The first 60 days: Salivary duct carcinoma
Salivary duct carcinoma is an aggressive cancer of the parotid gland that behaves like a high-grade breast cancer and carries the same switches: most tumours run on the androgen receptor and about a third on HER2, so hormone blockers borrowed from prostate cancer and trastuzumab borrowed from breast cancer now shrink many of them. Below, week by week, is what OnCo's record of Salivary duct carcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Localised, resectable.
- Medical oncologistNamed in the standard of care for: Localised, resectable, HER2-positive recurrent or metastatic, Androgen receptor-positive recurrent or metastatic, Marker-negative or after targeted treatment.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Localised, resectable.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Total parotidectomy (or resection of the affected gland) with facial nerve sacrifice where involved, neck dissection and postoperative radiotherapy, with cisplatin for extranodal extension or positive margins.
- 2.HER2-positive recurrent or metastaticNCCN category Category 2A, NCCN Guidelines: Head and Neck Cancers
Trastuzumab with docetaxel (phase 2, response rate 70 percent); trastuzumab deruxtecan on progression or as an alternative.
- 3.Androgen receptor-positive recurrent or metastaticNCCN category Category 2A, NCCN Guidelines: Head and Neck Cancers
Androgen deprivation with leuprorelin and bicalutamide; enzalutamide or apalutamide as alternatives or after progression.
- 4.Marker-negative or after targeted treatmentNCCN category Category 2A, NCCN Guidelines: Head and Neck Cancers
Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive, mutation-rich or mismatch repair-deficient tumours.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example Androgen receptor immunohistochemistry, HER2 immunohistochemistry and in situ hybridisation, TP53, PIK3CA and HRAS mutations, PD-L1 and tumour mutational burden, Extranodal extension and margin status), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Salivary duct carcinoma of the parotid, HER2-amplified salivary duct carcinoma, Androgen receptor-positive, HER2-negative salivary duct carcinoma.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Localised, resectable
- For my situation (localised, resectable), which of the standard options do you recommend and why?Guideline options include: Total parotidectomy (or resection of the affected gland) with facial nerve sacrifice where involved, neck dissection and postoperative radiotherapy, with cisplatin for extranodal extension or positive margins.
- Am I a candidate for Cisplatin, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
HER2-positive recurrent or metastatic
- For my situation (her2-positive recurrent or metastatic), which of the standard options do you recommend and why?Guideline options include: Trastuzumab with docetaxel (phase 2, response rate 70 percent); trastuzumab deruxtecan on progression or as an alternative.
- Am I a candidate for Trastuzumab, Docetaxel, Trastuzumab deruxtecan, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Androgen receptor-positive recurrent or metastatic
- For my situation (androgen receptor-positive recurrent or metastatic), which of the standard options do you recommend and why?Guideline options include: Androgen deprivation with leuprorelin and bicalutamide; enzalutamide or apalutamide as alternatives or after progression.
- Am I a candidate for Leuprolide (leuprorelin) and GnRH agonists, Bicalutamide, Enzalutamide or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
- How do the results of A Study of Apalutamide Combined With GnRH Agonist in Participants With Androgen Receptor Positive Salivary Gland Carcinoma apply to someone like me?Trial populations differ from individual patients; ask how closely you match.
Marker-negative or after targeted treatment
- For my situation (marker-negative or after targeted treatment), which of the standard options do you recommend and why?Guideline options include: Platinum-based chemotherapy (carboplatin-paclitaxel or cisplatin-based); pembrolizumab for PD-L1-positive, mutation-rich or mismatch repair-deficient tumours.
- Am I a candidate for Cisplatin, Carboplatin, Paclitaxel / nab-paclitaxel or related drugs, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Trastuzumab deruxtecan, Apalutamide, A Study of Apalutamide Combined With GnRH Agonist in Participants With Androgen Receptor Positive Salivary Gland Carcinoma, Enzalutamide?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Almost all responses to targeted treatment are followed by relapse”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Whether to give anti-HER2 or anti-androgen treatment first when both targets are present”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Salivary duct carcinoma: the full pageSalivary duct carcinoma is an aggressive cancer of the parotid gland that behaves like a high-grade breast cancer and carries the same switches: most tumours run on the androgen receptor and about a third on HER2, so hormone blockers borrowed from prostate cancer and trastuzumab borrowed from breast cancer now shrink many of them.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Extranodal extension (ENE): Extranodal extension means cancer in a lymph node has burst through the node's capsule into the surrounding fat; in head and neck cancer it is the single finding after surgery that most often turns radiotherapy into chemoradiotherapy, and in HPV-negative disease it moves the stage up.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Every term links to the glossary.