School of Medicine, Loma Linda University, Loma Linda, CA, USA.
Division of Hematology and Oncology, Department of Internal Medicine, Loma Linda University Medical Center, Loma Linda, CA, USA.
Am J Case Rep. 2020 Jun 30;21:e925181. doi: 10.12659/AJCR.925181.
BACKGROUND Salivary duct carcinoma (SDC) is a rare, aggressive head and neck cancer with frequent metastases. Current treatment options for recurrent or metastatic SDC include targeted anti-androgen therapy, HER2-targeted therapy, or systemic chemotherapy. We report the first use of a combination chemohormonal strategy. CASE REPORT A 68-year-old male who had never smoked with a past medical history of two-vessel coronary artery disease and systolic heart failure presented with a parotid mass and underwent surgical resection. Biopsy of the mass revealed high-grade, androgen receptor-positive and Erb-B2 receptor tyrosine kinase-2 (ERBB2)-amplified positive SDC. He subsequently received adjuvant radiation therapy. Four months after completion of adjuvant radiation therapy, recurrence with symptomatic pleural effusion and nodes, hepatic metastases, and boney metastases occurred. Due to significant symptomatic tumor, a rapid treatment response was desired. Combination chemohormonal therapy (CHT) was initiated with carboplatin area under the curve 4 and paclitaxel, 200 mg/m² in 21-day cycles along with combined androgen blockade using leuprolide, 45 mg subcutaneously every 6 months and bicalutamide, 50 mg daily. The treatment was well tolerated with fatigue as the main adverse event. Positron emission tomography-computed tomography at 3 and 6 months after treatment initiation showed good partial response. The patient experienced uveal progression after 8 months and alternate treatment was started. CONCLUSIONS Combination CHT with carboplatin, paclitaxel, and combined androgen deprivation may be a good treatment option in androgen receptor-positive recurrent or metastatic SDC if rapid treatment response is desired. Combination chemotherapy with androgen deprivation for validation through clinical trials.
唾液腺癌（SDC）是一种罕见的、侵袭性的头颈部癌症，常发生转移。复发性或转移性 SDC 的当前治疗选择包括靶向抗雄激素治疗、HER2 靶向治疗或全身化疗。我们报告了首次使用联合化疗激素策略。
一位 68 岁男性，从不吸烟，有两血管冠状动脉疾病和收缩性心力衰竭的既往病史，表现为腮腺肿块并接受了手术切除。肿块活检显示高级别、雄激素受体阳性和 Erb-B2 受体酪氨酸激酶-2（ERBB2）扩增阳性 SDC。随后他接受了辅助放疗。在辅助放疗完成后 4 个月，出现了有症状的胸腔积液和淋巴结、肝转移和骨转移的复发。由于肿瘤症状明显，需要快速治疗反应。因此，开始了联合化疗激素治疗（CHT），方案为卡铂曲线下面积 4 和紫杉醇，200mg/m²，每 21 天一次，同时联合使用亮丙瑞林（leuprolide）和比卡鲁胺（bicalutamide）进行联合雄激素阻断，亮丙瑞林每 6 个月皮下注射 45mg，比卡鲁胺每日 50mg。治疗耐受性良好，主要不良反应为疲劳。治疗开始后 3 个月和 6 个月的正电子发射断层扫描-计算机断层扫描（PET-CT）显示部分反应良好。患者在 8 个月后出现葡萄膜进展，开始了替代治疗。
对于需要快速治疗反应的雄激素受体阳性复发性或转移性 SDC，卡铂、紫杉醇和联合雄激素剥夺的联合 CHT 可能是一种较好的治疗选择。需要通过临床试验验证联合化疗加雄激素剥夺的治疗方案。
