Metastatic Salivary Duct Carcinoma with ERBB2 Amplification and Sequential Response to Ado-Trastuzumab Emtansine and Neratinib: A Case Report.

Introduction: Salivary duct carcinoma (SDC) is an aggressive and rare subtype of salivary gland carcinoma. Surgical excision and radiotherapy are standard of care for early cancer. Chemotherapies with taxanes and platinum show overall response rates between 39% and 50%. SDCs are often associated with an overexpression of the androgen receptor (AR) and HER2/neu which have recently become druggable targets. Case Presentation: Here, we report on an 84-year-old male patient with metastatic SDC of the right parotid gland. In 2017, he underwent a right total parotidectomy, a right neck dissection, and an infratemporal fossa clearance followed by 6 weeks of radiotherapy. In 2018, due to metastatic spread in the lungs, bones, and pararenal gland, a pathological workup of the tumor tissue was performed and revealed both AR and HER2 overexpression, respectively. Consequently, he underwent androgen deprivation therapy and, due to asymptomatic progression, sequentially human epidermal growth factor receptor 2 (HER-2)-targeted therapy with ado-trastuzumab emtansine and neratinib, which led to stable disease during the course of about 18 months. The electronically captured patient-reported outcome had demonstrated a good tolerance of all three therapeutic lines. Conclusion: In conclusion, since effective standard therapeutic treatment options for SDC may often not be tolerable in older patients, the implementation of personalized and adaptive treatments, especially in patients with rare tumor types, might offer valuable treatment options.

Systematic Analysis of Readability of Patient Information on Internet Pages from Departments for Trauma Surgery of German University Hospitals. / Systematische Analyse der Lesbarkeit von Patienteninformationstexten auf Internetseiten von Abteilungen für Unfallchirurgie deutscher Universitätskliniken.

INTRODUCTION: The need-based information transfer in education as well as for the recruitment of patients becomes more and more relevant. Here, the internet has emerged as an increasingly important factor in recent years and therefore information pages on hospital homepages can be very helpful. However, it is known that basic text comprehension skills are lacking among large populations. METHOD: The aim of the present study was to evaluate the readability of the patient information available on the websites of trauma departments of German university hospitals. For this purpose, a search for information material on 10 different diagnoses was carried out. Out of 360 texts possible, 185 were found and assigned to 2 superordinate thematic areas (emergency vs. elective operations), subjected to a systematic text analysis via software "Text-Lab" and rated using 5 known readability indices (Amstad, G-SMOG, LIX, HIX, WSTF). RESULTS: The indices used for both thematic complexes consistently showed poor readability, so that the texts only seem sufficiently comprehensible to readers with higher education. (Amstad: 21.4 ± 20.8; G-SMOG: 11.6 ± 2.0; WSTF 13.3 ± 2.1; LIX: 60.9 ± 7.6; HIX: 4.1 ± 3.2). CONCLUSION: For the medical information provided by university hospitals, there is a clear need for improvement in order to make the adequate acquisition of knowledge accessible to a broader spectrum of patients.