Cyclophosphamide, doxorubicin, and cisplatin combination chemotherapy for advanced carcinomas of salivary gland origin

Abstract

Thirteen patients with carcinomas of major and minor salivary gland origin (nine adenoid cystic carcinomas and four adenocarcinomas) were treated with cyclophosphamide (500 mg/m2), doxorubicin (50 mg/m2), and cisplatin (50 mg/m2) (CAP) by intravenous injections on the first day of a 28-day regimen. Sixty-one cycles of CAP were administered (mean, 4.7 cycles per patient). Eleven patients were treated for palliation of recurrent disease (locoregional, ten; lung, ten; liver, three; and bone, three). Two patients untreated previously, one with extensive local disease involving the base of the skull and one with a solitary lung metastasis (resected with a positive margin) and an initially unappreciated base of tongue primary, received two cycles of CAP followed by local treatment and adjuvant CAP. Previous therapy for the 11 patients with recurrent disease included surgery (ten), radiotherapy [RT(11)], chemotherapy (three), or hormonal therapy (two). Three complete and three partial responses to chemotherapy were noted for an overall response rate of 46%. The median duration of response in palliative patients was 5 months (range, 2 to 9). Of the two patients receiving induction CAP, one relapsed with distant disease 26 months after treatment, and the other remains disease-free after 60 months of follow-up examination. Chemotherapy was well tolerated generally, and no chemotherapy-related deaths occurred. One hypertensive patient suffered a stroke after 3 cycles of therapy. CAP is an active regimen against salivary gland carcinomas and deserves further study. Also, it may be of value as induction or adjuvant treatment for patients with advanced disease untreated previously.

Carcinoma Ex Pleomorphic Adenoma: Case Report and Options for Systemic Therapy

“…The choice of therapy was based on several small phase ii studies identifying that combination as active in the treatment of malignant salivary gland tumours, although with efficacy varying by histologic subtype [10][11][12] . Newer combinations such as carboplatin-paclitaxel or cisplatin-gemcitabine have demonstrated moderate activity in small trials involving salivary gland tumours with a mix of histologies 13,14 .…”

Gene expression profiling and its use in adenocarcinomas of unknown primary origin: A case report

“…Kaplan et al (26) recorded 5 objective responses, including 1 complete response, from a total of 6 patients. Additionally, 3 complete and 3 partial remissions, from a total of 13 patients, were reported in the study by Dreyfuss et al (27).…”

“…CAP, the most commonly studied regimen for cancer, is an actively used regimen for SGC (26)(27)(28). In a study by Alberts et al (29) responses were observed that included 2 patient who experienced complete remission, from a total of 5 patients.…”

Adenocarcinoma Not Otherwise Specified on Dorsum of Tongue: Case Report and Literature Review

“…One study reported an average response rate of 64%, with 28% achieving complete remission 24 50% response rate in tumours of the oropharynx and a 75% response rate in tumours classified as adenocarcinoma 25 ; however, the latter neoplasms were not exclusively of minor salivary gland origin. Although discussions of tumour grade have proved useful for certain histologic subtypes, including adenocarcinoma nos, mucoepidermoid carcinoma, and adenoid cystic carcinoma 26 , it has been suggested that stage and not grade of salivary gland tumours be considered the major factor, with a 4-cm "rule" suggested as a guideline for directing treatment decisions 26 .…”