A patient has recurrent metastatic salivary duct carcinoma after local treatment. Pathology demonstrates strong androgen-receptor expression and HER2 amplification. What is the most appropriate principle?
Salivary duct carcinoma may have actionable targets. Treatment selection requires confirmation of pathology, molecular findings, performance status, prior therapy and access to evidence-based options.
A. Treat as conventional squamous carcinoma without reviewing biomarkers: Histology and biomarkers can materially change systemic options.
B. Offer only antibiotics because metastases are incurable: Palliative systemic treatment may provide disease control and symptom benefit.
C. Assume one marker excludes the other: Molecular profiles can be complex and need expert interpretation.
D. Discuss biomarker-directed systemic treatment options in a specialist head-and-neck oncology MDT: Salivary duct carcinoma may have actionable targets. Treatment selection requires confirmation of pathology, molecular findings, performance status, prior therapy and access to evidence-based options.
E. Start systemic treatment without staging or performance assessment: Fitness, burden and goals of care are integral to treatment choice.
If there were no actionable target and disease was limited, local ablative or palliative radiotherapy options might be considered alongside systemic therapy.
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