Thalidomide therapy for metastatic adrenal carcinoma

Kashinath Dixit; Alaaeldin Shablak; Koshy Jacob; David Walmsley; Robert Hawkins; Peter Trainer

P177

Prev Next

Section Contents Cite

Endocrine Abstracts (2008) 15 P177

SFEBES2008 Poster Presentations Endocrine tumours and neoplasia (31 abstracts)

Thalidomide therapy for metastatic adrenal carcinoma

Kashinath Dixit ¹ , Alaaeldin Shablak ² , Koshy Jacob ³ , David Walmsley ³ , Robert Hawkins ² & Peter Trainer ¹

Author affiliations

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.

Sex	Age at ▲ (year)	Size of primary tumor (cm)	Hormones secreted	TV pre-TH (cm³)	TH dose and duration (months)	TV on TH (cm³)	Other Rx	Outcome
F#	22	16X18	Androgens	2556	50 mg	117	Nil	Stable
			Cortisol		38m	9
F	53	16X14X12	Nil	0.65	50 mg	0.3	Nil	Stable
					10 m	3
M	58	20X15	Androgens	15.13	50 mg	127	M	Alive with disease
					3 m
			Estrogen		100 mg	0.78
					6 m
					200 mg
					2 m
M	45	8X9X10	Cortisol	3.1	50 mg	6.1	M	Alive with good Rx response
					3 m	5
					100 mg	0
					3 m
M	34	8X12X10	Cortisol	623.67	50 mg	148	M	Died of disease
			Estrogen		4m	7.4	C
M	33	18X12	Cortisol	4.17	50 mg		Nil	Died 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.