Editorial Comment
Editorial Comment to Advanced adrenocortical carcinoma successfully treated with gemcitabine plus capecitabine as second-line chemotherapy
Yamamoto et al. presented the case of a patient with advanced adrenocortical carcinoma (ACC) who was treated successfully with gemcitabine, capecitabine, and mitotane (GC-M) therapy after etoposide, doxorubicin, cisplatin, and mitotane (EDP-M) therapy.1
ACC is a rare and aggressive malignant neoplasm that typ- ically has a poor prognosis. In cases with metastatic disease, 5-year survival rates have been reported to range from 0% to 28%.2 The First International Randomized Trial in Locally Advanced and Metastatic Adrenocortical Carcinoma Treat- ment demonstrated improved progression-free survival (PFS) in patients treated with EDP-M therapy compared to patients treated with streptozotocin plus mitotane.3 EDP-M therapy was generally accepted as the current first-line treatment for advanced ACC on the basis of the results of this trial.1 Sec- ond-line treatment for advanced ACC, however, is not well established. Based on preclinical data, several targeted thera- pies for advanced ACC have been investigated.4 However, none has yet been shown to definitively improve PFS or overall survival in large randomized trials.
The case report by Yamamoto et al. presented a patient with advanced ACC who was treated with GC-M therapy as a second-line treatment and achieved long-term disease con- trol.1 In an earlier study, Henning et al. reported the efficacy and safety of gemcitabine-based chemotherapy for patients with advanced ACC.5 Henning et al. found an objective response rate of 4.9% and a median PFS of 12 weeks (range 1-94 weeks), but a few patients with long-term disease con- trol were described.5 GC-M therapy would be a therapeutic
option for patients who progress under EDP-M therapy and cannot be enrolled in clinical trials.
Shuya Kandori M.D., Ph.D. İD Department of Urology, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan shuya79@md.tsukuba.ac.jp
DOI: 10.1002/iju5.12222
Conflict of interest
The author declares no conflict of interest.
References
1 Yamamoto A, Nakai Y, Oka T et al. Advanced adrenocortical carcinoma suc- cessfully treated with gemcitabine plus capecitabine as second-line chemother- apy. IJU Case Rep. 2020; 3: 270-3.
2 Fassnacht M, Dekkers OM, Else T et al. European Society of Endocrinology Clinical Practice Guidelines on the management of adrenocortical carcinoma in adults, in collaboration with the European Network for the Study of Adre- nal Tumors. Eur. J. Endocrinol. 2018; 179: G1-G46.
3 Fassnacht M, Terzolo M, Allolio B et al. Combination chemotherapy in advanced adrenocortical carcinoma. N. Engl. J. Med. 2012; 366: 2189-97.
4 Andolino L, Hansen A, Ackland S, Joshua A. Advanced adenocortical carc- noma (ACC): a review with focus on second-line therapies. Horm. Cancer 2020; 11: 155-69.
5 Henning JEK, Deutschbein T, Altieri B et al. Gemcitabine-based chemother- apy in adrenocortical carcinoma: a multicenter study of efficacy and predictive factors. J. Clin. Endocrinol. Metab. 2017; 102: 4323-32.