Outcome of Adrenocortical Cancer Patients after Discontinuation of Adjuvant Mitotane Therapy

Presentation Number: LB SAT 49
Date of Presentation: April 1st, 2017

Massimo Terzolo*1, Vittoria Basile2, Felix Megerle3, Wiebke Hermann3, Federica Cicciarella2, Rossella Libe4, Eric Baudin5, Harm Haak6, Massimo Mannelli7, Marco Boscaro8, Marcus Quinkler9, Isabelle Bourdeau10, Paola Carla Giuseppina Perotti2, Stefanie Hahner3, Felix Beuschlein11 and Martin Fassnacht12
1University of Turin, Orbassano, Italy, 2Dept of Clinical and Biological Sciences - Internal Medicine 1, University of Turin, Orbassano, Italy, 3Department of Internal Medicine I, University of Wuerzburg, Wuerzburg, Germany, 4INSERM U 1016, CNRS 8104, Institut Cochin, Paris Descartes University, Paris, France, 5Institut Gustave-Roussy, Villejuif, France, 6Máxima Medical Center, Eindhoven, Netherlands, 7Univ of Florence, Florence, Italy, 8Università di Padova, Padua, Italy, 9Endocrinology in Charlottenburg, Berlin, Germany, 10Centre hospitalier de l’Université de Montréal (CRCHUM), Montreal, QC, Canada, 11Klinikum der Universität München, Ludwig-Maximilian University, Munich, Germany, 12University of Wuerzburg, Wuerzburg, Germany


Background. Adjuvant mitotane therapy is frequently used in Europe following surgery for adrenocortical carcinoma (ACC). Management of adjuvant mitotane is mainly empirical and a major open question is the optimal duration of therapy, because no study has ever addressed this issue.

Objective. We aimed to assess the outcome of ACC patients who were treated with adjuvant mitotane for at least one year following surgery and then discontinued therapy for other reasons than ACC recurrence.

Design. We did a retrospective analysis of 132 patients (91 F, 41 M; median age 44 years) with histologically confirmed ACC who were treated at 9 European centres and 1 centre in Canada since 1999.

Results. Tumour stage was ENSAT I, 11%; ENSAT II, 79%; ENSAT III, 20%; hormone secretion was present in 44% and resection status was R0, 83% and Rx, 17%. Median Ki-67 was 10% and Weiss 6. Duration of adjuvant mitotane therapy was 34 months (12-141). Median duration of follow-up was 79 months (31-280), including 34 months after discontinuation (1-263). Seventeen patients (13%) recurred after treatment discontinuation with a recurrence-free survival from surgery of 74 months (31-277) and tumour-free survival after mitotane discontinuation of 32 months (1-263). The only difference in prognostic characteristics between patients with recurrent ACC and the remainders was a higher number of secreting tumours. Interestingly, no recurrence was observed among the 41 patients (31%) treated for >48 months; such patients had similar prognostic characteristics and follow-up duration after mitotane discontinuation than the remainders.

Conclusions. These first results suggest that a prolonged duration of adjuvant mitotane therapy may be associated with better recurrence-free survival.


Disclosure: MT: , HRA Pharma. MQ: , Shire, , Shire. Nothing to Disclose: VB, FM, WH, FC, RL, EB, HH, MM, MB, IB, PCGP, SH, FB, MF