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Molecular profiling and treatment patterns of advanced salivary gland cancers in head and neck region

In Annals of Oncology
By: Talreja V.
Contributor(s): Patil VM | Noronha V | Joshi A | Menon N | Chougule A | Menon M | Mittal N | Prabhash K [Corresponding Author].
Material type: materialTypeLabelArticlePublisher: 2019Description: .Subject(s): Advanced salivary gland | Palliation | Malignant salivary gland In: Annals of OncologySummary: Background Advanced salivary gland neoplasm have variable natural history. The goal of systemic treatment is palliation however no clear evidence regarding when and to whom it needs to be administered.The objective of this study was to determine the molecular profile of malignant salivary gland tumors and to evaluate the impact of systemic therapy.This was a retrospective cohort study. Methods Head and Neck Medical Oncology outpatient department maintains a prospective chemotherapy database of patients planned for any form of systemic therapy. Adult patients (Age > or = 18 years) with (ECOG PS) 0-3 histologically proven salivary gland malignancy treated between January 2010- September 2018 at the host institute.Data regarding demographics, baseline characteristics, tumor details, staging details, treatment details, outcome details expression of ER, PR, AR and HER-2 Neu status was extracted.The procedure for performing IHC, interpreting, and quality assurance is already published.Molecular profilingSnapshot profiling was performed using Multiplex polymerase chain reaction (PCR) followed by multiplex base extension assay utilizing the SNaPshot TM methodology. It consists of a combination of real time PCR looking for 21 hotspot mutation sites in nine cancer genes: (EGFR, HER2, KRAS, NRAS,PIK3CA, BRAF, MEK1, PTEN,AKT1-). Results Out of the 69 evaluable patients, 55% (n = 38) had actionable target. Androgen Receptor (AR) expression was present in majority of patients (n = 23,34%), with it alone being expressed in 17% (n = 12) of patients, and along with other actionable targets in the other. 60 (87%) patients received systemic therapy either in form of chemotherapy (35,58.3%) or targeted therapy (25,41.7%). The strategy of observation in asymptomatic status lead to an median OS of 32.27 (3.03-NA) similar to patients receiving systemic therapy (p = 0.992). In patients with visceral crisis, the median OS was higher in patients receiving chemotherapy than targeted therapy (19.07 (14.20-23.8) versus 6.07 (2.23-NA), p < 0.001).The median follow up was 42.1(95% CI 36.5-51.7) months. Conclusions Actionable targets are seen in salivary gland tumors and treatment strategies should be based on these and symptomatic status
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Articles Articles Tata Memorial Hospital
Available AR19840

Address for Corresponding Author: prabhashk@tmc.gov.in
Abstract presented at ESMO Asia Congress 22-24 November, Singapore

Background
Advanced salivary gland neoplasm have variable natural history. The goal of systemic treatment is palliation however no clear evidence regarding when and to whom it needs to be administered.The objective of this study was to determine the molecular profile of malignant salivary gland tumors and to evaluate the impact of systemic therapy.This was a retrospective cohort study.

Methods
Head and Neck Medical Oncology outpatient department maintains a prospective chemotherapy database of patients planned for any form of systemic therapy. Adult patients (Age > or = 18 years) with (ECOG PS) 0-3 histologically proven salivary gland malignancy treated between January 2010- September 2018 at the host institute.Data regarding demographics, baseline characteristics, tumor details, staging details, treatment details, outcome details expression of ER, PR, AR and HER-2 Neu status was extracted.The procedure for performing IHC, interpreting, and quality assurance is already published.Molecular profilingSnapshot profiling was performed using Multiplex polymerase chain reaction (PCR) followed by multiplex base extension assay utilizing the SNaPshot TM methodology. It consists of a combination of real time PCR looking for 21 hotspot mutation sites in nine cancer genes: (EGFR, HER2, KRAS, NRAS,PIK3CA, BRAF, MEK1, PTEN,AKT1-).

Results
Out of the 69 evaluable patients, 55% (n = 38) had actionable target. Androgen Receptor (AR) expression was present in majority of patients (n = 23,34%), with it alone being expressed in 17% (n = 12) of patients, and along with other actionable targets in the other. 60 (87%) patients received systemic therapy either in form of chemotherapy (35,58.3%) or targeted therapy (25,41.7%). The strategy of observation in asymptomatic status lead to an median OS of 32.27 (3.03-NA) similar to patients receiving systemic therapy (p = 0.992). In patients with visceral crisis, the median OS was higher in patients receiving chemotherapy than targeted therapy (19.07 (14.20-23.8) versus 6.07 (2.23-NA), p < 0.001).The median follow up was 42.1(95% CI 36.5-51.7) months.

Conclusions
Actionable targets are seen in salivary gland tumors and treatment strategies should be based on these and symptomatic status

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