This protocol addresses parotid gland cancer of the adenoid cystic carcinoma (ACC) histological subtype in the context of metastatic disease. ACC often follows an indolent but persistent clinical course; management at the metastatic stage requires careful patient-level assessment before initiating or escalating therapy.
Patients with confirmed adenoid cystic carcinoma of the parotid gland presenting with metastatic disease. In cases of indolent biology and limited metastatic burden, local ablative strategies may be considered prior to systemic therapy. When systemic treatment is indicated, specific criteria guide the decision to initiate.
When systemic therapy is warranted, the approach centres on a multitargeted tyrosine kinase inhibitor, considered when a clinical trial is not available. The precise eligibility criteria, agent selection, sequencing, and clinical decision points are detailed in the full structured protocol.
DOI: 10.1200/JCO.21.00449
In the setting of ACC and/or low-grade tumors with indolent biology with limited metastases (ie, # 5 metastases), local ablative treatments such as surgery (metastatectomy) or stereotactic body radiation therapy may be offered to delay local disease progression.
Patients may be considered for initiation systemic therapy in the following circumstances: (1) metastatic deposits are symptomatic and not amenable to palliative local therapy, (2) growth has the potential to compromise organ function, or (3) lesions have grown more than 20% in the preceding 6 months.
For patients with ACC who are candidates for initiation systemic therapy, a multitargeted tyrosine kinase inhibitor (TKI), such as lenvatinib or sorafenib, may be offered if a clinical trial is not available.
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