The experience with the application of first-line chemotherapy regimen with EDP-M (etoposide + doxorubicin + cisplatin + mitotane) in patients with advanced adrenocortical carcinoma in the Russian Federation

A combination of etoposide, doxorubicin and cisplatin plus mitotane (EPD-M) is the most effective regimen in patients with advanced adrenocortical carcinoma (ACC). Because in the Russian Federation mitotane is not registered, there are no publications about the effectiveness of EPD-M in the Russian patients. In the chemotherapy department of the NMITS of oncology named N.N.Blokhin of the Ministry of Health we conducted a retrospective analysis of the efficacy and tolerability of the EDP-M regimen as a first-line treatment in advanced ACC. We enrolled 24 patients with histologically confirmed ACC. Evaluation of the treatment effectiveness and toxicity was possible in 23 patients. Six patients (26%; 95% CI 8-44%) achieved a partial response, disease control rate was observed in 14 patients (61%; 95% CI 41-81%). Median time to progression was 4.9 months. Three patients (12.5%) were performed a radical surgical resection of residual disease after 6 cycles of chemotherapy. Then patients continued mitotane monotherapy after surgical resection. Treatment was well tolerated, with grade III and IV toxicities consisting of neutropenia in 8 (33%) patients, anemia in 1 (4%) patient, asthenia in 3 (12.5%) patients. The central neurotoxicity associated with mitotane, was observed in 2 (8.3%) patients. The EDP-M regimen is a well-tolerated and active regimen in patients with advanced ACC.