Feasibility and Activity of Megestrol Acetate in Addition to Etoposide, Doxorubicin, Cisplatin, and Mitotane as First-Line Therapy in Patients with Metastatic/Unresectable Adrenocortical Carcinoma with Low Performance Status

SIMPLE SUMMARY: Preclinical studies have shown an anti-neoplastic effect of progestins against adrenal cortical carcinoma. Progestins have a positive effect on patient cenesthesia and may make standard chemotherapy more tolerable. In this study, the addition of megestrol acetate to the etoposide, doxorubicin, cisplatin, and mitotane regimen (EDP-M) in patients with ACC and a low PS allowed the administration of EDP-M at adequate doses, and the efficacy was not inferior to that of EDP-M administered to patients with a good PS. Since a low PS is a predictive factor of poor efficacy of antineoplastic treatments in cancer patients, these results suggest a potentiating effect of megestrol acetate to EDP-M and provide the rationale for the ongoing randomized study at the Medical Oncology of Brescia. ABSTRACT: (1) Background: The standard first-line therapy for advanced adrenocortical carcinoma (ACC) is represented by EDP-M (etoposide, doxorubicin, cisplatin + mitotane). Progestins have shown cytotoxic activity both in vitro and in vivo on ACC; better EDP-M tolerability and efficacy have been hypnotized due to the association with progestins. (2) Methods: The feasibility and tolerability of EDP-M combined with oral megestrol acetate (EDP-MM) were tested in 24 patients (pts) affected by metastatic ACC with a low performance status (PS); the case group was compared with a 48 pts control group according to the propensity score. The secondary objectives were clinical benefit rate (CBR), progression-free survival (PFS), and overall survival (OS). (3) Results: Thirteen pts (54.2%) in the EDP-MM population experienced progestin-related toxicities; in particular, five pts experienced vaginal bleeding (20.8%); four pts experienced weight gain (16.7%); and thromboembolic events, worsening of hypertension, skin rashes, and hyperglycemia were registered in one patient each (4.2%). This led to the discontinuation of megestrol acetate in four pts (16.7%). EDP-M-related toxicities were similar in both groups. No differences in PFS and OS curves were observed; the CBR was 75.0% and 60.4%, respectively. (4) Conclusions: The association of EDP-M + megestrol acetate in ACC pts with a low PS is feasible and well tolerated; its efficacy appeared to be non-inferior to EDP-M administered to pts with a good PS.