Clinical presentation, treatment modalities and outcome in patients with adrenocortical carcinoma: A single center experience.

Michiel Bronswijk, Annouschka Laenen,  Oliver Bechter

Abstract:

Adrenocortical carcinoma is an orphan disease usually associated with a poor prognosis. Surgery is the only treatment with a curative intent, leaving systemic therapy mainly for the purpose of symptom control. First line combination chemotherapy with Etoposide, Doxorubicin, Cisplatin and Mitotane (EDP-Mitotane) is considered the standard of care, although this regimen is not associated with an overall survival benefit. Due to the rarity of the disease no standard therapy exists in the second line or when patients are intolerant to the first line treatment. Therefore, treatment of these patients is usually following a very individual path in daily practice. Our aim was to retrospectively analyze treatment of patients with adrenocortical carcinoma in our tertiary center and compare treatment outcomes with reports in the literature. Our findings reflect the daily practice in adrenocortical carcinoma treatment and showed that surgery is the mainstay of therapy, even in some cases with metastatic disease. Adjuvant therapy in adrenocortical carcinoma was initiated less frequently than suggested by current guidelines. Furthermore, most of the patients in our cohort received more than one line of chemotherapy for metastatic or inoperable disease with overall survival rates comparable to those published. In summary, our analysis stresses the importance of clinical trial activity in this rare disease in order to standardize and improve adrenocortical carcinoma therapy more profoundly.