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Cancers & treatments·Sequencing

Adenoid cystic carcinoma: lines of therapy

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6 standard-of-care settings across 5 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comers
Early / localised1
Locally advanced1
Advanced, first line1
Second line1
Other settings2

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersLocalised, resectableWide resection including involved nerves where needed, with neck dissection for node-positive disease, followed by postoperative radiotherapy to the bed and nerve pathways.
IMRT / IGRT (modern external beam)Proton therapy
93

Locally advanced

SubgroupSettingApproachProducts and trialsEvidence
All comersUnresectable or inoperableDefinitive radiotherapy; carbon-ion or proton therapy where available (COSMIC, Heidelberg; fast-neutron series).
Carbon-ion therapyProton therapyIMRT / IGRT (modern external beam)
93

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersSlow-growing metastatic diseaseObservation with scans every few months; stereotactic radiotherapy or resection for isolated symptomatic metastases.
SBRT / SABR (stereotactic radiotherapy)
40

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersProgressive metastatic diseaseLenvatinib or axitinib (phase 2 evidence); clinical trials preferred.
LenvatinibAxitinibSmall-molecule kinase inhibitors
97

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersChemotherapyCisplatin with doxorubicin and cyclophosphamide, or single agents, for symptomatic disease after kinase inhibitors; responses are uncommon.
CisplatinDoxorubicinCyclophosphamide
81
All comersTrialsMYB-directed REM-422, HG146 and NOTCH inhibitors for NOTCH1-mutant disease.
REM-422Study of REM-422 in Patients With Recurrent, Metastatic, or Unresectable Adenoid Cystic CarcinomaClinical Trial of HG146 Administered to Participants with Adenoid Cystic Carcinoma
26

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.