Keller Gunter, Steinmann Diana, Quaas Alexander, Grünwald Viktor, Janssen Stefan, Hussein Kais
Institute of Pathology, Hannover Medical School (MHH), Hannover, Germany; Department of Cranio-Maxillo-Facial Surgery, Henriettenstift, Hannover, Germany.
Institute for Radiation Therapy and Special Oncology, Hannover Medical School (MHH), Hannover, Germany.
Oral Oncol. 2017 May;68:103-113. doi: 10.1016/j.oraloncology.2017.02.018. Epub 2017 Mar 18.
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).
唾液腺癌是罕见肿瘤，其治疗策略不如肺癌、胃癌或乳腺癌那样标准化。治疗以手术为基础，但并非所有癌症都能完全切除，例如因为癌症常表现出神经浸润。对于进一步的治疗决策，建议进行病理检查，但评估个性化治疗的潜在靶点并非常规检查项目的一部分。许多唾液腺癌可能对放疗和/或化疗耐药，这限制了治疗选择。本综述总结了唾液腺癌患者个性化治疗的新概念。靶向生长受体HER2、EGFR、AR和ER是可行的，但在一些研究中，潜在的靶分子在治疗前未得到充分测试。此外，约20% - 25%的癌症存在RAS突变（主要是H-RAS），这可能解释了治疗耐药性。未来可能的治疗选择包括免疫调节（抑制PDL1/PD1信号传导）、纳米颗粒（与西妥昔单抗偶联的金纳米颗粒可提高放射敏感性）和药物递送系统（曲妥珠单抗 emtansine/T-DM1）。
