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Prost D, Iseas S, Gatineau M, Adam J, Cavalieri S, Bergamini C, Licitra L, Raymond É. Systemic treatments in recurrent or metastatic salivary gland cancer: a systematic review. ESMO Open 2024; 9:103722. [PMID: 39368417 DOI: 10.1016/j.esmoop.2024.103722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/20/2024] [Accepted: 08/12/2024] [Indexed: 10/07/2024] Open
Abstract
BACKGROUND Salivary gland cancers are infrequent and pose a challenge owing to their histological diversity and varied clinical behavior, making the selection of optimal systemic treatments for advanced or recurrent stages difficult. This systematic review aims to assess overall survival outcomes and systemic treatment responses across four types of salivary cancers. METHODS A PubMed and Google Scholar search identified studies involving initially advanced or relapsed cases undergoing systemic treatment. Studies with clear, individualized data on treatment responses and outcomes were selected based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Of the 723 studies screened, 44 met our inclusion criteria. RESULTS A total of 426 cases of recurrent/metastatic salivary gland cancer, mostly salivary duct carcinoma (SDC; n = 219) and adenoid cyst carcinoma (ACC; n = 167), were included. Histomolecular markers were heavily associated with histology, with HER2 overexpression and androgen receptor nuclear expression typically found in SDC and adenocarcinoma not otherwise specified cases and KIT overexpression only in ACC. The response rates were associated with specific receptor blockage, with trastuzumab plus chemotherapy, and bicalutamide being the most effective (overall response rate 80% and 42.8%, respectively). Moreover, the response to treatment positively influenced overall survival (responders 38 versus non-responders 18.7 median months; P < 0.001). In this retrospective analysis of a particular cohort, survival outcomes per histology types showed that anti-human epidermal growth factor receptor 2 therapy was more effective for SDC, while chemotherapy was more effective for ACC. CONCLUSION Systemic treatments contribute to the survival of patients with salivary gland cancer at relapsed or newly advanced stages. The response to treatment is heavily influenced by histological subtype and treatment specificity.
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Affiliation(s)
- D Prost
- Oncology Department, Hôpitaux Paris, Saint-Joseph Marie-Lannelongue, Paris; Sorbonne Université, Inserm, CNRS, UMR S 1127, Institut du Cerveau et de la Moelle Epinière, ICM, AP-HP, Hôpitaux Universitaires La Pitié Salpêtrière - Charles Foix, Service de Neurologie 2 Institute de Neurologie, Paris.
| | - S Iseas
- Oncology Department, Hôpitaux Paris, Saint-Joseph Marie-Lannelongue, Paris
| | - M Gatineau
- Oncology Department, Hôpitaux Paris, Saint-Joseph Marie-Lannelongue, Paris
| | - J Adam
- Pathology Department, Hôpitaux Paris Saint-Joseph Marie-Lannelongue, Paris, France
| | - S Cavalieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - C Bergamini
- Head and Neck Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan
| | - L Licitra
- Head and Neck Medical Oncology Department, Fondazione IRCCS, Istituto Nazionale dei Tumori di Milano, Milan; Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - É Raymond
- Oncology Department, Hôpitaux Paris, Saint-Joseph Marie-Lannelongue, Paris
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2
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Mayer M, Wolber P, Prinz J, Jansen L, Esser J, Shabli S, Quaas A, Klußmann JP, Sharma SJ, Nachtsheim L, Arolt C. The extent of androgen receptor and HER2 expression allows for targeted therapy in most cases of salivary duct carcinoma: analysis of clinical and histopathological data in a tertiary care center. Eur Arch Otorhinolaryngol 2024; 281:3779-3789. [PMID: 38587651 PMCID: PMC11211117 DOI: 10.1007/s00405-024-08627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE The incidence of salivary duct carcinoma (SDC) seems to be underestimated due to inaccurate classification. Further, the frequency of SDC patients with targeted therapy options according to current guidelines is unclear. Therefore, this study aimed at (a) describing the proportion of SDC among salivary gland carcinoma (SGC) before and after reclassification of cases initially classified as adenocarcinoma, not otherwise specified (ANOS); and (b) quantifying the frequency of SDC patients with targeted therapy options. METHODS All patients with SDC or ANOS treated in a tertiary care center between 1996 and 2023 were identified. Histopathological diagnosis was verified for patients primarily diagnosed with SDC and reviewed for patients initially diagnosed with ANOS. Clinical data for SDC patients were retrieved from clinical charts. Immunohistochemical (IHC) androgen receptor (AR) and HER2 staining was performed. RESULTS Among 46 SDC, 34 were primarily diagnosed as SDC and 12 had initially been classified as ANOS. The proportion of SDC among SGC was 12.1% and was rising when comparing the time periods 2000-2015 (7.1-11.5%) versus 2016-2023 (15.4-18.1%). Nuclear AR staining in > 70% of tumor cells was found in 56.8% and HER2 positivity (IHC 3 +) in 36.4% of cases. 70.5% of patients showed AR staining in > 70% of tumor cells and/or HER2 positivity and therefore at least one molecular target. 5-year overall and disease-free survival (DFS) were 62.8% and 41.0%. Multivariate Cox regression revealed positive resection margins (HR = 4.0, p = 0.03) as independent negative predictor for DFS. CONCLUSIONS The results suggest a rising SDC incidence and show that the extent of the AR and HER2 expression allows for targeted therapy in most SDC cases.
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Affiliation(s)
- Marcel Mayer
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany.
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany.
| | - Philipp Wolber
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Johanna Prinz
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn Cologne Duesseldorf, University of Cologne, Cologne, Germany
| | - Louis Jansen
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Julia Esser
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Sami Shabli
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Alexander Quaas
- Institute of Pathology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Jens Peter Klußmann
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Shachi Jenny Sharma
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Nachtsheim
- Department of Otorhinolaryngology, Head and Neck Surgery, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Molecular Medicine Cologne (CMMC), Medical Faculty, University of Cologne, Cologne, Germany
| | - Christoph Arolt
- Institute of Pathology, Medical Faculty, University of Cologne, Cologne, Germany
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3
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Perri F, Fusco R, Sabbatino F, Fasano M, Ottaiano A, Cascella M, Marciano ML, Pontone M, Salzano G, Maiello ME, Montano M, Calogero E, D'Aniello R, Maiolino P, Ciardiello F, Zotta A, Alfieri S, Ionna F. Translational Insights in the Landscape of Salivary Gland Cancers: Ready for a New Era? Cancers (Basel) 2024; 16:970. [PMID: 38473330 DOI: 10.3390/cancers16050970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 02/15/2024] [Accepted: 02/22/2024] [Indexed: 03/14/2024] Open
Abstract
Salivary gland carcinomas (SGCs) are rare neoplasms, representing less than 10% of all head and neck tumors, but they are extremely heterogeneous from the histological point of view, their clinical behavior, and their genetics. The guidelines regarding their treatment include surgery in most cases, which can also play an important role in oligometastatic disease. Where surgery cannot be used, systemic therapy comes into play. Systemic therapy for many years has been represented by polychemotherapy, but recently, with the affirmation of translational research, it can also count on targeted therapy, at least in some subtypes of SGCs. Interestingly, in some SGC histotypes, predominant mutations have been identified, which in some cases behave as "driver mutations", namely mutations capable of governing the carcinogenesis process. Targeting these driver mutations may be an effective therapeutic strategy. Nonetheless, it is not always possible to have drugs suitable for targeting driver mutations-and targeting driver mutations is not always accompanied by a clinical benefit. In this review, we will analyze the main mutations predominant in the various histotypes of SGCs.
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Affiliation(s)
- Francesco Perri
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Roberta Fusco
- Medical Oncology Devision, IGEA S.p.A., 80013 Naples, Italy
| | - Francesco Sabbatino
- Medical Oncology Department, Università degli Studi di Salerno, Via Giovanni Paolo II, 132, 84084 Salerno, Italy
| | - Morena Fasano
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Alessandro Ottaiano
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Marco Cascella
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Maria Luisa Marciano
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Monica Pontone
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Giovanni Salzano
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University of Naples Federico II, 80131 Naples, Italy
| | - Maria Elena Maiello
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Massimo Montano
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Ester Calogero
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Roberta D'Aniello
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Piera Maiolino
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
| | - Fortunato Ciardiello
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Alessia Zotta
- Department of Precision Medicine, Università degli Studi della Campania Luigi Vanvitelli, 80128 Naples, Italy
| | - Salvatore Alfieri
- Head and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Franco Ionna
- Istituto Nazionale Tumori di Napoli, IRCCS "G. Pascale", Via Mariano Semmola, 80131 Napoli, Italy
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Williams CYK, Townson AT, Terry N, Schmitt NC, Sharma A. Role of HER2 in Prognosis of Salivary Duct Carcinoma: A Systematic Review and Meta-Analysis. Laryngoscope 2023; 133:476-484. [PMID: 35567387 DOI: 10.1002/lary.30214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 04/28/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVES Salivary duct carcinoma (SDC) is a rare, aggressive malignancy with a poor prognosis. These tumors frequently stain positive for HER2/ErbB2, but data on the prognostic significance of HER2 status in SDC are mixed. We sought to determine whether HER2 status affects survival outcomes in SDC. METHODS PubMed, Embase, and Web of Science databases were searched from inception to October 2020. Eligibility was restricted to studies reporting HER2/ErbB2 overexpression in histologically confirmed de novo SDC or SDC ex pleomorphic adenoma, with corresponding overall (OS) and disease-free (DFS) survival measures. Separate multivariable and univariable meta-analyses were performed using random-effects models. Statistical heterogeneity was estimated by Cochran's Q and I2 tests. Funnel plots were generated and Egger's test was used to assess for publication bias. The risk of bias was assessed with the Newcastle-Ottawa Scale. RESULTS Of 183 unique citations, 14 studies of 663 patients were included. Most included studies determined HER2 status according to ASCO/CAP guidelines. The univariable meta-analysis did not reveal an effect between HER2 status and OS (HR 1.09, 95% CI 0.84-1.42). In the multivariable analysis, HER2 positivity was associated with a HR of 1.49 for OS (95% CI 0.96-2.30). Fewer studies reported data for DFS than OS, with no relationship between HER2 status and DFS found on multivariable or univariable meta-analyses. CONCLUSION In patients with salivary duct carcinoma, HER2 positivity was not found to be associated with worse overall survival. This information may be useful when counseling patients and considering treatment options. Laryngoscope, 133:476-484, 2023.
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Affiliation(s)
| | - Adam T Townson
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Nancy Terry
- Division of Library Services, Office of Research Services, National Institutes of Health, Bethesda, Maryland, U.S.A
| | - Nicole C Schmitt
- Department of Otolaryngology, Head and Neck Surgery and Winship Cancer Institute, Emory University, Atlanta, Georgia, U.S.A
| | - Arun Sharma
- Department of Otolaryngology, Head and Neck Surgery, Southern Illinois University, Springfield, Illinois, U.S.A
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5
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Abstract
Despite aggressive initial interventions, recurrent/metastatic salivary gland cancer is not uncommon. Standard chemotherapy has not been shown to have durable clinical benefits. Several potential molecular markers have been identified in different histologic subtypes of salivary cancers. The objective of this review is to highlight the molecular markers that have been targeted in clinical trials for salivary gland cancers.
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Affiliation(s)
- Katherine C Wai
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco 550 16th Street, 6th floor, UCSF Box 3213, San Francisco, CA 94158, USA
| | - Hyunseok Kang
- Department of Hematology and Oncology, University of California San Francisco, 1825 4th Street, San Francisco, CA 94158, USA
| | - Patrick K Ha
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco 550 16th Street, 6th floor, UCSF Box 3213, San Francisco, CA 94158, USA.
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6
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Combined androgen deprivation therapy in recurrent androgen-receptor-positive salivary duct carcinoma – a case report and review of the literature. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 121:599-603. [DOI: 10.1016/j.jormas.2019.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 12/27/2019] [Indexed: 12/12/2022]
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7
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Theocharis S, Tasoulas J, Masaoutis C, Kokkali S, Klijanienko J. Salivary gland cancer in the era of immunotherapy: can we exploit tumor microenvironment? Expert Opin Ther Targets 2020; 24:1047-1059. [PMID: 32744127 DOI: 10.1080/14728222.2020.1804863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Salivary gland cancers (SGCs) consist of a rare family of neoplasms with varying histology and biological behavior. Therapeutic regimens have been relatively unchanged for decades. The recent successes of immunotherapy have raised hopes for the development of more effective strategies in SGC, thus emphasizing the role of tumor microenvironment (TME) in the design for more effective therapies. AREAS COVERED This review presents an overview of the current knowledge on the pathobiology of SGC TME and discusses the potential of immunotherapeutic targeting. EXPERT OPINION Most data on the role of TME in SGC carcinogenesis are derived from preclinical studies. Signaling cascades of immunotherapeutic interest, PD-1/PD-L1 and PD-1/PD-L2, are active in many SGCs and might be associated with biological behavior and prognosis. Immunotherapeutic attempts are very limited, but recent findings in other tumors on the role of exosomes and PD-L2 signaling suggest that TME of SGCs warrants further research, emphasizing larger cohorts, histology-based stratification, and standardized evaluation of immunomodulatory molecules, to explore the potential of targeting tumor stroma and its signaling cascades. Furthermore, combination of immunotherapies or immunotherapies with the antineoplastic agents targeting AR, HER2, and tyrosine kinases, recently introduced in SGC treatment, constitutes a promising approach for the future.
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Affiliation(s)
- Stamatios Theocharis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece.,Department of Pathology, Institut Curie , Paris, France
| | - Jason Tasoulas
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Christos Masaoutis
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece
| | - Stefania Kokkali
- First Department of Pathology, Medical School, National and Kapodistrian University of Athens , Athens, Greece.,First Medical Oncology Clinic, Saint-Savvas Anticancer Hospital , Athens, Greece
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Uijen MJM, Lassche G, van Engen-van Grunsven ACH, Tada Y, Verhaegh GW, Schalken JA, Driessen CML, van Herpen CML. Systemic therapy in the management of recurrent or metastatic salivary duct carcinoma: A systematic review. Cancer Treat Rev 2020; 89:102069. [PMID: 32717621 DOI: 10.1016/j.ctrv.2020.102069] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/26/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Salivary duct carcinoma (SDC) is an aggressive subtype of salivary gland cancer. Approximately half of SDC patients will develop recurrences or metastases. Therapeutic palliative therapy is therefore often needed. The majority of SDC tumors expresses the androgen receptor (AR) and one-third expresses human epidermal growth factor receptor 2 (HER2), both are potential therapeutic targets. The aim of this paper is to systematically review and summarize the evidence on systemic palliative therapy for SDC and to provide treatment recommendations. MATERIALS AND METHODS Electronic libraries were systematically searched with a broad search strategy to identify studies where SDC patients received systemic therapy. Due to the rarity of SDC no restrictions were placed on study designs. RESULTS The search resulted in 2014 articles of which 153 were full-text analyzed. Forty-five studies were included in the analysis, which included in total 256 SDC patients receiving systemic therapy. Two phase 2 trials primarily including SDC patients were identified. The majority of the studies were case series or case reports, resulting in an overall low quality of available evidence. Based on studies including ≥ 5 SDC patients, objective responses to HER2 targeting agents were observed in 60-70%, to AR pathway agents in 18-53% and to chemotherapy in 10-50%. CONCLUSION For AR or HER2 positive SDC, agents targeting these pathways are the cornerstone for palliative treatment. Regarding chemotherapy, the combination of carboplatin combined with a taxane is best studied. Regarding other targeted agents and immunotherapy evidence is anecdotal, limiting formulation of treatment recommendations for these antineoplastic agents.
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Affiliation(s)
- M J M Uijen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - G Lassche
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A C H van Engen-van Grunsven
- Department of Pathology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Y Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - G W Verhaegh
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - J A Schalken
- Department of Urology, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C M L Driessen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C M L van Herpen
- Department of Medical Oncology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
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Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, Bruce JY, Busse PM, Caudell JJ, Cmelak AJ, Colevas AD, Eisele DW, Fenton M, Foote RL, Galloway T, Gillison ML, Haddad RI, Hicks WL, Hitchcock YJ, Jimeno A, Leizman D, Maghami E, Mell LK, Mittal BB, Pinto HA, Ridge JA, Rocco JW, Rodriguez CP, Shah JP, Weber RS, Weinstein G, Witek M, Worden F, Yom SS, Zhen W, Burns JL, Darlow SD. Head and Neck Cancers, Version 2.2020, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:873-898. [DOI: 10.6004/jnccn.2020.0031] [Citation(s) in RCA: 313] [Impact Index Per Article: 78.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Treatment is complex for patients with head and neck (H&N) cancers with specific site of disease, stage, and pathologic findings guiding treatment decision-making. Treatment planning for H&N cancers involves a multidisciplinary team of experts. This article describes supportive care recommendations in the NCCN Guidelines for Head and Neck Cancers, as well as the rationale supporting a new section on imaging recommendations for patients with H&N cancers. This article also describes updates to treatment recommendations for patients with very advanced H&N cancers and salivary gland tumors, specifically systemic therapy recommendations.
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Affiliation(s)
| | | | - David Adelstein
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Douglas Adkins
- 4Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine
| | - Yoshimi Anzai
- 5Huntsman Cancer Institute at the University of Utah
| | | | | | | | | | | | | | - David W. Eisele
- 12The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | - Moon Fenton
- 13The University of Tennessee Health Science Center
| | | | | | | | | | | | | | | | - Debra Leizman
- 3Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | | | | | - Bharat B. Mittal
- 22Robert H. Lurie Comprehensive Cancer Center of Northwestern University
| | | | | | - James W. Rocco
- 23The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | | | | | | | | | | | | | - Sue S. Yom
- 27UCSF Helen Diller Family Comprehensive Cancer Center
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10
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Takada N, Nishida H, Oyama Y, Kusaba T, Kadowaki H, Arakane M, Wada J, Urabe S, Daa T. Immunohistochemical Reactivity of Prostate-Specific Markers for Salivary Duct Carcinoma. Pathobiology 2019; 87:30-36. [PMID: 31865345 DOI: 10.1159/000504810] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Accepted: 11/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES NKX3.1, a transcription factor related to androgen expression, has recently been introduced as a diagnostic marker of prostate adenocarcinoma. Salivary duct carcinoma (SDC) is typically positive for androgen receptor (AR). Therefore, we hypothesized that NKX3.1 is a new immunohistochemical marker for SDC and aimed to investigate whether NKX3.1 staining in combination with other immunomarkers of prostate carcinoma could have a diagnostic or prognostic value in SDC. METHODS Materials obtained from 42 resected SDCs were examined by immunohistochemistry using antibodies against AR, NKX3.1, α-methylacyl-CoA racemase (AMACR), prostatic acid phosphatase (PAP), and prostate-specific antigen (PSA). RESULTS In immunoreactivity among SDC cases, 81.0, 35.7, 58.5, 33.3, and 0% were positive for AR, NKX3.1, AMACR, PAP, and PSA, respectively. AMACR and PAP immunoreactivity rates were higher in recurrence cases than in cases with no recurrence. CONCLUSIONS NKX3.1 expression is useful for SDC diagnosis, but decreased NKX3.1 expression was not correlated with SDC progression. The immunoreactivity of AMACR and PAP could be useful for assessing prognosis in SDC, but immunohistochemical staining of prostate-specific markers should be interpreted with caution when determining whether a metastatic tumor is of prostate origin, especially when patients have a history of SDC.
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Affiliation(s)
- Nami Takada
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan,
| | - Yuzo Oyama
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Takahiro Kusaba
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Hiroko Kadowaki
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Motoki Arakane
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
| | - Junpei Wada
- Department of Pathology, Clinical Laboratory, Oita Prefectural Hospital, Oita, Japan
| | - Shogo Urabe
- Department of Pathology, Clinical Laboratory, Oita Prefectural Hospital, Oita, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, Oita University, Oita, Japan
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11
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Lin VTG, Nabell LM, Spencer SA, Carroll WR, Harada S, Yang ES. First-Line Treatment of Widely Metastatic BRAF-Mutated Salivary Duct Carcinoma With Combined BRAF and MEK Inhibition. J Natl Compr Canc Netw 2019; 16:1166-1170. [PMID: 30323086 DOI: 10.6004/jnccn.2018.7056] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 06/29/2018] [Indexed: 11/17/2022]
Abstract
Salivary duct carcinoma (SDC) is a rare and aggressive malignancy for which limited data exist to guide treatment decisions. With the advent of advanced molecular testing and tumor genomic profiling, clinicians now have the ability to identify potential therapeutic targets in difficult-to-treat cancers such as SDC. This report presents a male patient with widely metastatic SDC found on targeted next-generation sequencing to have a BRAF p.V600E mutation. He experienced a prolonged and robust response to first-line systemic chemotherapy with dabrafenib and trametinib. During his response interval, new data emerged to justify subsequent treatment with both an immune checkpoint inhibitor and androgen blockade after his disease progressed. To our knowledge, this is the first report of frontline BRAF-directed therapy eliciting a response in metastatic SDC.
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12
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Gargano SM, Senarathne W, Feldman R, Florento E, Stafford P, Swensen J, Vranic S, Gatalica Z. Novel therapeutic targets in salivary duct carcinoma uncovered by comprehensive molecular profiling. Cancer Med 2019; 8:7322-7329. [PMID: 31609094 PMCID: PMC6885888 DOI: 10.1002/cam4.2602] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 09/20/2019] [Accepted: 09/22/2019] [Indexed: 01/01/2023] Open
Abstract
Salivary duct carcinoma (SDC) is a rare, aggressive salivary gland malignancy, which often presents at an advanced stage. A proportion of SDC are characterized by HER2 amplification and/or overexpression of androgen receptor (AR), which could be targeted in a subset of patients, but the presence of AR splice variant‐7 (AR‐V7) in some SDC cases could result in resistance to anti‐androgen therapy. We evaluated a cohort of 28 cases of SDC for potentially targetable biomarkers and pathways using immunohistochemistry (IHC) and next‐generation sequencing (DNA and RNA) assays. Pathogenic genetic aberrations were found in all but 1 case and affected TP53 (n = 19), HRAS (n = 7), PIK3CA, ERBB2 (HER2), and NF1 (n = 5 each); KMT2C (MLL3) and PTEN (n = 3 each); BRAF (p.V600E), KDM5C and NOTCH1 (n = 2 each). Androgen receptor was expressed in all cases and 13 of 27 harbored the AR‐V7 splice variant (including a case without any other detectable genetic alteration). HER2 IHC was expressed in 11 of 28 cases. The majority of SDC cases had no biomarkers predictive of immunotherapy response: 5 cases exhibited low (1%‐8%) programmed death ligand 1 (PD‐L1) expression in tumor cells, 2 cases exhibited elevated TMB, and no samples exhibited microsatellite instability. Notably, the pre‐treatment biopsies from 2 patients with metastatic disease, who demonstrated clinical responses to anti‐androgen therapy, showed AR expression and no AR splice variants. We conclude that comprehensive molecular profiling of SDCs can guide the selection of patients for targeted therapies involving AR, HER2, PD‐L1, mitogen‐activated protein kinase, and PIK3CA pathways.
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Affiliation(s)
- Stacey M Gargano
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | | | | | | | | | | | - Semir Vranic
- College of Medicine, QU Health, Qatar University, Doha, Qatar
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13
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Sekhri R, Ortanca I, Boals C, Agarwal S. Salivary duct carcinoma: A case report of oncocytic variant with possible treatment implications and review of literature. Pathol Res Pract 2019; 215:152549. [DOI: 10.1016/j.prp.2019.152549] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2019] [Revised: 07/17/2019] [Accepted: 07/20/2019] [Indexed: 01/10/2023]
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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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15
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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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16
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The Role of Molecular Testing in the Differential Diagnosis of Salivary Gland Carcinomas. Am J Surg Pathol 2019; 42:e11-e27. [PMID: 29076877 DOI: 10.1097/pas.0000000000000980] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Salivary gland neoplasms are a morphologically heterogenous group of lesions that are often diagnostically challenging. In recent years, considerable progress in salivary gland taxonomy has been reached by the discovery of tumor type-specific fusion oncogenes generated by chromosome translocations. This review describes the clinicopathologic features of a selected group of salivary gland carcinomas with a focus on their distinctive genomic characteristics. Mammary analog secretory carcinoma is a recently described entity characterized by a t(12;15)(p13;q25) translocation resulting in an ETV6-NTRK3 fusion. Hyalinizing clear cell carcinoma is a low-grade tumor with infrequent nodal and distant metastasis, recently shown to harbor an EWSR1-ATF1 gene fusion. The CRTC1-MAML2 fusion gene resulting from a t(11;19)(q21;p13) translocation, is now known to be a feature of both low-grade and high-grade mucoepidermoid carcinomas associated with improved survival. A t(6;9)(q22-23;p23-34) translocation resulting in a MYB-NFIB gene fusion has been identified in the majority of adenoid cystic carcinomas. Polymorphous (low-grade) adenocarcinoma and cribriform adenocarcinoma of (minor) salivary gland origin are related entities with partly differing clinicopathologic and genomic profiles; they are the subject of an ongoing taxonomic debate. Polymorphous (low-grade) adenocarcinomas are characterized by hot spot point E710D mutations in the PRKD1 gene, whereas cribriform adenocarcinoma of (minor) salivary glands origin are characterized by translocations involving the PRKD1-3 genes. Salivary duct carcinoma (SDC) is a high-grade adenocarcinoma with morphologic and molecular features akin to invasive ductal carcinoma of the breast, including HER2 gene amplification, mutations of TP53, PIK3CA, and HRAS and loss or mutation of PTEN. Notably, a recurrent NCOA4-RET fusion has also been found in SDC. A subset of SDC with apocrine morphology is associated with overexpression of androgen receptors. As these genetic aberrations are recurrent they serve as powerful diagnostic tools in salivary gland tumor diagnosis, and therefore also in refinement of salivary gland cancer classification. Moreover, they are promising as prognostic biomarkers and targets of therapy.
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17
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Villepelet A, Lefèvre M, Verillaud B, Janot F, Garrel R, Vergez S, Bertolus C, Malard O, de Gabory L, Mauvais O, Baujat B. Salivary duct carcinoma: Prospective multicenter study of 61 cases of the Réseau d'Expertise Français des Cancers ORL Rares. Head Neck 2018; 41:584-591. [PMID: 30421824 DOI: 10.1002/hed.25194] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Revised: 01/08/2018] [Accepted: 03/02/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purposes of this study were to describe the characteristics of a prospective multicenter series of patients with salivary duct carcinoma and to investigate prognostic factors. METHODS Patients included for salivary duct carcinoma between 2009 and 2016 in the Réseau d'Expertise Français des Cancers ORL Rares (REFCOR) database were selected. Immunohistochemical analyses were performed. RESULTS Sixty-one patients were included in this study. The primary site was the parotid gland in 90% of the cases. Fifty-seven percent of the tumors were stage IV, 65% of patients had lymph node involvement, and 10% had metastases. Tumors showed androgen receptor (89%) and human epidermal growth factor receptor 2 (HER2)/neu (36%). Ninety-four percent of patients underwent surgery and 86% had postoperative radiotherapy. Six patients were treated with targeted therapies. The 3-year overall survival (OS) was 74% and the 3-year disease-free survival (DFS) was 44%. Tumor stages III to IV reduced DFS (hazard ratio [HR] 4.3; P = .04). The N2/3 class reduced distant metastasis-free survival (HR 7.3; P = .007). CONCLUSION Salivary duct carcinoma prognosis is poor and is correlated with tumor stage and lymph node classification. Androgen receptor and HER2/neu should be tested as they offer the possibility of targeted therapies.
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Affiliation(s)
- Aude Villepelet
- Service d'ORL et de Chirurgie Cervicofaciale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris / Université Pierre et Marie Curie, Paris, Paris, France
| | - Marine Lefèvre
- Service d'Anatomie Pathologique, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Benjamin Verillaud
- Service d'ORL et de Chirurgie Cervicofaciale, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François Janot
- Département d'ORL et de Chirurgie Cervicofaciale, Institut Gustave-Roussy, Villejuif, Paris, France
| | - Renaud Garrel
- Service d'ORL et de Chirurgie Cervicofaciale, CHU de Montpellier, Paris, France
| | - Sébastien Vergez
- Service d'ORL et de Chirurgie Cervicofaciale, IUC Toulouse, Paris, France
| | - Chloé Bertolus
- Service de Chirurgie Maxillofaciale, Hôpital Pitié Salpétrière, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Olivier Malard
- Service d'ORL et de Chirurgie Cervicofaciale, CHU de Nantes, Paris, France
| | - Ludovic de Gabory
- Service d'ORL et de Chirurgie Cervicofaciale, CHU de Bordeaux, Paris, France
| | - Olivier Mauvais
- Service d'ORL et de Chirurgie Cervicofaciale, CHU de Besançon, Paris, France
| | - Bertrand Baujat
- Service d'ORL et de Chirurgie Cervicofaciale, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris / Université Pierre et Marie Curie, Paris, Paris, France
| | -
- Réseau d'Expertise Français des Cancers ORL Rares: (REFCOR, French Rare Head and Neck Cancer Expert Network): S. Albert, G. Andry, E. Babin, C. Bach, J.-M. Badet, C. Badoual, A.C. Baglin, A. Banal, B. Barry, E. Baudin, B. Baujat, R.J. Bensadoun, C. Bertolus, J.-P. Bessède, D. Blanchard, C. Borel, A. Bozorg-Grayeli, R. Breheret, P. Breton, L. Brugel, G. Calais, O. Casiraghi, E. Cassagnau, L. Castillo, P. Ceruse, F. Chabolle, D. Chevalier, J.C. Chobaut, O. Choussy, A. Cosmidis, A. Coste, V. Costes, L. Crampette, V. Darrouzet, P. Demez, P. Dessi, B. Devauchelle, G. Dolivet, F. Dubrulle, S. Duflo, X. Dufour, S. Faivre, N. Fakhry, C. Ferron, F. Floret, L. de Gabory, R. Garrel, L. Geoffrois, L. Gilain, A. Giovanni, A. Girod, B. Guerrier, S. Hans, P. Herman, P. Hofman, M. Housset, R. Jankowski, F. Jegoux, M. Juliéron, M.-C. Kaminsky, F. Kolb, J. Lacau St Guily, L. Laccoureye, B. Lallemant, P. Lang, E. Lartigau, J.-P. Lavieille, M. Lefevre, X. Leroy, O. Malard, F. Massip, O. Mauvais, J.-C. Merol, J. Michel, T. Mom, S. Morinière, E. de Monès, G. Moulin, G. Noel, G. Poissonnet, J.-M. Prades, D. de Raucourt, E. Reyt, C. Righini, Y. Marie Robin, F. Rolland, B. Ruhin, N. Sarroul, P. Schultz, E. Serrano, O. Sterkers, V. Strunski, A. Sudaka, M. Tassart, S. Testelin, J. Thariat, A. Timochenko, B. Toussaint, E. Uro Coste, G. Valette, T. Van den Abbeele, A. Varoquaux, F. Veillon, S. Vergez, M. Wassef
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18
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Wasano K, Sakurai K, Kawasaki T, Kusafuka K, Kasahara M, Kondo N, Inada KI, Ogawa K. Acquisition of resistance to androgen deprivation therapy in salivary duct carcinoma: A case report. Rare Tumors 2018; 10:2036361318798867. [PMID: 30263102 PMCID: PMC6149030 DOI: 10.1177/2036361318798867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 08/10/2018] [Indexed: 11/29/2022] Open
Abstract
Salivary duct carcinoma is a relatively rare salivary cancer, and most cases are
androgen receptor -positive. Salivary duct carcinoma growth is suggested to be
androgen dependent, which can reportedly be controlled by androgen deprivation
therapy. However, the effectiveness and underlying molecular mechanisms of
androgen deprivation therapy for salivary duct carcinoma remain unknown. We
report a salivary duct carcinoma case (65-year-old man) arising from the parotid
gland with metastasis to the neck lymph nodes and lungs. Androgen deprivation
therapy was performed according to the same protocol for prostate cancer
treatment. Expression levels of androgen receptor and FOXA1 (forkhead box A1)
were immunohistochemically analyzed before and after androgen deprivation
therapy. Although the tumor volume was partially diminished during the first 3
months, acquired resistance to androgen deprivation therapy occurred. FOXA1 was
not detected in parotid gland after androgen deprivation therapy, whereas
androgen receptor expression was positive. FOXA1 expression might be related to
acquired androgen deprivation therapy resistance in salivary duct carcinoma.
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Affiliation(s)
- Koichiro Wasano
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan.,Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Kouhei Sakurai
- Department of Diagnostic Pathology II, School of Medicine, Fujita Health University, Aichi, Japan
| | - Taiji Kawasaki
- Department of Otolaryngology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | | | - Masao Kasahara
- Department of Diagnostic Pathology, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Naoki Kondo
- Department of Diagnostic Pathology II, School of Medicine, Fujita Health University, Aichi, Japan
| | - Ken-Ichi Inada
- Department of Diagnostic Pathology II, School of Medicine, Fujita Health University, Aichi, Japan
| | - Kaoru Ogawa
- Department of Otolaryngology, Head and Neck Surgery, Keio University School of Medicine, Tokyo, Japan
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19
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Yang RK, Zhao P, Lu C, Luo J, Hu R. Expression pattern of androgen receptor and AR-V7 in androgen-deprivation therapy-naïve salivary duct carcinomas. Hum Pathol 2018; 84:173-182. [PMID: 30267779 DOI: 10.1016/j.humpath.2018.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 01/01/2023]
Abstract
Androgen-deprivation therapy has been used to treat salivary duct carcinoma (SDC). The androgen receptor splice variant-7 (AR-V7) has been detected in castration-resistant prostate cancer and implicated in resistance to androgen receptor (AR)-targeted therapies. Given the potential role of AR/AR-V7 in SDC treatment, this study focuses on AR/AR-V7 expression in SDC specimens collected before androgen-deprivation therapy. RNA in situ hybridization (ISH) and immunohistochemistry (IHC) to detect total AR and AR-V7 were performed on formalin-fixed, paraffin-embedded SDC specimens from 23 patients. Full-length AR and AR-V7 transcripts were quantified in a subset of tumors by reverse-transcription polymerase chain reaction. Twenty SDCs were positive for total AR by ISH and IHC. Among AR-positive SDCs, 70% (14/20) were positive for AR-V7 messenger RNA by ISH, whereas 15% (3/20) were positive for AR-V7 protein by IHC. The 3 SDCs that expressed the highest levels of AR-V7 were all from female patients; one of them expressed a significant amount of AR-V7 and barely detectable full-length AR transcripts by reverse-transcription polymerase chain reaction. IHC expression of Forkhead box protein A1, prostate-specific antigen, prostatic acid phosphatase, and NKX3.1 was observed in some SDCs regardless of patient sex. Five SDCs demonstrated strong human epidermal growth factor receptor 2 expression. We conclude that treatment-naïve SDCs may express AR-V7 at levels comparable to or even exceeding the levels detected in castration-resistant prostate cancer. Our data support the feasibility to incorporate AR-V7 assessment via ISH and/or IHC in the ongoing clinical trials evaluating the therapeutic benefit of AR-targeted therapies in SDC patients.
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Affiliation(s)
- Richard K Yang
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792, USA
| | - Pei Zhao
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Changxue Lu
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Jun Luo
- Department of Urology, James Buchanan Brady Urological Institute, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Rong Hu
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792, USA.
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20
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Corrêa TS, Matos GDR, Segura M, Dos Anjos CH. Second-Line Treatment of HER2-Positive Salivary Gland Tumor: Ado-Trastuzumab Emtansine (T-DM1) after Progression on Trastuzumab. Case Rep Oncol 2018; 11:252-257. [PMID: 29867432 PMCID: PMC5981674 DOI: 10.1159/000488669] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 01/22/2023] Open
Abstract
Patients with salivary duct cancer (SDC) and HER2 overexpression could receive trastuzumab in combination with chemotherapy for metastatic disease. No standard treatment exists for patients with HER2-positive metastatic SDC after progression. We report an excellent patient response to second-line treatment with T-DM1 after progression on paclitaxel plus trastuzumab.
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Affiliation(s)
| | | | - Marcos Segura
- Division of Medical Pathology, Lamina Pathology Laboratory, Brasilia, Brazil
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21
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Kanazawa T, Misawa K, Fukushima H, Misawa Y, Sato Y, Maruta M, Imayoshi S, Kusaka G, Kawabata K, Mineta H, Carey TE, Nishino H. Epigenetic inactivation of galanin receptors in salivary duct carcinoma of the parotid gland: Potential utility as biomarkers for prognosis. Oncol Lett 2018; 15:9043-9050. [PMID: 29805635 PMCID: PMC5958682 DOI: 10.3892/ol.2018.8525] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 02/23/2018] [Indexed: 01/21/2023] Open
Abstract
Salivary duct carcinoma (SDC) constitutes one of the most aggressive cancers in the salivary gland and is associated with a poor prognosis; however, no established systemic therapy options are available. SDC exhibits biological similarity to prostate and breast cancers, therefore anti-hormone therapy and molecular target therapies are available, however with limited beneficial effects. Galanin and galanin receptors (GALRs) are well established as molecular biomarkers to predict the survival rate and risk of recurrence of head and neck squamous cell carcinoma. The present study investigated the clinicopathological features of patients with SDC and the methylation status of their galanin and GALR genes to demonstrate the prognostic value for this disease. The median overall survival (OS) was 37.2 months. T-stage, N-stage, disease stage, tumor size, and preoperative facial paralysis were significantly associated with OS, whereas human epidermal growth factor receptor 2 (HER2) overexpression was not. GALR1 and GALR2 methylation rates in tumor tissues were significantly increased compared with normal tissues with 9.85- and 4.49-fold increase, respectively. p27kip1 and p57kip2 expression significantly inversely correlated with the methylation rate of GALR1 and GALR2. In addition, the observed GALR1 and/or GALR2 methylation rates were significantly correlated with a decrease in OS. These results suggest that GALR1 and GALR2 may serve as potential prognostic factors and therapeutic targets in SDC.
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Affiliation(s)
- Takeharu Kanazawa
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan.,Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Hirofumi Fukushima
- Division of Head and Neck, Cancer Institute, Japanese Foundation of Cancer Research, Tokyo 135-8550, Japan
| | - Yuki Misawa
- Department of Otolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Yukiko Sato
- Department of Pathology, Cancer Institute, Japanese Foundation of Cancer Research, Tokyo 135-8550, Japan
| | - Mikiko Maruta
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan
| | - Shoichiro Imayoshi
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
| | - Gen Kusaka
- Department of Neurosurgery, Jichi Medical University, Saitama Medical Center, Saitama 330-8503, Japan
| | - Kazuyoshi Kawabata
- Division of Head and Neck, Cancer Institute, Japanese Foundation of Cancer Research, Tokyo 135-8550, Japan
| | - Hiroyuki Mineta
- Department of Otolaryngology/Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Thomas E Carey
- Laboratory of Head and Neck Cancer Biology, Department of Otolaryngology/Head and Neck Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hiroshi Nishino
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
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22
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Fushimi C, Tada Y, Takahashi H, Nagao T, Ojiri H, Masubuchi T, Matsuki T, Miura K, Kawakita D, Hirai H, Hoshino E, Kamata S, Saotome T. A prospective phase II study of combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma. Ann Oncol 2018; 29:979-984. [PMID: 29211833 PMCID: PMC5913639 DOI: 10.1093/annonc/mdx771] [Citation(s) in RCA: 122] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background There is no standard first-line chemotherapy for recurrent/metastatic (RM) or unresectable locally advanced (LA) salivary gland carcinoma (SGC). Patients and methods We conducted a single institution, open-label, single arm, phase II trial of combined androgen blockade (CAB) for androgen receptor (AR)-positive SGC. Leuprorelin acetate was administered subcutaneously at a dose of 3.75 mg every 4 weeks. Bicalutamide was administered orally at a daily dose of 80 mg. Patients were treated until progressive disease or unacceptable toxicities. Results Thirty-six eligible patients were enrolled. Thirty-three patients had RM disease and three patients had LA disease. The pathological diagnoses were salivary duct carcinoma (34 patients, 94%) and adenocarcinoma, NOS (two patients, 6%). The best overall response rate was 41.7% [n = 15, 95% confidence interval (CI), 25.5%-59.2%], the clinical benefit rate was 75.0% (n = 27, 95% CI, 57.8%-87.9%). The median progression-free survival was 8.8 months (95% CI, 6.3-12.3 months) and the median overall survival was 30.5 months (95% CI, 16.8 months to not reached). Additional analyses between treatment outcomes and clinicopathological factors or biomarkers including AR positivity, human epidermal growth factor receptor 2 status, and its complex downstream signaling pathway gene mutations showed no statistically significant differences. Elevated grade 3 liver transaminases and increased serum creatinine were reported in two patients, respectively. Discontinuation of leuprorelin acetate or bicalutamide due to adverse event occurred in one patient. Conclusion This study suggests that CAB has equivalent efficacy and less toxicity for patients with AR-positive RM or unresectable LA SGC compared with conventional chemotherapy, which warrants further study. Clinical Trial Registration UMIN-CTR (http://www.umin.ac.jp/ctr/index-j.htm), identification number: UMIN000005703.
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Affiliation(s)
- C Fushimi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - Y Tada
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan.
| | - H Takahashi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Nagao
- Department of Anatomic Pathology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - H Ojiri
- Department of Radiology, The Jikei University School of Medicine, Tokyo, Japan
| | - T Masubuchi
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Matsuki
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - K Miura
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - D Kawakita
- Department of Otorhinolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - H Hirai
- Department of Anatomic Pathology, Tokyo Medical University School of Medicine, Tokyo, Japan
| | - E Hoshino
- Support Unit for Conducting Clinically Essential Studies, Graduate School of Public Health, St Luke's International University, Tokyo, Japan
| | - S Kamata
- Department of Head and Neck Oncology and Surgery, International University of Health and Welfare Mita Hospital, Tokyo, Japan
| | - T Saotome
- Division of Medical Oncology, Matsudo City Hospital, Chiba, Japan
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23
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Aro K, Tarkkanen J, Saat R, Saarilahti K, Mäkitie A, Atula T. Submandibular gland cancer: Specific features and treatment considerations. Head Neck 2017; 40:154-162. [PMID: 29083518 DOI: 10.1002/hed.24981] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/15/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In the absence of unified treatment protocol, we evaluated the management and outcomes of submandibular gland cancers in an unselected patient series. METHODS We included all patients with resected submandibular gland cancer treated at the Helsinki University Hospital from 2000 to 2010 with a 5-year minimum follow-up. RESULTS Twenty-five patients with cancer represented 30% of submandibular gland neoplasms, and most were adenoid cystic carcinomas (ACCs; 56%). At presentation, 3 patients showed clinical signs of probable malignancy. Of 22 neck dissection specimens, 5 patients (20%) had metastases with an occult metastasis rate of 4%. Cancer recurred in 11 patients (44%), of which 7 (28%) were only at a distant site. The 5-year disease-specific survival (DSS) and overall survival (OS) rates were 76%, and disease-free survival (DFS) was 68%. CONCLUSION Most tumors were ACCs differing from the histological pattern of parotid gland cancers. Occult metastases were rare. The rarity of submandibular gland cancer, its variable histological pattern, and varying biological behavior warrant centralized management.
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Affiliation(s)
- Katri Aro
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,School of Dentistry, University of California, Los Angeles, Los Angeles, California
| | - Jussi Tarkkanen
- Department of Pathology, HUSLAB, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riste Saat
- Department of Radiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Kauko Saarilahti
- Department of Radiation Oncology, HUS Cancer Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Antti Mäkitie
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Timo Atula
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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24
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Hong MH, Kim CG, Koh YW, Choi EC, Kim J, Yoon SO, Kim HR, Cho BC. Efficacy and safety of vinorelbine plus cisplatin chemotherapy for patients with recurrent and/or metastatic salivary gland cancer of the head and neck. Head Neck 2017; 40:55-62. [DOI: 10.1002/hed.24933] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 07/02/2017] [Accepted: 07/20/2017] [Indexed: 01/15/2023] Open
Affiliation(s)
- Min Hee Hong
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Chang Gon Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
- Graduate School of Medical Science and Engineering; KAIST; Daejeon Republic of Korea
| | - Yoon Woo Koh
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Eun Chang Choi
- Department of Otorhinolaryngology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Jinna Kim
- Department of Radiology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Sun Och Yoon
- Department of Pathology; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Hye Ryun Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
| | - Byoung Chul Cho
- Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center; Yonsei University College of Medicine; Seoul Republic of Korea
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25
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An Androgen Receptor-positive Carcinoma of the Lacrimal Drainage System Resembling Salivary Duct Carcinoma: Case Report and Review of the Literature. Appl Immunohistochem Mol Morphol 2017; 24:e69-71. [PMID: 26766124 DOI: 10.1097/pai.0000000000000313] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Carcinomas of the lacrimal drainage apparatus are rare and due to their aggressive behavior, they usually require extensive surgical treatment. We report a unique case of a 60-year-old man presenting with proptosis found to have a mass in the lacrimal drainage system on magnetic resonance imaging. Histology revealed a high-grade carcinoma with morphologic features of salivary gland duct carcinoma. Immunohistochemistry showed an extensive positive staining to androgen receptor. This is the first report of salivary gland-like duct carcinoma of the lacrimal drainage apparatus. Androgen receptor should be included in the immunohistochemical panel for the diagnostic work-up of lacrimal drainage system carcinomas, which resemble salivary gland duct carcinoma. This finding could have important diagnostic and therapeutic implications.
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26
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Can NT, Lingen MW, Mashek H, McElherne J, Briese R, Fitzpatrick C, van Zante A, Cipriani NA. Expression of Hormone Receptors and HER-2 in Benign and Malignant Salivary Gland Tumors. Head Neck Pathol 2017; 12:95-104. [PMID: 28681314 PMCID: PMC5873488 DOI: 10.1007/s12105-017-0833-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Accepted: 06/19/2017] [Indexed: 11/24/2022]
Abstract
With the advent of targeted therapies, expression of sex hormone receptors and HER-2 in salivary gland tumors (SGTs) is of clinical interest. Previous reports of estrogen (ER) and progesterone (PR) receptor expression have varied. Androgen receptor (AR) and HER-2 overexpression are frequently reported in salivary duct carcinoma (SDC), but have not been studied systematically in other SGTs. This study examines ER, PR, AR, and HER-2 expression in SGTs. Immunohistochemistry for ER, PR, AR, and HER-2 was performed on 254 SGTs (134 malignant). ER, PR, and AR expression was scored using Allred system. HER-2 expression was scored using Dako HercepTest guidelines. FISH for HER-2 amplification was performed on select cases with HER-2 overexpression (2-3+). No SGT demonstrated strong expression of ER or PR. Combined strong AR and HER-2 expression was seen in 22 carcinomas: 14/25 SDC, 3/16 poorly differentiated, two oncocytic, and one each carcinoma ex pleomorphic adenoma, squamous cell, and intraductal carcinoma. Eighteen additional high grade carcinomas had HER-2 overexpression with absent, weak, or moderate AR expression; eight high grade carcinomas had isolated strong AR expression with 0-1+ HER-2 staining. Of 15 tested cases, six demonstrated HER-2 amplification by FISH, all of which had 3+ immunoreactivity. Neither benign nor malignant SGTs had strong expression of ER or PR. None of the benign SGTs overexpressed AR or HER-2. Coexpression of AR and HER-2 should not define SDC, but immunostaining should be considered in high grade salivary carcinomas, as some show overexpression and may benefit from targeted therapy.
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Affiliation(s)
- Nhu Thuy Can
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA ,Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Mark W. Lingen
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
| | - Heather Mashek
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - James McElherne
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Renee Briese
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Carrie Fitzpatrick
- Constitutional Cytogenetics and Cytogenomics, Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, Chicago, IL 60637 USA
| | - Annemieke van Zante
- Department of Pathology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143 USA
| | - Nicole A. Cipriani
- Department of Pathology, The University of Chicago Medicine, 5841 S. Maryland Ave, MC 6101, Chicago, IL 60637 USA
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27
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Khoo TK, Yu B, Smith JA, Clarke AJ, Luk PP, Selinger CI, Mahon KL, Kraitsek S, Palme C, Boyer MJ, Dinger ME, Cowley MJ, O'Toole SA, Clark JR, Gupta R. Somatic mutations in salivary duct carcinoma and potential therapeutic targets. Oncotarget 2017; 8:75893-75903. [PMID: 29100278 PMCID: PMC5652672 DOI: 10.18632/oncotarget.18173] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 03/20/2017] [Indexed: 02/01/2023] Open
Abstract
Background Salivary duct carcinomas (SDCa) are rare highly aggressive malignancies. Most patients die from distant metastatic disease within three years of diagnosis. There are limited therapeutic options for disseminated disease. Results 11 cases showed androgen receptor expression and 6 cases showed HER2 amplification. 6 Somatic mutations with additional available targeted therapies were identified: EGFR (p.G721A: Gefitinib), PDGFRA (p.H845Y: Imatinib and Crenolanib), PIK3CA (p.H1047R: Everolimus), ERBB2 (p.V842I: Lapatinib), HRAS (p.Q61R: Selumetinib) and KIT (p.T670I: Sorafenib). Furthermore, alterations in PTEN, PIK3CA and HRAS that alter response to androgen deprivation therapy and HER2 inhibition were also seen. Materials and Methods Somatic mutation analysis was performed on DNA extracted from 15 archival cases of SDCa using the targeted Illumina TruSeq Amplicon Cancer Panel. Potential targetable genetic alterations were identified using extensive literature and international somatic mutation database (COSMIC, KEGG) search. Immunohistochemistry for androgen receptor and immunohistochemistry and fluorescent in situ hybridization for HER2 were also performed. Conclusions SDCa show multiple somatic mutations, some that are amenable to pharmacologic manipulation and others that confer resistance to treatments currently under investigation. These findings emphasize the need to develop testing and treatment strategies for SDCa.
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Affiliation(s)
- Timothy K Khoo
- Central Clinical School, The University of Sydney, Australia
| | - Bing Yu
- Central Clinical School, The University of Sydney, Australia.,Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Joel A Smith
- The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Angus J Clarke
- Central Clinical School, The University of Sydney, Australia
| | - Peter P Luk
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Christina I Selinger
- Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Kate L Mahon
- Central Clinical School, The University of Sydney, Australia.,The Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Spiridoula Kraitsek
- Department of Medical Genomics, Royal Prince Alfred Hospital, Sydney, Australia
| | - Carsten Palme
- Central Clinical School, The University of Sydney, Australia.,The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia
| | - Michael J Boyer
- Central Clinical School, The University of Sydney, Australia.,The Department of Medical Oncology, Chris O'Brien Lifehouse, Sydney, Australia
| | - Marcel E Dinger
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | - Mark J Cowley
- Kinghorn Cancer Centre and Garvan Institute of Medical Research, Darlinghurst, Sydney, Australia
| | - Sandra A O'Toole
- Central Clinical School, The University of Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Jonathan R Clark
- Central Clinical School, The University of Sydney, Australia.,The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,South West Clinical School, University of New South Wales, Sydney, Australia
| | - Ruta Gupta
- Central Clinical School, The University of Sydney, Australia.,The Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, Australia.,Department of Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
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28
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Keller G, Steinmann D, Quaas A, Grünwald V, Janssen S, Hussein K. New concepts of personalized therapy in salivary gland carcinomas. Oral Oncol 2017; 68:103-113. [PMID: 28325631 DOI: 10.1016/j.oraloncology.2017.02.018] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/18/2017] [Accepted: 02/20/2017] [Indexed: 12/13/2022]
Abstract
Salivary gland carcinomas are rare tumours and therapy strategies are less standardized than in lung, gastric or breast cancer. Therapy is based on surgery, but not all carcinomas are completely resectable, e.g. because carcinomas often show infiltration of nerves. For further therapy decision pathology is recommended, but evaluation of potential targets for personalized therapy is not part of the routine panel. Many salivary gland carcinomas can be resistant to radio- and/or chemotherapy, which limits therapeutic options. This review summarizes new concepts for personalized therapy in salivary gland carcinoma patients. Targeting growth receptors HER2, EGFR, AR and ER is possible but, in some studies, potential target molecules were not adequately tested before therapy. In addition, approximately 20-25% of carcinomas have RAS mutation (mainly H-RAS), which could explain resistance to therapy. Possible therapy options in the future could be immunomodulation (inhibition of PDL1/PD1 signalling), nanoparticles (gold nanoparticles conjugated to cetuximab can increase radiosensitivity) and drug delivery systems (trastuzumab emtansine/T-DM1).
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Affiliation(s)
- Gunter Keller
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany; Department of Cranio-Maxillo-Facial Surgery, Henriettenstift, Hannover, Germany
| | - Diana Steinmann
- Institute for Radiation Therapy and Special Oncology, Hannover Medical School (MHH), Hannover, Germany
| | - Alexander Quaas
- Institute of Pathology, University Hospital Cologne, Cologne, Germany
| | - Viktor Grünwald
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School (MHH), Hannover, Germany
| | | | - Kais Hussein
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany.
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29
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Griffith CC, Schmitt AC, Little JL, Magliocca KR. New Developments in Salivary Gland Pathology: Clinically Useful Ancillary Testing and New Potentially Targetable Molecular Alterations. Arch Pathol Lab Med 2017; 141:381-395. [PMID: 28234570 DOI: 10.5858/arpa.2016-0259-sa] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Accurate diagnosis of salivary gland tumors can be challenging because of the many diagnostic entities, the sometimes extensive morphologic overlap, and the rarity of most tumor types. Ancillary testing is beginning to ameliorate some of these challenges through access to newer immunohistochemical stains and fluorescence in situ hybridization probes, which can limit differential diagnostic considerations in some cases. These ancillary testing strategies are especially useful in small biopsy samples, including aspiration cytology. Molecular techniques are also expanding our understanding of salivary gland tumor pathology and are helping to identify potential targets that may improve treatment for some of these tumors. Here, we summarize the clinical use of new immunohistochemical markers in our practice and review the current understanding of chromosomal rearrangements in salivary gland tumor pathology, emphasizing the prospects for exploiting molecular alterations in salivary gland tumors for diagnosis and targeted therapy. We find that immunohistochemistry and fluorescence in situ hybridization are powerful tools toward the diagnosis of salivary gland tumors, especially when used in a systematic manner based on morphologic differential-diagnostic considerations. As new targeted therapies emerge, it will become increasingly vital to incorporate appropriate molecular testing into the pathologic evaluation of salivary gland cancers.
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Affiliation(s)
| | | | | | - Kelly R Magliocca
- From the Department of Pathology & Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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30
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Androgen Receptor Signaling in Salivary Gland Cancer. Cancers (Basel) 2017; 9:cancers9020017. [PMID: 28208703 PMCID: PMC5332940 DOI: 10.3390/cancers9020017] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/28/2017] [Accepted: 02/03/2017] [Indexed: 11/17/2022] Open
Abstract
Salivary gland cancers comprise a small subset of human malignancies, and are classified into multiple subtypes that exhibit diverse histology, molecular biology and clinical presentation. Local disease is potentially curable with surgery, which may be combined with adjuvant radiotherapy. However, metastatic or unresectable tumors rarely respond to chemotherapy and carry a poorer prognosis. Recent molecular studies have shown evidence of androgen receptor signaling in several types of salivary gland cancer, mainly salivary duct carcinoma. Successful treatment with anti-androgen therapy in other androgen receptor-positive malignancies such as prostate and breast cancer has inspired researchers to investigate this treatment in salivary gland cancer as well. In this review, we describe the prevalence, biology, and therapeutic implications of androgen receptor signaling in salivary gland cancer.
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31
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Seethala RR, Griffith CC. Molecular Pathology: Predictive, Prognostic, and Diagnostic Markers in Salivary Gland Tumors. Surg Pathol Clin 2016; 9:339-352. [PMID: 27523965 DOI: 10.1016/j.path.2016.04.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although initial attempts at using ancillary studies in salivary gland tumor classification were viewed with skepticism, numerous advances over the past decade have established a role for assessment of molecular alterations in the diagnosis and potential prognosis and treatment of salivary gland tumors. Many monomorphic salivary tumors are now known to harbor defining molecular alterations, usually translocations. Pleomorphic, high-grade carcinomas tend to have complex alterations that are often further limited by inaccuracy of initial classification by morphologic and immunophenotypic features. Next-generation sequencing techniques have great potential in many aspects of salivary gland tumor classification and biomarker discovery.
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Affiliation(s)
- Raja R Seethala
- Department of Pathology and Laboratory Medicine, Presbyterian University Hospital, University of Pittsburgh, 200 Lothrop Street, Pittsburgh, PA 15213, USA.
| | - Christopher C Griffith
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Midtown 550 Peachtree Street, Atlanta, GA 30308, USA
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32
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Kure S, Wada R, Peng WX, Ishii H, Kitamura T, Fujii T, Inai S, Nagao T, Naito Z. A case of oncocytic papillary cystadenocarcinoma of the parotid gland—Pathological and molecular features of a rare tumor. HUMAN PATHOLOGY: CASE REPORTS 2016. [DOI: 10.1016/j.ehpc.2015.10.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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33
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Andersson MK, Stenman G. The landscape of gene fusions and somatic mutations in salivary gland neoplasms - Implications for diagnosis and therapy. Oral Oncol 2016; 57:63-9. [PMID: 27101980 DOI: 10.1016/j.oraloncology.2016.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/01/2016] [Indexed: 12/15/2022]
Abstract
Recent studies of the genomic landscape of salivary gland tumors have provided important insights into the molecular pathogenesis of these tumors. The most consistent alterations identified include a translocation-generated gene fusion network involving transcription factors, transcriptional coactivators, tyrosine kinase receptors, and other kinases. In addition, next-generation sequencing studies of a few subtypes of salivary neoplasms have revealed hotspot mutations in individual genes and mutations clustering to specific pathways frequently altered in cancer. Although limited, these studies have opened up new avenues for improved classification and targeted therapies of salivary gland cancers. In this review, we summarize the latest developments in this field, focusing on tumor types for which clinically important molecular data are available.
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Affiliation(s)
- Mattias K Andersson
- Sahlgrenska Cancer Center, Department of Pathology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Göran Stenman
- Sahlgrenska Cancer Center, Department of Pathology, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
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34
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Lemound J, Schenk M, Keller G, Stucki-Koch A, Witting S, Kreipe H, Hussein K. Cytogenetic and immunohistochemical biomarker profiling of therapy-relevant factors in salivary gland carcinomas. J Oral Pathol Med 2016; 45:655-663. [PMID: 27037970 DOI: 10.1111/jop.12429] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2015] [Indexed: 12/22/2022]
Abstract
OBJECTIVES There is currently no established algorithm for the molecular profiling of therapy-relevant defects in salivary gland carcinomas (SGC). HER2 overexpression in a subfraction of SGC and low frequencies of EGFR mutations are known. Here, we established receptor and cell signalling profiles of 17 therapy-relevant factors and propose a molecular diagnostic algorithm for SGC. MATERIALS AND METHODS Formalin-fixed and paraffin-embedded tissue samples from SGC (n = 38) were analysed with immunohistochemistry and fluorescence in situ hybridisation (FISH). RESULTS Two or more expressed receptors and/or receptor gene amplification were detectable in eight of 38 (21%) tumours: HER2 3+/AR 1+, HER3 gene amplification/AR 1+/EGFR 1+, ER 3+/AR 1+, EGFR 2+/PR 1+ and EGFR 2+/PR 1+/AR 1+. No FGFR1-3, MET, ALK1, ROS1, RET, BRAF nor VEGFA defects were detectable, and ERCC1 was not overexpressed. No PD1+ tumour-infiltrating T cells were detectable. CONCLUSION Personalised therapy of patients with salivary gland carcinomas should include HER2 and EGFR signalling testing and, in negative cases, evaluation of rare potential target molecules. ERCC1 and PD1 do not appear to be reliable markers for the decision for or against chemotherapy or immunotherapy, respectively.
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Affiliation(s)
- Juliana Lemound
- Department of Cranio-Maxillo-Facial Surgery, Hannover Medical School (MHH), Hannover, Germany
| | - Maxie Schenk
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Gunter Keller
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | | | - Sandra Witting
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Hans Kreipe
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany
| | - Kais Hussein
- Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany.
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35
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Mifsud M, Sharma S, Leon M, Padhya T, Otto K, Caudell J. Salivary Duct Carcinoma of the Parotid: Outcomes with a Contemporary Multidisciplinary Treatment Approach. Otolaryngol Head Neck Surg 2016; 154:1041-6. [PMID: 26980918 DOI: 10.1177/0194599816636812] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 02/11/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Salivary duct carcinoma (SDC) is a rare and aggressive malignancy for which an optimal treatment algorithm is lacking. We endeavored to assess the current treatment outcomes for SDC with a multimodality treatment approach combining surgery with adjuvant radiotherapy ± concurrent chemotherapy. STUDY DESIGN Case series with chart review. SETTING A National Cancer Institute-designated comprehensive cancer center. SUBJECTS AND METHODS The clinical record of 17 patients with salivary duct carcinoma were analyzed to assess locoregional control, recurrence-free survival, and overall survival. RESULTS All SDC cases (n = 17) were managed with surgical resection, followed by adjuvant radiotherapy (47.1%) or concurrent chemotherapy and radiotherapy (52.9%). Median patient follow up was 37 months. An aggressive disease course was generally observed, with 3-year recurrence-free survival and overall survival of 34.4% and 35.5%, respectively. The majority of recurrences were distant. Intensification with adjuvant concurrent chemotherapy was not associated with improved outcomes on univariate survival analysis. CONCLUSION For salivary duct carcinoma, a multimodality treatment approach is associated with acceptable locoregional control rates but poor distant control and overall survival. Novel systemic therapies may be needed to optimize clinical outcomes.
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Affiliation(s)
- Matthew Mifsud
- Department of Otolaryngology-Head and Neck Surgery, University of Toronto, Toronto, Canada Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Saurabh Sharma
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Marino Leon
- Department of Pathology, H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, Florida, USA
| | - Tapan Padhya
- Department of Otolaryngology-Head and Neck Surgery, University of South Florida Morsani College of Medicine, Tampa, Florida, USA Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, Florida, USA
| | - Kristen Otto
- Department of Head and Neck and Endocrine Oncology, H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, Florida, USA
| | - Jimmy Caudell
- Department of Radiation Oncology, H. Lee Moffitt Comprehensive Cancer Center and Research Institute, Tampa, Florida, USA
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36
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Breinholt H, Elhakim MT, Godballe C, Andersen LJ, Primdahl H, Kristensen CA, Bjørndal K. Salivary duct carcinoma: a Danish national study. J Oral Pathol Med 2016; 45:664-671. [PMID: 26822194 DOI: 10.1111/jop.12426] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2015] [Indexed: 01/06/2023]
Abstract
BACKGROUND To present the first national series of salivary duct carcinoma patients, including survival rates and an analysis of prognostic factors. METHODS By merging three Danish nationwide registries that encompass an entire population, 34 patients diagnosed with salivary duct carcinoma from 1990 to 2005 were identified. Histological slides were reviewed, and data concerning demographics, tumour site, clinical stage, treatment profiles and follow-up were retrieved. Survival estimates and prognostic factors were evaluated by comparing Kaplan-Meier plots using the Mantel-Haenszel log-rank test. RESULTS Salivary duct carcinoma showed an incidence of 0.04/100.000 inhabitants/year. Distant recurrence was seen in 52% of patients. Five-year overall survival, disease-specific survival and recurrence-free survival were 32%, 42% and 35%, respectively. Univariate analyses suggested that overall stage (III/IV) and vascular invasion have a negative impact on all survival measures. Involved resection margins correlated with a poorer overall survival and disease-specific survival, whereas adjuvant radiotherapy improved overall survival and recurrence-free survival. CONCLUSIONS Salivary duct carcinoma incidence averages to two episodes per year in the entire Kingdom of Denmark. With half of patients in this study experiencing distant recurrences and only a third surviving at 5 years, prognosis is dismal. Advanced overall stage, vascular invasion and involved resection margins all seem to correlate with a poorer survival, while adjuvant radiotherapy significantly improved outcome. Extensive T-site surgery, neck dissection and adjuvant radiotherapy are therefore recommended.
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Affiliation(s)
- Helle Breinholt
- Department of ORL - Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | | | - Christian Godballe
- Department of ORL - Head and Neck Surgery, Odense University Hospital, Odense, Denmark
| | | | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Claus A Kristensen
- Department of Oncology, Copenhagen University Hospital/Rigshospitalet, Copenhagen, Denmark
| | - Kristine Bjørndal
- Department of ORL - Head and Neck Surgery, Odense University Hospital, Odense, Denmark.
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37
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Vagia E, Economopoulou P, Oikonomopoulos N, Athanasiadis I, Dimitriadis G, Psyrri A. Androgen-Receptor Positive Lacrimal Sac Adenocarcinoma Demonstrating Long-Lasting Response to LHRH Analog Plus Abiraterone Treatment. Front Oncol 2015; 5:10. [PMID: 25699235 PMCID: PMC4313611 DOI: 10.3389/fonc.2015.00010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 01/12/2015] [Indexed: 11/13/2022] Open
Abstract
Tumors arising at the lacrimal sac are extremely rare, as a limited number of cases have been reported worldwide. They are commonly primary and the majority of them are malignant and epithelial in origin. Adenocarcinomas account for a small percentage of these tumors. Treatment of local disease mainly includes complete surgical resection. However, metastatic disease has a poor prognosis and the development of new treatment strategies is highly important. Research efforts mainly focus on the identification of molecular targets for therapy. Herein, we describe for the first time a case of a patient with an androgen receptor expressing adenocarcinoma of the lacrimal sac that had an impressive response to abiraterone.
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Affiliation(s)
- Elena Vagia
- Oncology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University Hospital , Haidari , Greece
| | - Panagiota Economopoulou
- Oncology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University Hospital , Haidari , Greece
| | | | | | - George Dimitriadis
- Oncology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University Hospital , Haidari , Greece
| | - Amanda Psyrri
- Oncology Unit, 2nd Department of Internal Medicine - Propaedeutic, Attikon University Hospital , Haidari , Greece
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