|LETTER TO EDITOR
|Year : 2021 | Volume
| Issue : 2 | Page : 419-420
Authors' reply to Mohan
Akhil Kapoor1, Pratik Chandrani2
1 Department of Medical Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Mohan Malviya Cancer Center, Tata Memorial Hospital, Varanasi, India
2 Department of Medical Oncology, Tata Memorial Hospital, Tata Memorial Center, Homi Bhabha National Institute, Mumbai, Maharashtra, India
|Date of Submission||10-May-2021|
|Date of Decision||10-May-2021|
|Date of Acceptance||14-May-2021|
|Date of Web Publication||30-Jun-2021|
Department of Medical Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Mohan Malviya Cancer Center, Tata Memorial Hospital, Varanasi
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Kapoor A, Chandrani P. Authors' reply to Mohan. Cancer Res Stat Treat 2021;4:419-20
We thank Ms. Mohan for reading our article titled, “Molecular tumor board: Case 4 Salivary Gland Cancer: Novel therapeutic options as a result of comprehensive molecular profiling” with interest and providing valuable comments. We agree with Ms. Mohan that knowledge about the status of the androgen receptor variant 7 (AR-V7) protein might be helpful in clinical decision-making, and this has already been mentioned in the discussion section of our article. In addition, we would like to highlight that detection of the AR-V7 mRNA and protein expression in the circulating tumor cells (CTCs) is an important method for determining the AR-V7 status. Next-generation sequencing (NGS) analysis of the formalin-fixed paraffin-embedded tumor tissue alone is usually not sufficient for the detection of AR-V7, and thus, it needs to be coupled with noninvasive methods (based on cell-free DNA or CTCs) to account for tumor heterogeneity. Contrary to the comment by Ms. Mohan, the patient discussed in our article was not subjected to rebiopsy as the tissue was only 3 months old. We agree with Ms. Mohan that NGS, though expensive, should be used in patients as early as possible to identify any potential targetable mutations. With widespread use and availability of NGS, it is expected that the cost of NGS will come down in the near future, further widening the utilization of NGS in the era of personalized medicine. Alternatively, a relatively cost-effective Droplet Digital polymerase chain reaction (ddPCR) may also be useful in cost-constrained cases for the identification of androgen receptor mutations from tissue as well as plasma.
In the patient discussed in our article, there was no distant metastasis at baseline, as confirmed with a computed tomography scan of the thorax and abdomen. However, the patient's tumor was unresectable because of the involvement of the paraspinal muscles. Furthermore, there were multiple enlarged metastatic nodes in the left retropharyngeal; II, III, IV, and V supraclavicular; and retroauricular regions, with the largest one observed at the left level II measuring 2.3 cm × 2.0 cm. This too has already been described in the article.
Regarding the comment on the use of encorafenib and binimetinib, we would like to clarify that these are presently not available in India, and no study has shown their superiority over the presently available BRAF inhibitors. There are reports of the use of vemurafenib besides the combination of dabrafenib and trametinib in salivary gland cancers as described in our article.,, However, no such reports could be identified in a literature search for encorafenib and binimetinib at the time of writing this letter or in an article describing the novel therapeutic strategies in metastatic salivary gland cancer. Thus, using a combination of dabrafenib and trametinib remains the preferred method for BRAF inhibition.
Therefore, we would like to conclude on the note that this era of personalized medicine is very exciting, and we look forward to an increasing use of NGS with the hope of detecting more actionable targets.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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