Clinical Oncology Letters
https://www.clinicaloncologyletters.com/article/doi/10.4322/col.2019.003
Clinical Oncology Letters
Relato de Caso

Terapia de privação androgênica em tumor avançado de glândula salivar: Relato de caso

Androgen deprivation therapy in advanced salivary gland tumor: Case report

Cláudia Graziele Rodrigues Santos, Carolina Rossetti Rodrigues dos Santos, Auro del Giglio

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Resumo

O carcinoma de ducto salivar é um tumor maligno raro que representa 0.2 a 0.3% de todas as neoplasias malignas e 6 a 8% de todos os cânceres de cabeça e pescoço. Ele possui expressão para receptores androgênicos em 67 a 96% dos casos, de modo que a deprivação androgênica é uma opção de tratamento com taxa de resposta variando de 18 a 64.7%. Relatamos o caso de um paciente do sexo masculino de 74 anos com diagnóstico de carcinoma de ducto salivar, sendo inicialmente submetido a parotidectomia direita seguida de radioterapia adjuvante. Após 4 anos de seguimento, evolui com recidiva linfonodal cervical, a qual foi tratada com ressecção cirúrgica completa seguida de quimiorradioterapia adjuvantes. Após um ano desse tratamento, evolui com recidiva sistêmica (doença metastática óssea, pulmonar e linfonodal), sendo submetido a 4 linhas de tratamento paliativo. Após a última progressão, em maio de 2018, realizada punção aspirativa de linfonodo cervical metastático e pesquisa de mutação HER2/neu e expressão de receptores androgênicos. A pesquisa resultou negativa para o primeiro, porém positiva para o último, sendo proposta quinta linha de tratamento com Bicalutamida 50mg ao dia. Paciente segue há 9 meses com bloqueio androgênico periférico apresentando boa tolerância e resposta parcial em exame de PET-CT.

Palavras-chave

Carcinoma de ducto salivar; terapia de privação androgênica; estudo de caso.

Abstract

The salivary gland tumor is a rare malignant tumor that represents 0.2 to 0.3% of all the malignant cancers and 6 to 8% of all the head and neck cancers. It has expression for androgen receivers in 67 to 96% of all the cases so that the androgen deprivation therapy is a treatment option with response rates varying from 18 to 64.7%. We report the case of a 74 -year-old masculine patient with diagnosis of a salivary duct carcinoma, initially submitted to a right side parotidectomy followed by adjuvant radiotherapy. After four years of follow up, he develops recurrence in cervical lymph node which was treated with complete surgical resection followed by adjuvant chemoradiotherapy. After a year of this treatment, it evolves with systemic recurrence (metastatic bone disease, pulmonary and metastatic lymph nodes), being submitted to fourth palliative treatment line. After the last progression in May of 2018, it was performed a fine needle aspiration of the metastatic lymph node and screening for HER2/neu mutation and expression of androgen receivers. The screening turned out negative for the first one test, however it was positive for the latter and the fifth treatment line was proposed with Bicalutamide 50mg daily. The patient continues to receive androgen blockade in the last nine months, presenting good tolerance and partial response in examination of PET-CT.

Keywords

Salivary gland tumors; antiandrogen therapy; case report

Referências

1. Fushimi C, Tada Y, Takahashi H, et al. A prospective phase II study ỏ̉f combined androgen blockade in patients with androgen receptor-positive metastatic or locally advanced unresectable salivary gland carcinoma. Ann Oncol. 2018;29(4):979-84. http://dx.doi.org/10.1093/annonc/mdx771. PMid:29211833.

2. Boon E, van Boxtel W, Buter J, et al. Androgen deprivation therapy for androgen receptor-positive advanced salivary duct carcinoma: a nationwide case series of 35 patients in The Netherlands. Head Neck. 2018;40(3):605-13. http://dx.doi.org/10.1002/hed.25035. PMid:29272069.

3. Van Boxtel W, Locati LD, van Engen-van Grunsven ACH, et al. Adjuvant androgen deprivation therapy for poor-risk, androgen receptor-positive salivary duct carcinoma. Eur J Cancer. 2019;110:62-70. http://dx.doi.org/10.1016/j.ejca.2018.12.035. PMid:30771738.

4. Locati LD, Perrone F, Cortelazzi B, et al. Clinical activity of androgen deprivation therapy in patients with metastatic/relapsed androgen receptor-positive salivar gland cancers. Head Neck. 2016;38(5):724-31. http://dx.doi.org/10.1002/hed.23940. PMid:25522335.

5. Jaspers HC, Verbist BM, Schoffelen R, et al. Androgen receptor-positive salivary duct carcinoma: a disease entity with promising new treatment options. J Clin Oncol. 2011;29(16):e473-6. http://dx.doi.org/10.1200/JCO.2010.32.8351. PMid:21422415.

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