Endocrine Abstracts (2008) 15 P177

Thalidomide therapy for metastatic adrenal carcinoma

Kashinath Dixit1, Alaaeldin Shablak2, Koshy Jacob3, David Walmsley3, Robert Hawkins2 & Peter Trainer1

Departments of 1Endocrinology and 2Medical Oncology, Christie Hospital, Manchester, UK; 3Department of Diabetes and Endocrinology, Royal Lancaster Infirmary, Lancaster, UK.

Adrenocortical carcinoma are rare, highly vascular tumours with a generally poor prognosis. We have studied the use of the antiangiogenic drug, thalidomide (TH), in 6 patients with metastatic adrenocortical carcinoma (5 patients had adrenalectomy and one patient was inoperable#). The response to thalidomide treatment is summarized in the following Table. Assuming the residual/metastatic tumours to have a spheroidal form, the tumour volume (V) was calculated using the equation, V=[4/3πab(a+b)/2]×1/8] where a=maximum and b=minimum tumour diameter.

SexAge at ▲ (year)Size of primary tumor (cm)Hormones secretedTV pre-TH (cm3)TH dose and duration (months)TV on TH (cm3)Other Rx Outcome
F#2216X18Androgens255650 mg117NilStable
F5316X14X12Nil0.6550 mg0.3NilStable
10 m3
M5820X15Androgens15.1350 mg127MAlive with disease
3 m
Estrogen100 mg0.78
6 m
200 mg
2 m
M458X9X10Cortisol3.150 mg6.1MAlive with good Rx response
3 m5
100 mg0
3 m
M348X12X10Cortisol623.6750 mg148MDied of disease
M3318X12Cortisol4.1750 mgNilDied of acute liver failure
2 m
TV, cumulative volume of all residual/metastatic tumours; M, mitotane; C, chemotherapy.

The patient who died of acute liver failure was a known alcohol and recreational drug abuser. There has been no response in two men. One man had complete resolution of metastatic disease on higher dose of TH+mitotane. Both women have responded well on thalidomide monotherapy. We conclude that thalidomide therapy is certainly worth further investigation in patients with metastatic adrenocortical carcinoma, especially in combination with mitotane.

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