IACS9 9th International Adrenal Cancer Symposium 2024 Abstracts (18 abstracts)
Outcome of combination chemotherapy for metastatic adrenocortical carcinoma
Joakim Crona 1 , Eric Baudin 2* , Mouhammed Amir Habra 3* , Otilia Kimpel 4* , Vania Balderrama-Brondani 3 , Matthias Kroiss 5 , Marta Lagana 6 , Ulrich Dischinger 4 , Marcus Quinkler 7 , Britt Skogseid 1 , Anthony Stell 8 , Maria Boudina 9 , Jonathan Wadsley 10 , Letizia Canu 11 , Malgorzata Trofimiuk-Muldner 12 , Cristina Lamas 13 , Emanuela Arvat 14 , Maria Cristina De Martino 15 , Christophe Sajous 16 , Barbara Altieri 4 , Julien Hadoux 2 , Magalie Haissaguerre 17 , Darko Kastelan 18 , Cristina L Ronchi 19 , James Pittaway 20 , Rossella Libe 21 , Carmina T. Fuss 4 , Livia Lamartina 2 , Massimo Terzolo 22 , Deborah Cosentini 6 , Sophie Moog 2 , Alfredo Berruti 6 , Martin Fassnacht 4 & Felix Beuschlein 5,23,24
1Department of Medical Sciences, Uppsala University, Uppsala, Sweden 2Gustave Roussy, Universite Paris-Saclay, Departement d’Imagerie, Service d’Oncologie Endocrinienne, Villejuif, France 3 Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA 4 Division of Endocrinology and Diabetes, University Hospital of Wurzburg, Wurzburg, Germany 5 Department of Internal Medicine IV, University Hospital, Ludwig-Maximilians-Universitat Munchen, Munchen, Germany 6 Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, University of Brescia at ASST Spedali Civili, Brescia, Italy 7 Endocrinology in Charlottenburg, Berlin, Germany 8 School of Computing and Information Systems, University of Melbourne, Melbourne, Victoria 3053, Australia 9 Department of Endocrinology, Theagenio Cancer Hospital, Thessaloniki, Greece 10 Weston Park Hospital, Sheffield, UK 11 Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy 12 Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland 13 Endocrinology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain 14 Oncological Endocrinology; City of Health and Science University Hospital; Department of Medical Sciences; University of Turin, Turin, Italy 15 Dipartimento di Medicina Clinica e Chirurgia, Sezione di Endocrinologia, Universita Federico II di Napoli, Naples, Italy 16 Hospices Civils de Lyon, Federation d’Endocrinologie, Universite Claude Bernard Lyon 1, Lyon, France 17 Service d’Endocrinologie – Diabete et Nutrition CHU de Bordeaux, Bordeaux, France 18 Department of Endocrinology, University Hospital Centre Zagreb, Zagreb, Croatia 19 Department of Metabolism and Systems Science, College of Medicine and Health, University of Birmingham, Birmingham, UK 20 Department of Endocrinology, St Bartholomews Hospital, London, UK 21 Service Endocrinologie, AP-HP, Hopital Cochin, Paris, France 22 Department of Clinical and Biological Sciences, University of Turin at San Luigi Hospital, Orbassano, Italy 23 Department of Endocrinology, Diabetology and Clinical Nutrition, University of Zurich (USZ) and University of Zurich (UZH), Zurich, Switzerland 24 The LOOP Zurich Medical Research Center, Zurich, Switzerland
Background: Etoposide, doxorubicin, cisplatin, and mitotane (EDP-M) is considered the firstline treatment for metastatic adrenocortical carcinoma (ACC). However, a considerable proportion of patients experience serious adverse events and impact of the EDP-M regimen on patient survival remains unclear. On that ground, it has been hypothesized that omitting doxorubicin from the EDP-M protocol would increase tolerability without a relevant loss of efficacy.
Objectives: To investigate the efficacy of EDP-M in terms of overall survival and objective response (by local criteria), and to compare it to that of patients treated with cisplatin, etoposide and mitotane (EP-M).
Methods: A multi-centric observational study based on a retrospectively cohort from the ENS@T registry. Patients enrolled were at least 18 years of age, had been diagnosed with advanced or unresectable ACC and started first-line chemotherapy treatment with EDP-M or EP-M between 2010 and 2020. Difference in overall survival (from start of chemotherapy) was examined using log-rank and cox-regression analyses including adjustment for relevant baseline parameters (age, Ki-67, oligometastatic disease, performance status, and disease stage) by using multiple imputation methodology.
Result: 517 ACC patients from 17 centers were included, 392 received EDP-M and 125 EPM. Median Ki67 was 24% and 30% and the median age was 47 and 51 years in EDP-M and EP-M groups, respectively. Proportion oligometastatic ACC (Stage IVa and ≤5 metastases) was 36% (EDP-M) and 12% (EP-M) with 74% (EDP-M) and 76% (EP-M) of patients having WHO performance status 0-1. Overall survival for the EDP-M group was 20.6 months compared to 12.5 months in the EP-M group (hazard ratio 0.57 [95% confidence interval (CI) 0.46-0.7], P < 0.0001). The adjusted overall survival comparison resulted in in a hazard ratio of 0.6 (95% CI 0.47-0.75) in favor of EDP-M. An objective response was reported in 28% and 16% (P = 0.017) of patients receiving EDP-M or EP-M, respectively.
Discussion/Conclusion: This study validates findings of the FIRM-ACT study and confirms the activity of EDP-M in a real-world setting. EDP-M treated patients had more favorable outcomes and less aggressive disease characteristics as compared to EP-M treated cases. A randomized clinical trial would be needed to add further evidence on this topic.
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Endocrine Abstracts
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