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      Adenoid cystic carcinoma: A review of recent advances, molecular targets, and clinical trials

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          Abstract

          Background

          Adenoid cystic carcinoma (ACC) is a rare tumor of secretory glands. In this study, recent advances in molecular characterization and in therapeutics are reviewed.

          Methods

          A search of articles in PubMed and of abstracts from national meetings was performed regarding ACC.

          Results

          Recent genetic analyses found that recurrent chromosome 6:9 translocations in ACC generate an MYB:NFIB gene fusion resulting in overexpression of the MYB oncoprotein. Several other frequent mutations are recently published that may be relevant for drug development. Several trials of targeted drugs are reviewed. Some agents delay tumor progression, but tumor responses remain rare.

          Conclusion

          ACCs have a characteristic chromosomal translocation, but also frequently pick up additional mutations. Clinical research is limited by the rarity and slow growth of ACC. Several ongoing trials are testing agents that inhibit fibroblast growth factor receptor signaling or other signaling pathways. Novel treatments based on the recently sequenced tumor genome are under development. © 2015 The Authors Head & Neck Published by Wiley Periodicals, Inc. 38: 620–627, 2016

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          Most cited references85

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          The Mutational Landscape of Adenoid Cystic Carcinoma

          Adenoid cystic carcinomas (ACCs) are among the most enigmatic of human malignancies. These aggressive salivary cancers frequently recur and metastasize despite definitive treatment, with no known effective chemotherapy regimen. Here, we determined the ACC mutational landscape and report the exome or whole genome sequences of 60 ACC tumor/normal pairs. These analyses revealed a low exonic somatic mutation rate (0.31 non-silent events/megabase) and wide mutational diversity. Interestingly, mutations selectively involved chromatin state regulators, such as SMARCA2, CREBBP, and KDM6A, suggesting aberrant epigenetic regulation in ACC oncogenesis. Mutations in genes central to DNA damage and protein kinase A signaling also implicate these processes. We observed MYB-NFIB translocations and somatic mutations in MYB-associated genes, solidifying these aberrations as critical events. Lastly, we identified recurrent mutations in the FGF/IGF/PI3K pathway that may potentially offer new avenues for therapy (30%). Collectively, our observations establish a molecular foundation for understanding and exploring new treatments for ACC.
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            Systemic therapy in the management of metastatic or locally recurrent adenoid cystic carcinoma of the salivary glands: a systematic review.

            Adenoid cystic carcinomas (ACC) are rare cancers usually arising in the salivary glands. Once metastatic, the natural history can vary; some patients with indolent cancer remain asymptomatic for long periods, whereas others have rapidly progressive disease. Chemotherapy is generally reserved for the palliative treatment of symptomatic locally recurrent or metastatic disease that is not amenable to further surgery or radiation. Prospective trials of chemotherapy in advanced ACC are limited, and the optimum regimen is unclear. The aim of this systematic review is to summarise and rate the quality of trials assessing chemotherapy for treatment of ACC, by use of the European Lung Cancer Working Party scoring system. Endpoints evaluated include tumour response and rates of symptomatic improvement. 34 trials involving 441 patients are included. We give evidence-based recommendations for management of ACC with chemotherapy, along with considerations for the design of future clinical trials in this disease. Copyright © 2011 Elsevier Ltd. All rights reserved.
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              Phase I trial of the oral antiangiogenesis agent AG-013736 in patients with advanced solid tumors: pharmacokinetic and clinical results.

              We studied the safety, clinical activity, and pharmacokinetics (PK) of AG-013736, an oral receptor tyrosine kinase inhibitor of vascular endothelial cell growth factor, platelet-derived growth factor, and c-Kit, in patients with advanced cancer. Patients received fixed doses of AG-013736 orally in 28-day cycles. In the first cohort, patients initially received two single test doses of AG-013736 (10 and 30 mg); subsequent dosing was determined by individual PK parameters. Doses in subsequent cohorts were assigned by using a traditional dose-escalation/de-escalation rule based on observed toxicities in the current and previous cohorts. PK analysis included evaluation of the effect of food and antacid. Thirty-six patients received AG-013736 at doses ranging from 5 to 30 mg by mouth twice daily. The dose-limiting toxicities observed included hypertension, hemoptysis, and stomatitis and were seen primarily at the higher dose levels. The observed hypertension was manageable with medication. Stomatitis was generally tolerable and managed by dose reduction or drug holidays. AG-013736 was absorbed rapidly, with peak plasma concentrations observed within 2 to 6 hours after dosing. The maximum-tolerated dose and recommended phase II dose of AG-013736 is 5 mg, twice daily, administered in the fasted state. No significant drug interaction with antacid was seen. There were three confirmed partial responses and other evidence of clinical activity. In this study, we have demonstrated clinical activity and safety of AG-013736 in patients with advanced solid tumors and identified the dose for phase II testing. The unique phase I study design allowed early identification of important absorption and metabolic issues critical to phase II testing of this agent.
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                Author and article information

                Journal
                Head Neck
                Head Neck
                10.1002/(ISSN)1097-0347
                HED
                Head & Neck
                John Wiley and Sons Inc. (Hoboken )
                1043-3074
                1097-0347
                16 June 2015
                April 2016
                : 38
                : 4 ( doiID: 10.1002/hed.v38.4 )
                : 620-627
                Affiliations
                [ 1 ] Division of Hematology/Oncology University of Virginia Charlottesville Virginia
                [ 2 ] Division of Hematology/Oncology New Jersey Medical School Newark New Jersey
                [ 3 ] Department of Pathology University of Virginia Charlottesville Virginia
                [ 4 ] Department of Internal Medicine University of Virginia Charlottesville Virginia
                [ 5 ] Division of Hematology/Oncology Wake Forest University Winston‐Salem North Carolina
                Author notes
                [*] [* ] Corresponding author: P. Dillon, Division of Hematology/Oncology, University of Virginia, Box 800716, Charlottesville, VA 22908. E‐mail: Pmd5b@ 123456virginia.edu
                Article
                HED23925
                10.1002/hed.23925
                6166139
                25487882
                8bf61af5-db26-4290-b947-c5d2e329dc05
                © 2015 The Authors Head & Neck Published by Wiley Periodicals, Inc.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 03 December 2014
                Page count
                Pages: 8
                Funding
                Funded by: Dr. Dillon is supported by University of Virginia Cancer Center Support Grant. Dr. Thomas is supported by Wake Forest Cancer Center Support Grant
                Categories
                Clinical Review
                Clinical Reviews
                Custom metadata
                2.0
                hed23925
                April 2016
                Converter:WILEY_ML3GV2_TO_NLMPMC version:version=5.5.0 mode:remove_FC converted:01.10.2018

                Otolaryngology
                adenoid cystic carcinoma,salivary gland,tyrosine kinase inhibitor,myb gene,nfib gene,nuclear factor i/b

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