Recurrent Adrenocortical Carcinoma After EDP-M Failure: Recurrence Interval Under 6 Months

This protocol covers the next step for patients with recurrent adrenocortical carcinoma whose disease recurred within 6 months of last surgery or loco-regional therapy, and in whom first-line systemic treatment with EDP-M did not achieve the expected response.

Clinical Scenario Recurrent adrenocortical carcinoma with a short recurrence interval — under 6 months since last surgery or loco-regional therapy. In this high-risk recurrence setting, systemic treatment is the recommended first approach rather than repeat local or regional intervention.

Previous Line — Failure Condition First-line treatment with EDP-M (doxorubicin, etoposide, cisplatin, plus oral mitotane) was the indicated approach for this early-recurrence population. Escalation to this second-line protocol is triggered when EDP-M fails to achieve the target mitotane blood level of 14–20 mg/L, or when it does not produce tumour response or stable disease.

Next Step (Partial Overview) For patients who progress under EDP-M, second-line systemic cytotoxic therapy is the next consideration. Two established cytotoxic regimens are used in this setting, and enrolment in clinical trials is also recommended on an individual basis. The complete regimen selection, combination details, and decision algorithm are in the full protocol.

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References

DOI: 10.1530/EJE-18-0608

We recommend EDP-M as first-line treatment if the time interval between last surgery/loco-regional therapy and recurrence is less than 6 months (++OO), rather than repeat loco-regional measures.

In patients who progress under EDP-M we suggest considering additional therapies including clinical trials on an individual basis (+OOO).

Beyond cisplatin-based therapies, the two reasonably well-studied second-line cytotoxic regimens are gemcitabine + capecitabine (+/− mitotane) and streptozotocin + mitotane.

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