What is your first line therapy for progressive symptomatic metastatic adenoid cystic carcinoma?

Although platinum regimens can be considered for treatment of metastatic ACC, I generally reserve such regimens for patients with large, bulky symptomatic disease. Over the past few years, TKIs have tested in this patient population with the last report published with lenvatinib (Tchekmedyian, et al...

Patients with advanced metastatic adenoid cystic carcinoma, in my experience, are not well served by cisplatin. I prefer a TKI as there is a lack of survival advantage with cisplatin.