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Endobronchial Ultrasound-guided Intratumoral Injection of Cisplatin for the Treatment of Isolated Mediastinal Recurrence of Lung Cancer
Published on: February 12, 2017
Phase II study of cisplatin and imatinib in advanced salivary adenoid cystic carcinoma
Niladri Ghosal1, Kathleen Mais, Patrick Shenjere
1Glan Clwyd Hospital, Rhyl, Denbighshire LL18 5UJ, United Kingdom. niladrighosal@hotmail.com
Abstract:
Patients with adenoid cystic carcinoma of the salivary glands show over-expression of KIT in a high proportion of cases. Options for systemic treatment are limited in locally advanced and metastatic disease. We explored the efficacy of imatinib and cisplatin combined in this group of patients. A Gehan's two-stage, phase II trial was conducted on 28 patients. Those with progressive, locally advanced, and metastatic disease with an over-expression of KIT were treated with single agent imatinib 800 mg daily for two months, followed by a combination of imatinib 400mg daily and cisplatin 80 mg/m(2) at four-weekly intervals for six cycles. This was followed by maintenance single agent imatinib 400mg daily until the disease progressed. Response was monitored using fluorodeoxyglucose positron emission tomography (FDG-PET) and morphological imaging using computed tomography, magnetic resonance, and chest radiographs (CT/MRI/CXR). Morphological imaging showed partial response in three of 28 patients, and five patients showed a response on FDG-PET. In addition, 19 patients had useful stabilisation of disease. The median time to progression and overall survival was 15 months (range 1-43) and 35 months (range 1-75), respectively. The combination of imatinib and cisplatin was reasonably well tolerated. This combination may provide stabilisation in locally advanced and metastatic adenoid cystic carcinoma of the salivary glands.
Insights
KIT-positive adenoid cystic carcinoma patients showed disease stabilization with imatinib and cisplatin combination therapy. This treatment offers a new option for advanced salivary gland cancer when other treatments fail.
Area of Science:
- Oncology
- Pharmacology
Background:
- Adenoid cystic carcinoma (ACC) of salivary glands frequently overexpresses KIT.
- Limited systemic treatment options exist for locally advanced and metastatic ACC.
- KIT-driven signaling pathways are implicated in ACC progression.
Purpose of the Study:
- To evaluate the efficacy of combined imatinib and cisplatin in patients with KIT-positive advanced ACC.
- To assess treatment response using both morphological imaging and fluorodeoxyglucose positron emission tomography (FDG-PET).
Main Methods:
- A Gehan's two-stage, phase II clinical trial involving 28 patients.
- Treatment involved initial imatinib monotherapy followed by combination imatinib and cisplatin, then maintenance imatinib.
- Response assessment utilized computed tomography (CT), magnetic resonance (MR), chest radiographs (CXR), and FDG-PET imaging.
Main Results:
- Partial response observed in 3/28 patients via morphological imaging; 5/28 patients showed response on FDG-PET.
- 19 patients achieved useful disease stabilization.
- Median time to progression was 15 months, and median overall survival was 35 months.
- The combination therapy was generally well-tolerated.
Conclusions:
- The combination of imatinib and cisplatin demonstrates potential for disease stabilization in advanced KIT-positive adenoid cystic carcinoma.
- This regimen offers a viable therapeutic option for patients with limited treatment alternatives.
- Further investigation into KIT-targeted therapies for ACC is warranted.
