TY - JOUR
T1 - Efficacy of the EDP-M scheme plus adjunctive surgery in the management of patients with advanced adrenocortical carcinoma
T2 - The brescia experience
AU - Laganà, Marta
AU - Grisanti, Salvatore
AU - Cosentini, Deborah
AU - Ferrari, Vittorio Domenico
AU - Lazzari, Barbara
AU - Ambrosini, Roberta
AU - Sardini, Chiara
AU - Volta, Alberto Dalla
AU - Palumbo, Carlotta
AU - Poliani, Pietro Luigi
AU - Terzolo, Massimo
AU - Sigala, Sandra
AU - Tiberio, Guido Alberto Massimo
AU - Berruti, Alfredo
N1 - Funding Information:
This work was granted by: AIRC project IG14411 (PI: A.B.), Fondazione Camillo Golgi, Brescia and Fondazione Internazionale di Ricerca in Medicina (F.I.R.M.) ONLUS, Cremona (Italy).
Publisher Copyright:
© 2020 by the authors. Licensee MDPI, Basel, Switzerland.
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/4
Y1 - 2020/4
N2 - Etoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center for this rare disease in Italy. In this series, EDP-M obtained a partial response in 50% of patients; median progression free survival (PFS) and overall survival were 10.1 months (95% Confidence Interval [CI 95%] 8.1-12.8) and 18.7 months (95% CI: 14.6-22.8), respectively. EDP-M was not interrupted in five patients showing disease progression after two cycles without the appearance of new lesions and mitotane levels below the therapeutic range. In two of them, the disease remained stable at further imaging evaluations and the other three obtained a partial response. Twenty-six responding patients underwent surgery of residual disease and 13 of them became disease free. Surgery identified a pathological complete response (pCR) in four patients (7%) and Ki67 expression in post-chemotherapy tumor specimens, inferior to 15% (median value), was associated with better PFS and survival. In the present study, the EDP-M regimen is confirmed to have a limited efficacy. Early disease progression does not mean treatment inefficacy. Surgery of residual disease in partially responding patients allows for the detection of pCR in few of them and this condition is predictive of long-term survival. Ki67 expression of post chemotherapy residual disease could be an additional prognostic factor that deserves to be studied further.
AB - Etoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center for this rare disease in Italy. In this series, EDP-M obtained a partial response in 50% of patients; median progression free survival (PFS) and overall survival were 10.1 months (95% Confidence Interval [CI 95%] 8.1-12.8) and 18.7 months (95% CI: 14.6-22.8), respectively. EDP-M was not interrupted in five patients showing disease progression after two cycles without the appearance of new lesions and mitotane levels below the therapeutic range. In two of them, the disease remained stable at further imaging evaluations and the other three obtained a partial response. Twenty-six responding patients underwent surgery of residual disease and 13 of them became disease free. Surgery identified a pathological complete response (pCR) in four patients (7%) and Ki67 expression in post-chemotherapy tumor specimens, inferior to 15% (median value), was associated with better PFS and survival. In the present study, the EDP-M regimen is confirmed to have a limited efficacy. Early disease progression does not mean treatment inefficacy. Surgery of residual disease in partially responding patients allows for the detection of pCR in few of them and this condition is predictive of long-term survival. Ki67 expression of post chemotherapy residual disease could be an additional prognostic factor that deserves to be studied further.
UR - http://www.scopus.com/inward/record.url?scp=85083787416&partnerID=8YFLogxK
U2 - 10.3390/cancers12040941
DO - 10.3390/cancers12040941
M3 - Journal articles
AN - SCOPUS:85083787416
VL - 12
JO - Cancers
JF - Cancers
IS - 4
M1 - 941
ER -