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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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Autores principales: Laganà, Marta, Grisanti, Salvatore, Cosentini, Deborah, Ferrari, Vittorio Domenico, Lazzari, Barbara, Ambrosini, Roberta, Sardini, Chiara, Dalla Volta, Alberto, Palumbo, Carlotta, Poliani, Pietro Luigi, Terzolo, Massimo, Sigala, Sandra, Tiberio, Guido Alberto Massimo, Berruti, Alfredo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226395/
https://www.ncbi.nlm.nih.gov/pubmed/32290298
http://dx.doi.org/10.3390/cancers12040941
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author Laganà, Marta
Grisanti, Salvatore
Cosentini, Deborah
Ferrari, Vittorio Domenico
Lazzari, Barbara
Ambrosini, Roberta
Sardini, Chiara
Dalla Volta, Alberto
Palumbo, Carlotta
Poliani, Pietro Luigi
Terzolo, Massimo
Sigala, Sandra
Tiberio, Guido Alberto Massimo
Berruti, Alfredo
author_facet Laganà, Marta
Grisanti, Salvatore
Cosentini, Deborah
Ferrari, Vittorio Domenico
Lazzari, Barbara
Ambrosini, Roberta
Sardini, Chiara
Dalla Volta, Alberto
Palumbo, Carlotta
Poliani, Pietro Luigi
Terzolo, Massimo
Sigala, Sandra
Tiberio, Guido Alberto Massimo
Berruti, Alfredo
author_sort Laganà, Marta
collection PubMed
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.
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spelling pubmed-72263952020-05-18 Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience Laganà, Marta Grisanti, Salvatore Cosentini, Deborah Ferrari, Vittorio Domenico Lazzari, Barbara Ambrosini, Roberta Sardini, Chiara Dalla Volta, Alberto Palumbo, Carlotta Poliani, Pietro Luigi Terzolo, Massimo Sigala, Sandra Tiberio, Guido Alberto Massimo Berruti, Alfredo Cancers (Basel) Article 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. MDPI 2020-04-10 /pmc/articles/PMC7226395/ /pubmed/32290298 http://dx.doi.org/10.3390/cancers12040941 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Laganà, Marta
Grisanti, Salvatore
Cosentini, Deborah
Ferrari, Vittorio Domenico
Lazzari, Barbara
Ambrosini, Roberta
Sardini, Chiara
Dalla Volta, Alberto
Palumbo, Carlotta
Poliani, Pietro Luigi
Terzolo, Massimo
Sigala, Sandra
Tiberio, Guido Alberto Massimo
Berruti, Alfredo
Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226395/
https://www.ncbi.nlm.nih.gov/pubmed/32290298
http://dx.doi.org/10.3390/cancers12040941
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