How is salivary gland cancer treated?

The treatment of salivary gland cancer depends on several factors, including the type, stage, and location of the cancer, as well as the patient's overall health and preferences. The main treatment options for salivary gland cancer include:

1. Surgery: Surgery is the primary treatment for most types of salivary gland cancer. The goal of surgery is to remove the tumor and surrounding tissue, and in some cases, nearby lymph nodes or other structures. The extent of surgery depends on the location and size of the tumor, as well as the stage of the cancer.

2. Radiation therapy: Radiation therapy may be used alone or in combination with surgery to destroy any remaining cancer cells and reduce the risk of recurrence. It may also be used as the primary treatment for small tumors or for tumors that cannot be completely removed with surgery.

3. Chemotherapy: Chemotherapy is not typically used as the primary treatment for salivary gland cancer, but may be used in combination with radiation therapy for advanced or recurrent tumors.

4. Targeted therapy: Targeted therapies are drugs that specifically target certain molecules or proteins that are involved in cancer growth and spread. They may be used in combination with other treatments for advanced or recurrent salivary gland cancer.

5. Palliative care: Palliative care is a type of supportive care that focuses on improving the quality of life for patients with advanced or incurable cancer. It may include pain management, symptom relief, and emotional support.

The treatment of salivary gland cancer is often complex and requires a multidisciplinary team of specialists, including head and neck surgeons, radiation oncologists, medical oncologists, and pathologists. The choice of treatment depends on several factors, including the type and stage of cancer, as well as the patient's overall health and preferences. It is important to discuss the potential benefits and risks of each treatment option with a specialist in cancer treatment.

Rivoceranib trial data. Most of my conversations this week were about rivoceranib in adenoid cystic carcinoma …. Summary of trial results presented at ASCO below:

A phase 2 study of the oral vascular endothelial growth factor receptor 2 (VEGFR2) inhibitor rivoceranib for recurrent or metastatic (R/M) adenoid cystic carcinoma (ACC).

Presented by Dr Hyunseok Kang and colleagues at ASCO22.

In this single-arm, open-label trial, patients with R/ M ACC with evidence of ≥20% progression by RECIST v1.1 or new lesions within the preceding 6 mo were eligible; there was no limit on prior tx. Pts received rivoceranib 700 mg once dailY.

Results: 80 pts (72 evaluable) were enrolled at 11 sites in the US and Korea (53% male; median age: 55 yr). Primary tumor sites: major (34%) and minor (59%) salivary glands and other (8%). 5 (6%) pts had locoregional disease only and 74 (93%) had metastatic dis- ease. Most had prior surgery (89%) and radiation (96%); 53% had prior systemic tx (44% chemother- apy; 18% VEGFR TKI). Median follow-up was 15 mo (2–19); 20 pts remain on tx. PI-assessed efficacy data are listed in the table. ORR in pts with or without prior systemic tx was 13.9% and 16.9%, re- spectively. ORR by CHOI was 50.8% overall (51% VEGFR TKI-naive and 50% VEGFR TKI treated). 18% of pts discontinued tx, 74% had at least 1 dose reduction, and 93% dose interruption for adverse events (AEs). All pts had ≥1 AE and 80% had Grade ≥3 AEs, including 3 Grade 5 AEs (2 epistaxis [1 related], 1 acute respiratory failure). Common (> 30%) AEs were hypertension (65%), fatigue (61%), nausea and headache (50%), stomatitis (46%), diarrhea (40%), decreased appetite (38%), protein- uria (36%) and palmar-plantar erythrodysesthesia syndrome (34%). Grade ≥3 AEs in ≥5% of pts were hypertension (43%), stomatitis (8%), fatigue and anemia (6%), and back pain and pneumothorax (5%).

ASCO 2022 Innovations in Salivary Cancers

Just arrived back in the UK after giving the discussant lecture introducing the salivary cancer session at ASCO (American Society of Clinical Oncology) Annual Meeting in Chigago!

I introduced three salivary cancer trials which reported this weekend and am posting the details below for people to look up:

A phase 2 clinical trial of axitinib and avelumab in patients with recurrent/metastatic adenoid cystic carcinoma (ACC) by Dr Ferrarotto and colleagues.

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2022.40.16_suppl.6019

A phase 2 study of the oral vascular endothelial growth factor receptor 2 (VEGFR2) inhibitor, rivoceranib, for recurrent or metastatic (R/M) adenoid cystic carcinoma (ACC) by Dr Kang and colleagues.

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2022.40.16_suppl.6020

Phase II study of trastuzumab-pkrb and docetaxel anhydrous combination therapy in recurrent or metastatic salivary ductal carcinomas (KCSG HN18-08/KM11) by Dr Lee and colleagues.

https://ascopubs.org/doi/pdfdirect/10.1200/JCO.2022.40.16_suppl.6018

2018/19 A Year of Real Progress in Salivary Gland Cancer Research

The last year has been a really exciting time and there has been so much progress in salivary gland cancer research. I am personally really excited by the progress of the clinical, translational and laboratory program I am developing at The Christie/CRUK Manchester Institute and across the UK network as well as those through the combined efforts of the International salivary gland cancer research community. I have been so busy with my research program that I haven’t posted any updates. However, I am having my first proper break now since Christmas, and have had a chance to stop and reflect on all the progress. I have listed just a few of the items below and I will expand on these topics over the next few weeks …. but in brief:

• The UK adenoid cystic carcinoma patient group has held face-to-face meetings on three occasions through 2018/19 with 40-50 people attending each meeting - which I think makes us the World’s largest face-to-face ACC national body. I jointly lead these with Emma Kinloch, but thanks so much to Emma for all the hard work as she does the lions share of the organising.

• We have formally established a charity salivaryglandcancer.uk to support the activity of the UK patient group and professional community (thanks so much again to Emma who put so much work into this).

• Through the salivary gland clinic in Manchester I have begun collecting the samples to develop the World’s largest fully clinically annotated sequencing bio-repository (whole exome, transcriptome and immune phenotyping) for adenoid cystic carcinoma patients (part of The Ella Project). This is generously funded though two charitable foundations (Syncona Foundation and the Infrastructure Industry Foundation) with the support of the FightBACC events hosted by Ella and her family and friends.

• I presented the results of the first 100 patients that I sequenced with focused genomic profiling though the salivary gland cancer trials clinic at The Christie (using a targeted next generation sequencing panel) at ASCO annual meeting, Chicago - this is the global oncology meeting for these clinical/translational studies.

• In parallel to the patient-facing side of my life, I have made really exciting progress setting up a laboratory research program into adenoid cystic carcinoma: I had an interview with the Cancer Research UK Clinical Careers Committee in late 2018 and have been invited to reapply for funding with the data I generate through 2019/20.

• I was honoured to present an update on my clinical, translational and laboratory research program at the Updated in Adenoid Cystic Carcinoma Translation Research Meeting held at Massachusetts General Hospital in March 2019 (noted by the US ACC Research Foundation) - it was an inspirational weekend with talks by all ‘the great and the good’ of the global ACC research community.

• From the International research community there have been a flurry of studies looking at targeted therapies in sub-groups of salivary gland cancer patients: androgen deprivation therapy in AR over expressing ductal carcinoma; entrectinib in NTRK rearranged secretory carcinoma; lorotrectinib in NTRK rearranged secretory carcinoma; trastuzumab and docetaxel in HER2 over expressing salivary gland cancer; ado-trastuzumab emtansine in HER2 amplified/over-expressing salivary gland cancer; neratinib in ERBB2 mutated solid tumours; and lenvatinib in adenoid cystic carcinoma. In addition, there are studies recruiting in NOTCH mutated adenoid cystic carcinoma and RET rearranged intra-ductal carcinoma which I will be recruiting to through 2019/20.

Salivary Gland Cancer Clinic at The Christie, Manchester

One achievement which makes me most proud is having set up a clinic at The Christie NHS Foundation Trust for patients with Salivary Gland Cancer. This Salivary Gland Cancer clinic is integrated with leading researchers at the CRUK Manchester Institute, The University of Manchester, the Experimental Cancer Medicine Team and the Head and Neck Cancer Clinical Team.

Through this clinic, patients with Salivary Gland Caner have the opportunity to be involved in research incorporating both tumour profiling and new drug therapies. This is a unique clinic focussed on developing new drug treatments for Salivary Gland Cancer.

Patients often ask what motivated me set up a clinic for such a rare disease. In 2012 - 2016 I studied for my PhD in the Lab of Prof Caroline Dive at the CRUK Manchester Institute, which was focussed on lung cancer. However, I identified that in Manchester there was a real opportunity for this same research to benefit patients with Head and Neck Cancers. In 2016/17 I set up a Medical Oncology practice connecting the Head and Neck Caner and Experimental Cancer Medicine Teams at The Christie. Within this clinic, it soon became obvious that the greatest unmet need was for patients with Salivary Gland Cancers where there have been very few effective drug treatments discovered in the last 50 years.

With the support of the Head and Neck Cancer clinical community across the UK, this has become a real success. Seeing 2 new patients per week, we have moved clinic space twice to increase our capacity and now take pride of place in the new Clinical Research Facility at The Christie. 

It is the direct link to the patients through this clinic that still motivates me to develop a laboratory research program and clinical trial portfolio for Salivary Gland Cancer with the aim of developing new treatments. It is only possible to do this because I am part of a large and successful research and clinical programme in the CRUK Manchester Institute/University of Manchester, and the Head and Neck and Experimental Cancer Medicine Teams at The Christie.

Dr Metcalf is an Honorary Consultant Medical Oncologist at The Christie NHS Foundation Trust and Clinician Scientist at the Cancer Research UK Manchester Institute. He leads the Head and Neck Cancer Medical Oncology Services at The Christie NHS.