2023 Volume 69 Issue 4 Pages 178-184
Systemic therapy for salivary gland carcinoma (SGC) is indicated for recurrent and/or metastatic (RM) disease. The background, goals of therapy, organ function, symptomatic or a symptomatic, and histopathology should be considered in each case. Adenoid cystic carcinoma with only lung metastasis often progresses slowly and many cases are followed up without therapy, whereas salivary duct carcinoma, adenocarcinoma NOS, or adenoid cystic carcinoma with multiple metastases, including lung, liver, and bone, often require the early introduction of systemic therapy.
The selection of drugs for RM SGC is often based on drugs approved for squamous cell carcinoma of the head and neck, and relatively favorable results have been reported for combination chemotherapy with platinum and taxane. On the other hand, in recent years, personalized therapies based on biomarkers have been developed. Two U.S. guidelines already recommend drug selection based on biomarkers of androgen receptor (AR) status, NTRK gene fusion, HER2 status, and tumor mutation burden (TMB): Leuprorelin and Bicalutamide for AR-positive cases, Larotrectinib or Entrectinib for NTRK gene fusion-positive cases, Trastuzumab, Trastuzumab + Pertuzumab, Trastuzumab emtansine, Trastuzumab + Docetaxel, and Trastuzumab deruxtecan for HER2-positive cases, and Pembrolizumab for TMB-high cases, respectively. In Japan, Trastuzumab was approved for HER2-positive SGCs in November 2021.
