Efficacy of Immunotherapy Combined with Antiangiogenic Therapy in Treatment-Failure Patients with Advanced Carcinoma Ex Pleomorphic Adenoma of the Submandibular Gland: A Case Report

Round 1

Reviewer 1 Report

The authors present a case report of CA ex PA treated by immunotherapy with antiangiogenic therapy. It is interesting report with practical clinical implication.

The discussion can be improved by summary of other salivary gland tumors and their potential treatment by immunotherapy and antiangiogenic therapy.

The CT figure should be enlarged as it is hard to follow.

Figure 1H should be replaced by picture with higher resolution showing better sparse positivity.

Why authors used CD34 and not CD31? Please explain and discuss angiogenic markers.

Author Response

Please see the attachment.

Author Response File: Author Response.pdf

Reviewer 2 Report

Huanlan Sa and colleagues provided a case report of promising efficacy from an immuno/ antiangiogenic combination therapy in a prior treatment-failure patient with advanced carcinoma ex pleomorphic adenoma of the submandibular gland. It is a well written manuscript that discusses a clinical meaningful treatment option for highly unmet medical needs of Ca ex PA.

Overall, the manuscript is clear and relevant to the potentially new and effective treatment option for Ca ex PA.   I do have some suggestions:
1) The authors describe in Figure 1H that IHC showed that tumor proportion score (TPS) for programmed cell death ligand 1 (PD-L1) was < 1% (clone 22C3). Can the authors expand discussions on why they think the patient with PD-L1<1% expression can benefit from adding anti-PD-1 in the treatment regimen when the disease progressed post-Anotinib therapy.

2) Can the authors add black or white arrows in Figure 2 (each sub-figure) to point out where were the tumor lesions prior and post treatments? 

3) In page 4 line 126-128, can the authors describe if the response observed after two cycles of treatment can be classified as a partial response according to RECIST guideline version 1.1.? Can the authors provide an update whether the response sustained for how may cycles up to date, e.g. duration of response time?  

Author Response

Please see the attachment.

Author Response File: Author Response.pdf