Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience
Etoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center...
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| Format: | Article |
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MDPI AG
2020-04-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/12/4/941 |
| _version_ | 1797570902322315264 |
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| author | Marta Laganà Salvatore Grisanti Deborah Cosentini Vittorio Domenico Ferrari Barbara Lazzari Roberta Ambrosini Chiara Sardini Alberto Dalla Volta Carlotta Palumbo Pietro Luigi Poliani Massimo Terzolo Sandra Sigala Guido Alberto Massimo Tiberio Alfredo Berruti |
| author_facet | Marta Laganà Salvatore Grisanti Deborah Cosentini Vittorio Domenico Ferrari Barbara Lazzari Roberta Ambrosini Chiara Sardini Alberto Dalla Volta Carlotta Palumbo Pietro Luigi Poliani Massimo Terzolo Sandra Sigala Guido Alberto Massimo Tiberio Alfredo Berruti |
| author_sort | Marta Laganà |
| collection | DOAJ |
| description | Etoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center for this rare disease in Italy. In this series, EDP-M obtained a partial response in 50% of patients; median progression free survival (PFS) and overall survival were 10.1 months (95% Confidence Interval [CI 95%] 8.1–12.8) and 18.7 months (95% CI: 14.6–22.8), respectively. EDP-M was not interrupted in five patients showing disease progression after two cycles without the appearance of new lesions and mitotane levels below the therapeutic range. In two of them, the disease remained stable at further imaging evaluations and the other three obtained a partial response. Twenty-six responding patients underwent surgery of residual disease and 13 of them became disease free. Surgery identified a pathological complete response (pCR) in four patients (7%) and Ki67 expression in post-chemotherapy tumor specimens, inferior to 15% (median value), was associated with better PFS and survival. In the present study, the EDP-M regimen is confirmed to have a limited efficacy. Early disease progression does not mean treatment inefficacy. Surgery of residual disease in partially responding patients allows for the detection of pCR in few of them and this condition is predictive of long-term survival. Ki67 expression of post-chemotherapy residual disease could be an additional prognostic factor that deserves to be studied further. |
| first_indexed | 2024-03-10T20:32:01Z |
| format | Article |
| id | doaj.art-82160d30f209420dab63520b7e304b2c |
| institution | Directory Open Access Journal |
| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-03-10T20:32:01Z |
| publishDate | 2020-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-82160d30f209420dab63520b7e304b2c2023-11-19T21:17:49ZengMDPI AGCancers2072-66942020-04-0112494110.3390/cancers12040941Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia ExperienceMarta Laganà0Salvatore Grisanti1Deborah Cosentini2Vittorio Domenico Ferrari3Barbara Lazzari4Roberta Ambrosini5Chiara Sardini6Alberto Dalla Volta7Carlotta Palumbo8Pietro Luigi Poliani9Massimo Terzolo10Sandra Sigala11Guido Alberto Massimo Tiberio12Alfredo Berruti13Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyRadiology Unit, ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyUrology Unit, Department of Medical and Surgical Specialties, Radiological Science and Public Health, University of Brescia at ASST Spedali Civili of Brescia, 25123 Brescia, ItalyPathology Unit, Department of Molecular and Translational Medicine, University of Brescia at ASST Spedali Civili di Brescia, 25123 Brescia, ItalyInternal Medicine, Department of Clinical and Biological Sciences, San Luigi Hospital, University of Turin, Orbassano, 10043 Turin, ItalySection of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, ItalySurgical Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, ItalyMedical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, ItalyEtoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center for this rare disease in Italy. In this series, EDP-M obtained a partial response in 50% of patients; median progression free survival (PFS) and overall survival were 10.1 months (95% Confidence Interval [CI 95%] 8.1–12.8) and 18.7 months (95% CI: 14.6–22.8), respectively. EDP-M was not interrupted in five patients showing disease progression after two cycles without the appearance of new lesions and mitotane levels below the therapeutic range. In two of them, the disease remained stable at further imaging evaluations and the other three obtained a partial response. Twenty-six responding patients underwent surgery of residual disease and 13 of them became disease free. Surgery identified a pathological complete response (pCR) in four patients (7%) and Ki67 expression in post-chemotherapy tumor specimens, inferior to 15% (median value), was associated with better PFS and survival. In the present study, the EDP-M regimen is confirmed to have a limited efficacy. Early disease progression does not mean treatment inefficacy. Surgery of residual disease in partially responding patients allows for the detection of pCR in few of them and this condition is predictive of long-term survival. Ki67 expression of post-chemotherapy residual disease could be an additional prognostic factor that deserves to be studied further.https://www.mdpi.com/2072-6694/12/4/941adrenocortical tumortreatmentEDPmitotane |
| spellingShingle | Marta Laganà Salvatore Grisanti Deborah Cosentini Vittorio Domenico Ferrari Barbara Lazzari Roberta Ambrosini Chiara Sardini Alberto Dalla Volta Carlotta Palumbo Pietro Luigi Poliani Massimo Terzolo Sandra Sigala Guido Alberto Massimo Tiberio Alfredo Berruti Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience Cancers adrenocortical tumor treatment EDP mitotane |
| title | Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience |
| title_full | Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience |
| title_fullStr | Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience |
| title_full_unstemmed | Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience |
| title_short | Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience |
| title_sort | efficacy of the edp m scheme plus adjunctive surgery in the management of patients with advanced adrenocortical carcinoma the brescia experience |
| topic | adrenocortical tumor treatment EDP mitotane |
| url | https://www.mdpi.com/2072-6694/12/4/941 |
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