Goyal Gaurav, Mehdi Syed A, Ganti Apar Kishor
Oncology (Williston Park). 2015 Oct;29(10):773-80.
Salivary gland tumors are a relatively rare and heterogeneous group of tumors with variable pathologic and phenotypic characteristics. The lack of clinical outcomes data and randomized controlled trials pertaining to them makes it difficult to formulate definitive treatment protocols that could help with making decisions regarding choice of therapy. Most studies involving systemic chemotherapy have not shown promising patient outcome results. With recent advances in molecular technology, however, it is now possible to identify specific genetic alterations and biomarkers as possible targets for therapeutic purposes. For example, in mucoepidermoid carcinomas, one of the most common types of malignant salivary gland tumors, a commonly seen genetic translocation [t(11;19)(q21;p13), which involves the CRTC1 and MAML2 genes] has been found to be associated with improved survival, making it a possible prognostic marker. Also, this translocation gives rise to a fusion protein that appears to render tumors highly sensitive to epidermal growth factor receptor (EGFR) inhibition. However, the results of phase II trials of EGFR inhibitors-as well as other targeted agents--in salivary gland tumors have been disappointing: there has been some disease stabilization but no objective responses. There remains a need for well-designed prospective clinical studies to improve management of these tumors.
涎腺肿瘤是一组相对罕见且异质性的肿瘤，具有多样的病理和表型特征。缺乏关于它们的临床结局数据和随机对照试验，使得制定有助于做出治疗选择决策的明确治疗方案变得困难。大多数涉及全身化疗的研究并未显示出有前景的患者结局结果。然而，随着分子技术的最新进展，现在有可能识别特定的基因改变和生物标志物作为潜在的治疗靶点。例如，在黏液表皮样癌（最常见的恶性涎腺肿瘤类型之一）中，已发现一种常见的基因易位[t(11;19)(q21;p13)，涉及CRTC1和MAML2基因]与生存率提高相关，使其成为一种可能的预后标志物。此外，这种易位产生一种融合蛋白，似乎使肿瘤对表皮生长因子受体（EGFR）抑制高度敏感。然而，EGFR抑制剂以及其他靶向药物在涎腺肿瘤中的II期试验结果令人失望：虽有一些疾病稳定情况，但无客观缓解。仍需要设计良好的前瞻性临床研究来改善这些肿瘤的管理。
