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10 slides generated from the cancer page, with a quiz from the open benchmark and speaker notes that cite the sources. Arrow keys move between slides; Print gives one slide per page.
Salivary duct carcinoma is an aggressive cancer of the parotid gland that behaves like a high-grade breast cancer and carries the same switches: most tumours run on the androgen receptor and about a third on HER2, so hormone blockers borrowed from prostate cancer and trastuzumab borrowed from breast cancer now shrink many of them.
Salivary duct carcinoma is a high-grade adenocarcinoma of the salivary ducts, usually of the parotid gland in men over sixty, that under the microscope looks like high-grade ductal carcinoma of the breast with comedo necrosis, and sometimes arises within a long-standing pleomorphic adenoma. It spreads early to the neck nodes and to lung and bone, and facial nerve palsy at presentation is common. The great majority of tumours express the androgen receptor, about a third have HER2 amplification, and TP53, PIK3CA and HRAS mutations are frequent, so molecular profiling at diagnosis is standard.
Local treatment is parotidectomy with sacrifice of the facial nerve when it is involved, neck dissection and postoperative radiotherapy or chemoradiation, but most patients relapse at a distance, and systemic treatment borrowed from breast and prostate cancer is what has changed the disease. For HER2-positive tumours a Japanese phase 2 of trastuzumab with docetaxel in 57 patients produced responses in 70.2 percent with median progression-free survival of 8.9 months and median overall survival of 39.7 months, and trastuzumab deruxtecan and trastuzumab emtansine have produced responses in HER2-positive salivary cancers in tumour-agnostic studies.
| Setting | Approach | Guideline |
|---|---|---|
| Localised, resectable | Total parotidectomy (or resection of the affected gland) with facial nerve sacrifice where involved, neck dissection and postoperative radiotherapy, with cisplatin for extranodal extension or positive margins. | NCCN Category 2A |
| HER2-positive recurrent or metastatic | Trastuzumab with docetaxel (phase 2, response rate 70 percent); trastuzumab deruxtecan on progression or as an alternative. | NCCN Category 2A |
| Androgen receptor-positive recurrent or metastatic | Androgen deprivation with leuprorelin and bicalutamide; enzalutamide or apalutamide as alternatives or after progression. | NCCN Category 2A |
| Marker-negative or after targeted treatment | Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive, mutation-rich or mismatch repair-deficient tumours. | NCCN Category 2A |