14592 Background: Adrenocortical carcinoma (ACC) is a rare cancer associated with a poor prognosis. We describe our experience with the effectiveness of various chemotherapies in the treatment of ACC. Methods: We performed a detailed retrospective review of every patient diagnosed with ACC at the M.D. Anderson Cancer Center between the years 1980 and 2000. We included only those patients with a histological diagnosis of ACC who had radiologically measurable disease and received chemotherapy followed by post-treatment imaging. Patients without a pathological diagnosis, serial imaging studies, or adequate follow-up were excluded from our study. In each case, we compared radiological tumor burden after a given drug or drug combination to the radiological tumor burden preceding the treatment session. Radiologist reports were used to categorize post-treatment imaging studies as showing either a decrease in tumor burden, no change in tumor burden, or an increase in tumor burden. Patients who did not have post-treatment imaging due to rapid progressive clinical deterioration were regarded as having increased tumor burden. Results: 224 patients with a diagnosis of ACC were identified in our database, of which 62 had histological confirmation and received chemotherapy with documented radiological follow-up. 38 different chemotherapeutic regimens were reviewed. Patients given single agent fluorouracil, taxol, taxotere, trimetrexate, navelbine, and patients given combination treatment with cyclophosphamide/adriamycin/cisplatin, gemcitabine/taxotere, and mitotane/cisplatin/taxol did not show any improvement. Treatment with single agent mitotane and combination VP-16/cisplatin resulted in either no change or decrease in tumor burden in over 50% of sessions. Promising trends were seen in patients treated with single agent VP-16 and carboplatinum, and with combination adriamycin/cisplatin/ifosfamide, mitotane/cisplatin, and VP-16/adriamycin/cisplatin. Conclusions: We have identified specific drugs and drug combinations of no apparent benefit in this cohort, and have also identified select agents and combinations which offer benefit. Further prospective clinical trials should focus on the use of those agents and combinations which offer benefit. No significant financial relationships to disclose.
Adrenocortical carcinoma – fatal evolution of a rare cancer in children
