Thorpe Lauren M, Schrock Alexa B, Erlich Rachel L, Miller Vincent A, Knost James, Le-Lindqwister Nguyet, Jujjavarapu Srinivas, Ali Siraj M, Liu Jane J
Foundation Medicine Inc, Cambridge, Massachusetts.
Illinois Cancer Care, Peoria, Illinois.
Head Neck. 2017 Mar;39(3):E40-E44. doi: 10.1002/hed.24634. Epub 2016 Dec 22.
Salivary ductal carcinoma and carcinoma ex pleomorphic adenoma (CEPA) are aggressive salivary gland cancers with poor prognosis. The standard of care is resection with or without radiotherapy, and there are no established systemic therapy options.
We describe 1 patient with metastatic CEPA and 1 patient with metastatic recurrent salivary duct carcinoma whose tumors were evaluated by comprehensive genomic profiling. Testing identified human epidermal growth factor receptor 2 (HER2) amplification in both patients, and an additional activating HER2 mutation in the CEPA case.
Both patients were treated with the HER2-targeting monoclonal antibody trastuzumab (herceptin) plus chemotherapy and experienced rapid responses. Subsequently, both patients were given single-agent maintenance trastuzumab and continue to experience durable disease control.
Given the poor prognosis for salivary gland cancers and the limited treatment options upon recurrence or metastasis, patients should be tested for all classes of HER2 alterations. In cases with HER2 overexpression or activation, targeted therapies, such as trastuzumab are promising. © 2016 Wiley Periodicals, Inc. Head Neck 39: E40-E44, 2017.
涎腺导管癌和多形性腺瘤癌变（CEPA）是侵袭性涎腺癌，预后较差。治疗标准是手术切除并辅以或不辅以放疗，目前尚无既定的全身治疗方案。
我们描述了1例转移性CEPA患者和1例转移性复发性涎腺导管癌患者，其肿瘤通过综合基因组分析进行评估。检测发现两名患者均存在人表皮生长因子受体2（HER2）扩增，且CEPA病例中还存在额外的HER2激活突变。
两名患者均接受了靶向HER2的单克隆抗体曲妥珠单抗（赫赛汀）联合化疗，且反应迅速。随后，两名患者均接受了曲妥珠单抗单药维持治疗，并持续实现了持久的疾病控制。
鉴于涎腺癌预后较差且复发或转移时治疗选择有限，应对患者进行所有类型HER2改变的检测。对于HER2过表达或激活的病例，曲妥珠单抗等靶向治疗具有前景。©2016威利期刊公司。《头颈》39: E40 - E44，2017年。
