase II Trial of Trastuzumab and Docetaxel in Patients With Human Epidermal Growth Factor Receptor 2-Positive Salivary Duct Carcinoma. J Clin Oncol 2018; 37:125-134. [PMID: 30452336 DOI: 10.1200/jco.18.00545] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Clinical evidence demonstrating the effectiveness of systemic therapy for advanced salivary duct carcinoma (SDC) is lacking because of the disease's rarity. We assessed the efficacy and toxicity of trastuzumab plus docetaxel in patients with locally advanced and/or recurrent or metastatic human epidermal growth factor receptor 2-positive SDC. PATIENTS AND METHODS This was a single-center, single-arm, open-label, phase II study in Japan. The patients received trastuzumab at a loading dose of 8 mg/kg, followed by 6 mg/kg every 3 weeks. Docetaxel 70 mg/m2 was administrated every 3 weeks. The primary end point was the overall response rate; the secondary end points included the clinical benefit rate, progression-free survival, overall survival, and toxicity. This study is registered with the University Hospital Medical Information Network Clinical Trials Registry (Identification No. UMIN000009437). RESULTS Fifty-seven eligible patients with SDC were enrolled. The overall response rate was 70.2% (95% CI, 56.6% to 81.6%), and the clinical benefit rate was 84.2% (95% CI, 72.1% to 92.5%). Median progression-free and overall survival times were 8.9 months (95% CI, 7.8 to 9.9 months) and 39.7 months (95% CI, not reached), respectively. The most frequent adverse event was anemia (52 patients [91%]), followed by a decreased WBC count (51 patients [89%]) and neutropenia (50 patients [88%]). The most frequently observed grade 4 adverse event was a decreased neutrophil count (34 patients [60%]). Grade 3 febrile neutropenia was reported in eight patients (14%). No grade 2 or greater adverse events of heart failure or left ventricular ejection fraction decline to less than 50% occurred. CONCLUSION Our data show encouraging efficacy of trastuzumab plus docetaxel therapy in patients with human epidermal growth factor receptor 2-positive SDC, with a manageable toxicity profile.
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Affiliation(s)
- Hideaki Takahashi
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Yuichiro Tada
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | | | - Kohei Akazawa
- 3 Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Hiroya Ojiri
- 4 The Jikei University School of Medicine, Tokyo, Japan
| | - Chihiro Fushimi
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Tatsuo Masubuchi
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Takashi Matsuki
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Kaori Tani
- 3 Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Robert Y Osamura
- 5 International University of Health and Welfare Graduate School, Chiba, Japan.,6 Nippon Koukan Hospital, Kanagawa, Japan
| | - Hideaki Hirai
- 7 Tokyo Medical University School of Medicine, Tokyo, Japan
| | | | - Daisuke Kawakita
- 9 Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kouki Miura
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Shin-Etsu Kamata
- 1 International University of Health and Welfare Mita Hospital, Tokyo, Japan
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116
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Urano M, Hirai H, Tada Y, Kawakita D, Shimura T, Tsukahara K, Kano S, Ozawa H, Okami K, Sato Y, Fushimi C, Shimizu A, Takase S, Okada T, Sato H, Imanishi Y, Otsuka K, Watanabe Y, Sakai A, Ebisumoto K, Togashi T, Ueki Y, Ota H, Sato Y, Saigusa N, Nakaguro M, Hanazawa T, Nagao T. The high expression of FOXA1 is correlated with a favourable prognosis in salivary duct carcinomas: a study of 142 cases. Histopathology 2018; 73:943-952. [PMID: 29993139 DOI: 10.1111/his.13706] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/10/2018] [Indexed: 12/25/2022]
Abstract
AIMS Salivary duct carcinoma (SDC) is an uncommon, aggressive tumour that, histologically, resembles high-grade mammary ductal carcinoma, and is characterised by the expression of androgen receptor (AR). The androgen signalling pathway, a potential therapeutic target, can be regulated by FOXA1. This study aimed to evaluate the clinicopathological implications of FOXA1 in SDC. METHODS AND RESULTS We examined the relationship between the immunoexpression of FOXA1 and FOXA1 mutations and clinicopathological factors, including the biomarker status and clinical outcome, in 142 SDCs. FOXA1 was expressed in 128 SDCs (90.1%); the immunoexpression was heterogeneous. SDCs with a higher FOXA1 labelling index (LI) (≥20%) more frequently showed less advanced tumors on T classification (P = 0.002). FOXA1 LI was correlated positively with the AR expression value (r = 0.430, P < 0.001). PI3K and p-mTOR positivity, and intact-PTEN, were associated with a higher FOXA1 LI. Twenty-two of 121 SDCs (18.2%) harboured FOXA1 gene mutations at the flanking regions in and around the forkhead DNA binding domain; however, the given gene mutation and the expression of FOXA1 were not significantly correlated. A multivariate analysis revealed that SDCs with a higher FOXA1 LI were associated with longer overall survival and progression-free survival (P = 0.029 and 0.016, respectively). CONCLUSIONS In SDC, FOXA1, which may biologically interact with the AR and PI3K signalling pathways, is a putative biomarker that may be associated with a favourable prognosis. Further studies are needed to apply the findings to the development of targeted personalised therapy for patients with SDC.
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Affiliation(s)
- Makoto Urano
- Department of Diagnostic Pathology, School of Medicine, Fujita Health University, Toyoake, Japan
| | - Hideaki Hirai
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Yuichiro Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Daisuke Kawakita
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Tomotaka Shimura
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otolaryngology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Satoshi Kano
- Department of Otolaryngology-Head and Neck Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Hiroyuki Ozawa
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kenji Okami
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Yuichiro Sato
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Chihiro Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Akira Shimizu
- Department of Otolaryngology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Soichiro Takase
- Department of Otolaryngology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Takuro Okada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Hiroki Sato
- Department of Otolaryngology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - Yorihisa Imanishi
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kuninori Otsuka
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yoshihiro Watanabe
- Department of Otorhinolaryngology-Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Akihiro Sakai
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Koji Ebisumoto
- Department of Otolaryngology-Head and Neck Surgery, Tokai University School of Medicine, Isehara, Japan
| | - Takafumi Togashi
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yushi Ueki
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Hisayuki Ota
- Department of Head and Neck Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Yukiko Sato
- Department of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Natsuki Saigusa
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Toyoyuki Hanazawa
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Toshitaka Nagao
- Department of Anatomic Pathology, Tokyo Medical University, Tokyo, Japan
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117
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Rack S, Rahman R, Carter L, McKay C, Metcalf R. Impact of tumour profiling on clinical trials in salivary gland cancer. Clin Otolaryngol 2018; 44:1-6. [PMID: 30102009 DOI: 10.1111/coa.13206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 08/02/2018] [Indexed: 01/21/2023]
Affiliation(s)
- Samuel Rack
- The University of Manchester, Manchester, UK
| | | | - Louise Carter
- The University of Manchester, Manchester, UK.,The Christie NHS Foundation Trust, Manchester, UK
| | - Craig McKay
- The Christie NHS Foundation Trust, Manchester, UK
| | - Robert Metcalf
- The Christie NHS Foundation Trust, Manchester, UK.,The Cancer Research UK Manchester Institute, Manchester, UK
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118
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Detection of AR-V7 transcript with RNA in situ hybridization in human salivary duct cancer. Oral Oncol 2018; 84:134-136. [PMID: 30122219 DOI: 10.1016/j.oraloncology.2018.06.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 11/23/2022]
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119
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Affiliation(s)
- A L Ho
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, USA; Department of Medicine, Weill Cornell Medical College, New York City, USA.
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