Salivary gland malignancy (SG) SACT

This consensus document is not a rigid constraint on clinical practice, but a concept of good practice against which the needs of the individual patient should be considered. It therefore remains the responsibility of the individual clinician to interpret the application of the Clinical Management Pathway (CMP), taking into account local service constraints and the needs and wishes of the patient. It is not intended that these consensus documents are applied as rigid clinical protocols.There are no approved SACT treatment options for salivary gland malignancy and there is a lack of robust evidence of effectiveness. Clinical trials should be first considered.

Consider on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request.

SG Concurrent SACT with radiotherapy

There is no role for the routine use of concurrent SACT in salivary gland tumours outwith clinical trials. Due to the lack of robust evidence the following SACT may be considered only in highly selective salivary gland SCC cases.

Cisplatin

Cisplatin 100mg/m² IV Week 1 and week 4 or 5 of Radiotherapy

For 2-3 cycles*

(maximum dose of surface area (SA)=2.00/m²)

*For patients receiving 7 weeks of radiotherapy , a third cycle can also be considered on day 43 (week 7)

Alternative regimen

Cisplatin 40mg/m² IV Week 1 of radiotherapy then weekly during radiotherapy for 6-7 cycles

In cases of concern over renal/cardiac function or patient factors, switch Cisplatin to Carboplatin AUC5

Carboplatin

Carboplatin AUC5 IV Week 1 and week 4 (day 1 and day 22) of Radiotherapy

For 2-3 cycles*

*For patients receiving 7 weeks of radiotherapy, a third cycle can also be considered on day 43 (week 7)

Refer to regional or local protocols for carboplatin prescribing advice

SG Non-curative SACT

Potential options

All pathology

See Head and Neck Squamous Cell Cancer SACT (HNSCC) HNSCC first-line non-curative SACT section.

Cisplatin and vinorelbine

No standard regimen. Other similar regimens may be suitable treatment options

Example regimen:

Cisplatin 80mg/m² IV Day 1

Vinorelbine 25mg/m² IV Day 1 and 8

Every 21 days for 6 cycles

Alternative regimen:

Cisplatin 75mg/m² IV Day 1

Vinorelbine 60mg/m² PO Day 1 and 8

Every 21 days for 6 cycles

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Adenoid cystic carcinoma

Lenvatinib

Lenvatinib 24mg OD PO continuous until progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Axitinib and Avelumab

Axitinib 5mg BD PO continuous, avelumab IV 800mg, IV, D1 and 15, repeat every 28 days until progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Androgen receptor positive salivary duct carcinomas

Bicalutamide

Bicalutamide 150mg PO OD, until disease progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Bicalutamide and LHRH agonist

Bicalutamide 80mg PO OD and LHRH agonist, until disease progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Abiraterone, prednisolone and LHRH agonist

Abiraterone 1000mg PO BD, prednisolone 5mg PO BD and LHRH agonist continuous, until disease progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

LHRH agonist/antagonist

As per local formulary

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Her-2 receptor positive salivary gland carcinomas

Anti HER-2 therapy

Trastuzumab

Trastuzumab/ Pertuzumab +/-taxane

Trastuzumab deruxtecan

Trastuzumab emtansine

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Other agents with potential activity

Pembrolizumab

Pembrolizumab 200mg IV every 3 weeks or 400mg IV every 6 weeks, until progression or unacceptable toxicity

Consider, on an individual patient basis, whether it may be appropriate to make an unlicensed medicines request

Regional SACT protocols

Links to Regional Guidance/Protocols where available (access to local intranet may be required):

NCA

NHS Highland

NHS Grampian

(For Tayside protocols refer to Chemocare)

SCAN

WoSCAN