Sinonasal undifferentiated carcinoma (SNUC) and SWI/SNF-deficient sinonasal carcinoma
Prepared with OnCo (onco.cc/prep/sinonasal-undifferentiated-carcinoma/). Orientation, not medical advice; your team knows your case.
My details
What I know, what is unclear, changes to discuss
Saved in this browserMy questions
17 on the sheet- 1.What is my exact diagnosis, stage, and grade, and which tests established them?
- 2.Which biomarkers have been tested on my tumour (for example IDH2 R172 mutation, SMARCB1and SMARCA4 immunohistochemistry, NUT immunohistochemistryand EBV, Response to induction chemotherapy on imaging, Neck node status), and what were the results?
- 3.Which subtype is my cancer, and does that change the recommended treatment?
- 4.Is germline (inherited) genetic testing recommended for me or my family?
- 5.For my situation (diagnosis), which of the standard options do you recommend and why?
- 6.For my situation (locally advanced disease, first step), which of the standard options do you recommend and why?
- 7.Am I a candidate for Cisplatin, Etoposide, Platinum + etoposide (EP / CE), and what side effects should I expect?
- 8.For my situation (responders to induction), which of the standard options do you recommend and why?
- 9.Am I a candidate for Cisplatin, and what side effects should I expect?
- 10.For my situation (non-responders to induction), which of the standard options do you recommend and why?
- 11.For my situation (metastatic or recurrent disease), which of the standard options do you recommend and why?
- 12.Am I a candidate for Platinum + etoposide (EP / CE), Pembrolizumab, Nivolumab or related drugs, and what side effects should I expect?
- 13.Are there clinical trials I could join, for example of Enasidenib, Proton therapy, Pembrolizumab?
- 14.Would a second opinion at a high-volume centre change anything, and can you help arrange it?
- 15.What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?
- 16.I read that “No randomised trial exists and the induction-response strategy rests on one centre's series”. How does that affect my plan?
- 17.I read that “Enasidenib's activity in IDH2-mutant sinonasal carcinoma is unproven”. How does that affect my plan?
The words I may hear
- Head and neck subsites (oral cavity, oropharynx, larynx): Head and neck cancer is really several cancers named by exact location: mouth (oral cavity), back of the throat (oropharynx, where HPV cancers arise), voice box (larynx), lower throat (hypopharynx) and behind the nose (nasopharynx).
- Rare cancers: Rare cancers are those with fewer than about 6 new cases per 100,000 people per year.
- Chemoradiation (chemoradiotherapy, CRT): Radiotherapy given at the same time as chemotherapy, which sensitises the cancer to radiation.
Tests and results to bring
Diagnosis: Biopsy with immunohistochemistry (cytokeratins, NUT, INI1, SMARCA4, neuroendocrine markers, EBER) and IDH2 testing; MRI and CT of the sinuses, skull base and neck; PET-CT.
Biomarker results to ask for: IDH2 R172 mutation (diagnosis; enasidenib eligibility), SMARCB1 (INI1) and SMARCA4 immunohistochemistry (SWI/SNF-deficient carcinomas), NUT immunohistochemistry (exclude NUT carcinoma) and EBV (exclude nasopharyngeal-type carcinoma), Response to induction chemotherapy on imaging (decides surgery versus chemoradiotherapy), Neck node status, PD-L1 (investigational).
Scans and tests linked to this cancer: CT (computed tomography), Histopathology & immunohistochemistry, MRI, PET/CT.
Bring copies of scan reports, pathology and blood results, and a list of every medicine and supplement.
The treatments I may be offered
- Locally advanced disease, first step: Induction chemotherapy with cisplatin and etoposide (or docetaxel-platinum) for two to three cycles. (Cisplatin, Etoposide, Platinum + etoposide (EP / CE), Cytotoxic chemotherapy)
- Responders to induction: Definitive chemoradiotherapy with concurrent cisplatin (intensity-modulated or proton), including elective neck irradiation. (Cisplatin, IMRT / IGRT (modern external beam), Proton therapy, Chemoradiation (chemoradiotherapy, CRT))
- Non-responders to induction: Surgical resection where feasible followed by radiotherapy or chemoradiotherapy. (Robotic & minimally invasive surgery, IMRT / IGRT (modern external beam), Chemoradiation (chemoradiotherapy, CRT))
- Metastatic or recurrent disease: Platinum-etoposide; PD-1 antibodies (pembrolizumab, nivolumab) on case series evidence; enasidenib for IDH2-mutant tumours in trials; EZH2 inhibitors for SWI/SNF-deficient carcinoma in trials. (Platinum + etoposide (EP / CE), Pembrolizumab, Nivolumab, Enasidenib, Immune checkpoint inhibitors)
From the standard of care recorded for this cancer; which apply depends on your stage and biomarkers. Ask which the team recommends and why.