Introduction: Although systemic therapy, including multi-kinase inhibitors and cytotoxic chemotherapy, is an option for recurrent or metastatic adenoid cystic carcinoma of the head and neck (HNACC), it is not proven whether these therapies can prolong overall survival (OS). The present study investigated the impact of cytotoxic chemotherapy on survival outcomes compared with observation without chemotherapy. Methods: We retrospectively reviewed the medical records of the patients diagnosed with recurrent or metastatic HNACC. We compared the survival outcomes, including survival time from recurrence/metastasis (OS) patients who received systemic chemotherapy with paclitaxel (200 mg/m2) and carboplatin (area under the curve 6) (TC) on day 1 of a 3-week cycle and observation alone. Subgroup analysis was conducted to identify patients who can get benefit from TC. Results: Seventy-five patients (32 in TC and 43 in observation) were analyzed. There was no difference in median OS between TC and observation (52.2 months vs. 44.0 months, hazard ratio 0.76, 95% confidence interval 0.32–1.30, p = 0.21). Landmark analysis to reduce immortal bias also showed no difference between TC and observation in terms of OS. Subgroup analysis showed nonsignificant trends toward longer OS in asymptomatic patients with pulmonary metastasis and without bone metastasis. Conclusions: In our non-randomized comparison, patients who underwent TC did not show prolonged survival time from recurrence and/or metastasis diagnosis compared with observation alone in patients with recurrent or metastatic HNACC. Although systemic chemotherapy is a possible option for metastatic/recurrent HNACC, initial observation might be a valid strategy for asymptomatic patients without extrapulmonary diseases. Further research is warranted to identify the optimal patients and therapeutic regimens to prolong OS in HNACC.

1.
Coca-Pelaz
A
,
Rodrigo
JP
,
Bradley
PJ
,
Vander Poorten
V
,
Triantafyllou
A
,
Hunt
JL
.
Adenoid cystic carcinoma of the head and neck: an update
.
Oral Oncol
.
2015
;
51
(
7
):
652
61
.
2.
Ellington
CL
,
Goodman
M
,
Kono
SA
,
Grist
W
,
Wadsworth
T
,
Chen
AY
.
Adenoid cystic carcinoma of the head and neck: incidence and survival trends based on 1973–2007 Surveillance, Epidemiology, and End Results data
.
Cancer
.
2012
;
118
(
18
):
4444
51
.
3.
Jones
AS
,
Hamilton
JW
,
Rowley
H
,
Husband
D
,
Helliwell
TR
.
Adenoid cystic carcinoma of the head and neck
.
Clin Otolaryngol Allied Sci
.
1997
;
22
(
5
):
434
43
.
4.
Geiger
JL
,
Ismaila
N
,
Beadle
B
,
Caudell
JJ
,
Chau
N
,
Deschler
D
.
Management of salivary gland malignancy: ASCO guideline
.
J Clin Oncol
.
2021
;
39
(
17
):
1909
41
.
5.
Chau
NG
,
Hotte
SJ
,
Chen
EX
,
Chin
SF
,
Turner
S
,
Wang
L
.
A phase II study of sunitinib in recurrent and/or metastatic adenoid cystic carcinoma (ACC) of the salivary glands: current progress and challenges in evaluating molecularly targeted agents in ACC
.
Ann Oncol
.
2012
;
23
(
6
):
1562
70
.
6.
Thomson
DJ
,
Silva
P
,
Denton
K
,
Bonington
S
,
Mak
SK
,
Swindell
R
.
Phase II trial of sorafenib in advanced salivary adenoid cystic carcinoma of the head and neck
.
Head Neck
.
2015
;
37
(
2
):
182
7
.
7.
Locati
LD
,
Perrone
F
,
Cortelazzi
B
,
Bergamini
C
,
Bossi
P
,
Civelli
E
.
A phase II study of sorafenib in recurrent and/or metastatic salivary gland carcinomas: translational analyses and clinical impact
.
Eur J Cancer
.
2016
;
69
:
158
65
.
8.
Ho
AL
,
Dunn
L
,
Sherman
EJ
,
Fury
MG
,
Baxi
SS
,
Chandramohan
R
.
A phase II study of axitinib (AG-013736) in patients with incurable adenoid cystic carcinoma
.
Ann Oncol
.
2016
;
27
(
10
):
1902
8
.
9.
Wong
SJ
,
Karrison
T
,
Hayes
DN
,
Kies
MS
,
Cullen
KJ
,
Tanvetyanon
T
.
Phase II trial of dasatinib for recurrent or metastatic c-KIT expressing adenoid cystic carcinoma and for nonadenoid cystic malignant salivary tumors
.
Ann Oncol
.
2016
;
27
(
2
):
318
23
.
10.
Tchekmedyian
V
,
Sherman
EJ
,
Dunn
L
,
Tran
C
,
Baxi
S
,
Katabi
N
.
Phase II study of lenvatinib in patients with progressive, recurrent or metastatic adenoid cystic carcinoma
.
J Clin Oncol
.
2019
;
37
(
18
):
1529
37
.
11.
Zhu
G
,
Zhang
L
,
Dou
S
,
Li
R
,
Li
J
,
Ye
L
.
Apatinib in patients with recurrent or metastatic adenoid cystic carcinoma of the head and neck: a single-arm, phase II prospective study
.
Ther Adv Med Oncol
.
2021
;
13
:
17588359211013626
.
12.
Kang
EJ
,
Ahn
MJ
,
Ock
CY
,
Lee
KW
,
Kwon
JH
,
Yang
Y
.
Randomized phase II study of axitinib versus observation in patients with recurred or metastatic adenoid cystic carcinoma
.
Clin Cancer Res
.
2021
;
27
(
19
):
5272
9
.
13.
Creagan
ET
,
Woods
JE
,
Rubin
J
,
Schaid
DJ
.
Cisplatin-based chemotherapy for neoplasms arising from salivary glands and contiguous structures in the head and neck
.
Cancer
.
1988
;
62
(
11
):
2313
9
.
14.
Licitra
L
,
Cavina
R
,
Grandi
C
,
Palma
SD
,
Guzzo
M
,
Demicheli
R
.
Cisplatin, doxorubicin and cyclophosphamide in advanced salivary gland carcinoma. A phase II trial of 22 patients
.
Ann Oncol
.
1996
;
7
(
6
):
640
2
.
15.
Nakano
K
,
Sato
Y
,
Sasaki
T
,
Shimbashi
W
,
Fukushima
H
,
Yonekawa
H
.
Combination chemotherapy of carboplatin and paclitaxel for advanced/metastatic salivary gland carcinoma patients: differences in responses by different pathological diagnoses
.
Acta Otolaryngol
.
2016
;
136
(
9
):
948
51
.
16.
Fukuda
N
,
Fujiwara
Y
,
Wang
X
,
Ohmoto
A
,
Urasaki
T
,
Hayashi
N
.
Tumor growth rate as a prognostic factor for metastatic or recurrent adenoid cystic carcinoma of the head and neck patients treated with carboplatin plus paclitaxel
.
Eur Arch Otorhinolaryngol
.
2021
;
278
(
8
):
3037
43
.
17.
Imamura
Y
,
Tanaka
K
,
Kiyota
N
,
Hayashi
H
,
Ota
I
,
Arai
A
.
Docetaxel plus cisplatin in recurrent and/or metastatic non-squamous-cell head and neck cancer: a multicenter phase II trial
.
Med Oncol
.
2021
;
38
(
11
):
128
.
18.
Eisenhauer
EA
,
Therasse
P
,
Bogaerts
J
,
Schwartz
LH
,
Sargent
D
,
Ford
R
.
New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)
.
Eur J Cancer
.
2009
;
45
(
2
):
228
47
.
19.
Kanda
Y
.
Investigation of the freely available easy-to-use software “EZR” for medical statistics
.
Bone Marrow Transplant
.
2013
;
48
(
3
):
452
8
.
20.
Simon
R
,
Makuch
RW
.
A non-parametric graphical representation of the relationship between survival and the occurrence of an event: application to responder versus non-responder bias
.
Stat Med
.
1984
;
3
(
1
):
35
44
.
21.
Sung
MW
,
Kim
KH
,
Kim
JW
,
Min
YG
,
Seong
WJ
,
Roh
JL
.
Clinicopathologic predictors and impact of distant metastasis from adenoid cystic carcinoma of the head and neck
.
Arch Otolaryngol Head Neck Surg
.
2003
;
129
(
11
):
1193
7
.
22.
van der Wal
JE
,
Becking
AG
,
Snow
GB
,
van der Waal
I
.
Distant metastases of adenoid cystic carcinoma of the salivary glands and the value of diagnostic examinations during follow-up
.
Head Neck
.
2002
;
24
(
8
):
779
83
.
23.
Bobbio
A
,
Copelli
C
,
Ampollini
L
,
Bianchi
B
,
Carbognani
P
,
Bettati
S
.
Lung metastasis resection of adenoid cystic carcinoma of salivary glands
.
Eur J Cardiothorac Surg
.
2008
;
33
(
5
):
790
3
.
24.
Costelloe
CM
,
Chuang
HH
,
Madewell
JE
,
Ueno
NT
.
Cancer response criteria and bone metastases: RECIST 1.1, MDA and PERCIST
.
J Cancer
.
2010
;
1
:
80
92
.
25.
Tokito
T
,
Shukuya
T
,
Akamatsu
H
,
Taira
T
,
Ono
A
,
Kenmotsu
H
.
Efficacy of bevacizumab-containing chemotherapy for non-squamous non-small cell lung cancer with bone metastases
.
Cancer Chemother Pharmacol
.
2013
;
71
(
6
):
1493
8
.
26.
Persson
M
,
Andrén
Y
,
Mark
J
,
Horlings
HM
,
Persson
F
,
Stenman
G
.
Recurrent fusion of MYB and NFIB transcription factor genes in carcinomas of the breast and head and neck
.
Proc Natl Acad Sci U S A
.
2009
;
106
(
44
):
18740
4
.
27.
Brayer
KJ
,
Frerich
CA
,
Kang
H
,
Ness
SA
.
Recurrent fusions in MYB and MYBL1 define a common, transcription factor-driven oncogenic pathway in salivary gland adenoid cystic carcinoma
.
Cancer Discov
.
2016
;
6
(
2
):
176
87
.
28.
Lee
RH
,
Wai
KC
,
Chan
JW
,
Ha
PK
,
Kang
H
.
Approaches to the management of metastatic adenoid cystic carcinoma
.
Cancers
.
2022
;
14
(
22
):
5698
.
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