Salivary galnd tumors are not common in stage IV and not much is known about how to optimally treat metastatic salivary galnd cancer. Their cancer may be responsive to aggressive combinations of chemotherapy and radiation. Patients with any metastatic lesions could be considered for clinical trials. Chemotherapy using doxorubicin, cisplatin, cyclophosphamide, and fluorouracil as single agents or in various combinations is associated with modest responses. NCCN recommends trials, supportive care, chemotherapy (without specifying regimen) or radiotherapy with chemotherapy.
Bevacizumab is an anti-VEGF monoclonal antibody that is FDA-approved for use in other malignancies. Savvides and colleagues from Case Comprehensive Cancer Center in Cleveland reported the preliminary results of a phase 2 study examining the efficacy of bevacizumab in combination with docetaxel and radiation in locally advanced HNC. Eight patients with stage IV disease completed therapy and 5 of 8 had a posttreatment neck dissection that demonstrated a pathologic complete response. These patients are now receiving adjuvant bevacizumab. The addition of this agent to curative CRT appears to be feasible. No episodes of severe bleeding were noted, which has been a concern with this agent. Khuntia and colleagues from the University of Wisconsin presented the design of an ongoing phase 1 trial of neoadjuvant bevacizumab followed by concurrent radiation, cisplatin, and bevacizumab for locally advanced HNC. Results of this study were not yet available.Seiwert and colleagues reported the results of a phase 1 study of bevacizumab plus 5-FU and hydroxyurea with concomitant radiotherapy for poor-prognosis HNC. Thirty-four patients completed treatment and, although there were toxicities, the addition of bevacizumab did not appear to be associated with a major synergistic toxic effect.
Speight PM, Barrett AW: Salivary gland tumours. Oral Dis 8 (5): 229-40, 2002.
Seiwert TY, Haraf DJ, Cohen EE, et al. A phase I study of bevacizumab with fluorouracil and hydroxyurea with concomitant radiotherapy for poor prognosis head and neck cancer. Proc Am Soc Clin Oncol. 2006;24:287s. Abstract 5530.
nccn.org, salvary gland
Savvides P, Greskovich J, Bokar J, et al. Phase II study of bevacizumab in combination with docetaxel and radiation in locally advanced squamous cell cancer of the head and neck (SCCHN). Program and abstracts of the 2007 Multidisciplinary Head and Neck Cancer Symposium; January 18-20, 2007; Rancho Mirage, California. Abstract 122.
Khuntia D, Jeraj R, Kruser TJ, et al. Phase I trial of neoadjuvant bevacizumab followed by concurrent radiation, cisplatin and bevacizumab for locoregionally advanced squamous cell carcinoma of the head and neck. Program and abstracts of the 2007 Multidisciplinary Head and Neck Cancer Symposium; January 18-20, 2007; Rancho Mirage, California. Abstract 63.