This protocol addresses patients with advanced adrenocortical carcinoma who present with limited intra-abdominal or extra-abdominal metastases amenable to local treatment, and whose disease has progressed or failed to respond adequately to first-line EDP plus mitotane therapy.
Advanced adrenocortical carcinoma with limited intra-abdominal or extra-abdominal metastases. When complete resection of all lesions is considered feasible, surgical approaches may be evaluated. Other local ablative measures — including radiation therapy and image-guided ablation techniques — are also recognised as options in the management of advanced disease.
First-line therapy was EDP plus mitotane (EDP-M), combining doxorubicin, etoposide, and cisplatin with oral mitotane. Escalation to this protocol is warranted when EDP-M fails to achieve the target mitotane blood level or fails to produce tumour response or long-term stable disease.
After EDP-M failure, alternative cytotoxic combination regimens are available as second-line systemic options. Enrolment in clinical trials and evaluation for loco-regional therapies are also considered at this stage. The complete structured regimen — including sequencing, agents, and individualisation criteria — is available via the link below.
DOI: 10.1530/EJE-18-0608