Dr Patel on the Rationale for Studying ADT Plus Pembrolizumab in Salivary Gland Cancer

“Insurance was denying everything we put forward other than cytotoxic chemotherapy. We saw there was a critical gap in the understanding of what kind of treatments could be effective for this patient population.”

Manish Patel, DO, a medical oncologist at the University of Minnesota Health and an associate professor of medicine in the Division of Hematology, Oncology and Transplantation in the Department of Medicine at the University of Minnesota Medical School, discussed the rationale for conducting the phase 2 BTCRC HN17-111trial (NCT03942653) investigating androgen deprivation therapy (ADT) in combination with pembrolizumab (Keytruda) in patients with advanced-stage, androgen receptor–positive salivary gland carcinoma.

Patel began by discussing the clinical challenges inherent in managing rare salivary gland cancers, noting that the existence of diverse histotypes within this disease has prevented the establishment of a standard of care for patients presenting with advanced or recurrent disease. Patel highlighted that previous research efforts, including small-scale clinical trials and retrospective studies focused on immunotherapy, have historically yielded low response rates for this patient population.

Patel emphasized that the motivation for investigating ADT plus pembrolizumab in this population stemmed directly from clinical observations and the practical difficulties of securing treatment approvals for patients with salivary gland cancers. Specifically, Patel explained that insurance providers frequently deny coverage for treatments proposed by oncologists, leaving cytotoxic chemotherapy as the only accessible option for many patients. This systemic barrier underscored a critical gap in the current understanding of which treatments are truly effective for patients with these rare malignancies, he added.

By identifying these limitations, Patel noted the urgent necessity of expanding the oncology community’s knowledge of this disease and its potential treatment avenues to provide better outcomes for patients. Patel concluded that addressing this deficiency is essential for developing more successful, targeted strategies that move beyond the limitations of traditional chemotherapy protocols.