Nelfinavir treatment of adenoid cystic carcinoma: A case report

Adenoid cystic carcinoma (ACC) accounts for about 1% of all head and neck cancers and most commonly arises from the major and minor salivary glands, but may also develop in other sites.1 Complete resection with negative margins, the recommended surgical treatment, is commonly compromised by extensive perineural spread. Anatomic constraints such as extension to or through the skull base may also preclude meaningful resection, in which case the standard postoperative radiation therapy may serve as primary therapy instead. Despite displaying an indolent behavior, ACC is highly lethal. Disease-free survival at 5 years is around 50% and decreases to 30% to 40% at 15 years.2,3 Management options for recurrence are usually limited by the location and extent of the cancer (which is often metastatic), precluding further surgery or reirradation. Systemic treatment has been limited to toxic chemotherapy regimens with low efficacy. As a result, management of recurrent disease warrants further investigation.