ECEESPE2025 Oral Communications Oral Communications 1: Adrenal and Cardiovascular Endocrinology (6 abstracts)
Clinical predictors of treatment response in advanced adrenocortical carcinoma: a multicentre ENSAT study
Alessandra Mangone 1,2 , Barbara Altieri 3,4 , Emanuele Ferrante 2 , Irina Bancos 5 , Michaela Luconi 6 , Barbara Ziółkowska 7 , Anja Barač Nekić 8 , Rossella Libe 9 , Filippo Ceccato 10,11 , James F. H. Pittaway 12 , Marta Laganà 13 , Guido Di Dalmazi 14 , Otilia Kimpel 3 , Bahar Bahrani Fard 5 , Letizia Canu 6 , Agnieszka Kotecka-Blicharz 15 , Darko Kastelan 8 , Lucas Bouys 9 , Irene Tizianel 10,11 , Gillian Bennet 12 , Marc P. Schauer 3 , Yasir S Elhassan 16 , Mario Detomas 3 , Lorenzo Zanatta 6 , Giovanna Mantovani 1,2 & Cristina L Ronchi 16,17,18
1University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy; 2Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Endocrinology Unit, Milan, Italy; 3University Hospital, University of Würzburg, Division of Endocrinology and Diabetes, Department of Internal Medicine I, Würzburg, Germany; 4University Hospital, University of Würzburg, Bavarian Cancer Research Center (BZKF), Würzburg, Germany; 5Mayo Clinic, Division of Endocrinology, Rochester, MN 55905, United States; 6University of Florence, Department Experimental and Clinical Biomedical Sciences, Endocrinology Section, Florence, Italy; 7Maria Sklodowska-Curie National Research Institute of Oncology, Second Clinic of Radiotherapy and Chemiotherapy, Gliwice, Poland; 8University Hospital Centre Zagreb, Zagreb, Croatia; 9Hôpital Cochin, Serivice d’Endocrinologie, Paris, France; 10Department of Medicine DIMED, Padua, Italy; 11University-Hospital of Padova, Endocrine Unit, Padua, Italy; 12St Bartholomew’s Hospital, Department of Endocrinology, London, United Kingdom; 13University of Brescia, ASST Spedali Civili, Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Brescia, Italy; 14Policlinico di Sant’Orsola Bologna, Bologna, Italy; 15Maria Sklodowska-Curie National Research Institute of Oncology; 15Department of Nuclear Medicine and Endocrine Oncology, Gliwice, Poland; 16Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Department of Endocrinology,, Birmingham, United Kingdom; 17University of Birmingham, Department of Metabolism and Systems Science, Birmingham, United Kingdom; 18Birmingham Health Partners, Centre for Endocrinology, Diabetes and Metabolism, Birmingham, United Kingdom
JOINT2115
Background: Pharmacological treatment for advanced adrenocortical carcinoma (ACC) consists of mitotane alone or combined with cytotoxic chemotherapy. However, reliable predictors of response to therapy are lacking. We aimed to explore the predictive role of clinical parameters in a large cohort of patients with advanced ACC treated with systemic therapy.
Methods: We investigated a total of 418 patients with advanced ACC (61.5%=women, median age=52 years) from 11 European centres, treated with mitotane monotherapy (mitotane cohort, n=161), etoposide+cisplatin±doxorubicin±mitotane (EDP cohort, n=178) or two different 2nd-line chemotherapy schemes (gemcitabine+capecitabine±mitotane or temozolomide+mitotane n=79). Clinical parameters were collected at start of therapy including age, cortisol excess, ECOG-performance status (ECOG-PS), tumor burden (4 grades defined depending on size, number and site of metastasis), neutrophil-to-lymphocyte-ratio (NLR). Patients underwent regular radiological surveillance according to European and local guidelines. Our endpoints were overall-survival (OS) and time-to-progression (TTP) from treatment initiation and best objective response to treatment according to RECIST 1.1 criteria. Descriptive, contingency table, Kaplan-Meier survival and Cox regression analyses were performed using STATA version 17.
Results: At multivariable analysis tumour burden, cortisol excess, ECOG-PS and NLR≥5 significantly and independently predicted shorter OS in all cohorts (HR between 1.55 and 2.68). We therefore calculated a combined BUCENscore as a sum of the following points: tumour BUrden (1=0, 2=1, 3/4=2), Cortisol excess (present=1), ECOG-PS (0=0, 1=1, 2/3=2), and NLR (≥5=1). A high BUCEN (≥3) resulted a significant predictor of shorter OS and TTP in all groups (mitotane cohort: OS HR= 3.05, 95%CI= 2.06-4.51, TTP HR=2.68, 95%CI= 1.81-3.98, EDP cohort: OS HR= 3.38, 95%CI= 2.22-5.14, TTP HR= 2.53, 95%CI= 1.68-3.84, 2nd-lines cohort: OS HR=3.96, 95%CI= 1.68-9.29, TTP HR= 3.08, 95%CI= 1.31-7.24). BUCEN score≥3 also predicted best objective response to mitotane (P<0.01) and 2nd line therapies (P=0.04), without reaching significance for EDP (P=0.07).
Conclusions: Our new proposed BUCEN score resulted a promising predictor of response to pharmacological treatment in patients with advanced ACC. This score can be calculated starting from readily available clinical and biochemical parameters and could be used in routine practice to pre-select patients who could most benefit from systemic therapy.
Volume 110
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Endocrine Abstracts
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