Minor Salivary Gland Cancer: Role for Upfront Chemotherapy? The 10-year survival

A diagram showing the lacrimal apparatus
A diagram showing the lacrimal apparatus (Photo credit: Wikipedia)

Today, we turn to a rare salivary gland tumor to illustrate the potential impact of using chemotherapy before surgery. The lacrimal glands are ones that secrete tears and are located above and to the side of the eye. Lacrimal tumors can be either benign (not cancer) or malignant (cancer, meaning that it has the capacity to spread to distant part of the body). One rare type of lacrimal gland tumor is adenoid cystic carcinoma (AdCC). As it grows, AdCC can push the due forward, causing it to bulge. This is known as proptosis. Some patients may have associated pain, owing to invasion of nearby nerves.

The Study: Investigators at the University of Miami Miller School of Medicine (USA) looked at 19 consecutively treated patients. Patients who had chemotherapy (through an artery) before the surgery had better outcomes (longer survival). All patients were treated with intra-arterial chemotherapy to reduce the tumor size before surgery (that is, they had neoadjuvant chemotherapy). The patients then had a removal of the affected eye (orbital exenteration), chemotherapy with radiation therapy, and intravenous chemotherapy.

Reference: Tse DT. Ophthalmology 2013;120:1313-1323.

Results: Kudos! I know, I know. Small study… Eight of the 19 patients in the analysis had an intact lacrimal artery. Those patients demonstrated a 10-year overall and disease free survival rate of 100%, as compared to 29% for the group that did not get the intra-arterial chemotherapy.

My Take: Intra-arterial pre surgical chemotherapy appears to improve overall survival, while decreasing disease recurrence. An intact lacrimal artery, no disruption of the nearby bone, and no upfront tumor manipulation, and protocol compliance were associated with favorable outcomes. The authors describe the complication rate as limed (and manageable). A small series, but certainly suggestive of a potential role for intra-arterial neoadjuvant chemotherapy (in addition to the standard approaches). I’m Dr. Michael Hunter.

The small print: The material presented herein is informational only, and is not designed to provide specific guidance for an individual. Please check with a valued health care provider with any questions or concerns. As for me, I am a Harvard- , Yale- and UPenn-educated radiation oncologist, and I practice in the Seattle, WA (USA) area. I feel genuinely privileged to be able to share with you. If you enjoyed today’s offering, please consider clicking the follow button at the bottom of this page.

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Breakthrough for eye melanoma

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For the first time, a systemic treatment has been found to be effective for a rare form of melanoma that affects the eye. This cancer is known as uveal melanoma, and it is one of the most challenging cancers to treat. Now comes an exciting report from the 2013 Annual Meeting of the American Society of Clinical Oncology pointing to a practice-changing development. A drug known as a MEK inhibitor appears to improve clinical outcomes for advanced disease. With the use of the drug Selumetinib, 50% of patients had some tumor shrinkage, and 15% had major tumor shrinkage. In the control arm (treatment with temozolomide), not a single patient had significant tumor shrinkage. The bottom line? This is the first study any systemic therapy has been shown to work among patients with ocular melanoma.

But… the drug will probably not be on the market for a couple of years. In this context, if you have advanced uveal melanoma, ask about clinical trials in which you might participate. I’m Dr. Michael Hunter

Addendum: MEK is a molecule that is activated by something called BRAF. When BRAF is mutated (changed) in melanoma, it directly activates MEK and unleashs a host of negative effects.