Combined systemic treatments in two patients with ductal salivary carcinoma

Ductal carcinomas, a variant of salivary gland cancer, are characterized by concurrent androgen receptor (AR) positivity and overexpression of HER2, making them potential targets for tailored therapies extensively explored in literature. We present two consecutive cases of patients diagnosed with inoperable metastatic ductal carcinoma, both displaying HER2 overexpression and AR positivity, who underwent combination therapy involving chemotherapy and dual targeted agents. Both patients diagnosed with centralized inoperable ductal carcinoma were retrospectively analyzed and received trastuzumab, docetaxel, leuprolide and bicalutamida as first-line therapy until progression, defined by RECIST criteria. The first patient exhibited a partial response, with a 34% reduction in nodal metastases, remaining progression-free for 20 months. Despite rapid progression on initial treatment lines, the second patient achieved a partial response with a 35% reduction in metastases upon receiving third-line therapy, sustaining a progression-free interval. Importantly, both patients tolerated the treatment regimen well without severe acute toxicities. Although they responded favorably to the combined therapy, the addition of antiandrogen, anti-HER2, and chemotherapy did not appear to enhance efficacy. The use of combined target therapy seems to be effective in selected patients, but this indication requires further investigation through prospective studies.