← All algorithms · Related notes →
This algorithm addresses systemic therapy for recurrent or metastatic salivary gland tumors, and the first branch point is molecular profiling. When an actionable target is present, therapy is biomarker-directed: androgen deprivation (abiraterone, bicalutamide, or LHRH agonist) for androgen receptor positive tumors; HER2-targeted therapy (T-DM1 or T-DXd, or trastuzumab with or without pertuzumab) for HER2-positive tumors; a TRK inhibitor (larotrectinib or entrectinib) for NTRK fusions; selpercatinib for RET alterations, linked to LIBRETTO-001; and dabrafenib plus trametinib for BRAF-mutant tumors, linked to ROAR.
When no actionable target is identified, the chart shows cytotoxic chemotherapy with carboplatin and paclitaxel, or alternatively cisplatin and vinorelbine or CAP. Adenoid cystic carcinoma is shown as a separate branch, where VEGFR-directed tyrosine kinase inhibitors are used: lenvatinib, with sorafenib as an alternative. The trial evidence linked from these boxes is largely drawn from other tumor types (RET fusion NSCLC for LIBRETTO-001, and radioiodine-refractory thyroid cancer for the sorafenib DECISION trial), reflecting the rarity of randomized data in salivary cancers.
Starting point: Recurrent / metastatic salivary gland tumor.