Adenoid cystic carcinoma: A review of clinical features, treatment targets and advancement in improving the immune response to monoclonal antibody therapy.

Abstract

The natural history of adenoid cystic carcinoma (ACC) is relentless, defined by treatment failure heralded by reasonable locoregional recurrence and poor long-term distant metastatic disease. In this review, we present an update of clinical features, molecular classification, current targeted therapies, immune landscapes and novel treatment targets with their respective clinical trials. The presented results are defined by a lack of overall response rate and limited progression free survival, with restriction to stable. In addition, ACC is resistant to immune checkpoint inhibition due to low tumour immunogenicity and lack of PD-L1 expression. Here we present a new prospective research paradigm for ACC, including the potential to target prostate specific membrane antigen (PSMA) and the potential for manipulation of target receptors in the clinic. The presentation of this review aims to promote future research to improve response rates and outcomes for therapeutics undergoing clinical trial in ACC.