Loco-Regional Therapies in Oligometastatic Adrenocortical Carcinoma

Roux, Charles; Boilève, Alice; Faron, Matthieu; Lamartina, Livia; Delpla, Alexandre; Tselikas, Lambros; Durand-Labrunie, J.; Hescot, Ségolène; Baère, Thierry De; Hadoux, Julien; Deschamps, Frédèric; Baudin, Éric

doi:10.3390/cancers14112730

Cited by 9 publications

(23 citation statements)

References 37 publications

(42 reference statements)

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“…In this study, higher response rates were observed in lesions with a diameter < 3 cm [40]. Roux et al reported a significantly longer time to second line treatments in 60 patients following loco-regional treatment (n = 20 treated with TACE) and a signifi-cantly higher rate of disease control in a subgroup of cases ( < = 5 metastases or maximum diameter < 3 cm) (27). Mauda-Havakuk et al stated a possible prolonged life expectancy in patients (n = 39) after loco-regional treatment (TACE: n = 12) [41].…”

Section: Transarterial Chemoembolisation (Tace) and Transarterial Rad...mentioning

confidence: 46%

“…Treatment with RT was mostly (especially in the older publications) used for palliative intention such as pain control and, therefore, these studies did not report objective responses [25,29,36]. However, the more recent studies reported also on tumour response [26,27] and here tumour control was achieved in the vast majority of patients. As described above, toxicity data have to be judged with cautious, but in all studies that report adverse events these were manageable.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies reported concomitant therapies with mitotane during RT 25 26 27 29 . We reported 38 (29%) patients with a mitotane therapy and a mitotane level>14 mg/l during RT.…”

Section: Methodsmentioning

confidence: 99%

“…Roux et al showed a similar response rate after treatment with a thermal ablation therapy. Nineteen out of 30 (63 %) patients showed a disease control after therapy [27].…”

Section: Image-guided Thermal Ablation: Radiofrequency Ablation Micro...mentioning

confidence: 98%

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Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Kimpel,

Dischinger,

Altieri

et al. 2024

Horm Metab Res

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International guidelines emphasise the role of local therapies (LT) for the treatment of advanced adrenocortical carcinoma (ACC). However, large studies are lacking in this field. Therefore, we performed a review of the literature to synthesise current evidence and develop clinical guidance. PubMed database was searched for systematic literature. We identified 119 potentially relevant articles, of which 21 could be included in our final analysis. All were retrospective and reported on 374 patients treated with LT for advanced ACC (12 studies on radiotherapy, 3 on transarterial chemoembolisation and radioembolisation, 4 on image-guided thermal ablation [radiofrequency, microwave ablation, and cryoablation, and two studies reporting treatment with several different LT]). Radiotherapy was frequently performed with palliative intention. However, in most patients, disease control and with higher dosage also partial responses could be achieved. Data for other LT were more limited, but also point towards local disease control in a significant percentage of patients. Very few studies tried to identify factors that are predictive on response. Patients with a disease-free interval after primary surgery of more than 9 months and lesions<5 cm might benefit most. Underreporting of toxicities may be prevalent, but LT appear to be relatively safe overall. Available evidence on LT for ACC is limited. LT appears to be safe and effective in cases with limited disease and should be considered depending on local expertise in a multidisciplinary team discussion.

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Section: Transarterial Chemoembolisation (Tace) and Transarterial Rad...mentioning

confidence: 46%

Section: Discussionmentioning

confidence: 99%

“…Some studies reported concomitant therapies with mitotane during RT 25 26 27 29 . We reported 38 (29%) patients with a mitotane therapy and a mitotane level>14 mg/l during RT.…”

Section: Methodsmentioning

confidence: 99%

“…Roux et al showed a similar response rate after treatment with a thermal ablation therapy. Nineteen out of 30 (63 %) patients showed a disease control after therapy [27].…”

Section: Image-guided Thermal Ablation: Radiofrequency Ablation Micro...mentioning

confidence: 98%

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Current Evidence on Local Therapies in Advanced Adrenocortical Carcinoma

Kimpel,

Dischinger,

Altieri

et al. 2024

Horm Metab Res

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“…While evidence is accumulating for the use of locoregional therapies such as cryoablation [25] or radiofrequency ablation [26] in oligometastatic ACC, experience with HDR-BT in ACC has not been reported to our knowledge. Our case series demonstrates the favorable local outcome of this interventional method with complete or partial remission observed in all treated metastases.…”

Section: Discussionmentioning

confidence: 99%

High-Dose Rate Brachytherapy Combined with PD-1 Blockade as a Treatment for Metastatic Adrenocortical Carcinoma – A Single Center Case Series

Schwarzlmueller,

Corradini,

Seidensticker

et al. 2023

Horm Metab Res

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The response rate of advanced adrenocortical carcinoma (ACC) to standard chemotherapy with mitotane and etoposide/doxorubicin/cisplatin (EDP-M) is unsatisfactory, and benefit is frequently short lived. Immune checkpoint inhibitors (CPI) have been examined in patient’s refractory to EDP-M, but objective response rates are only approximately 15%. High-dose rate brachytherapy (HDR-BT) is a catheter-based internal radiotherapy and expected to favorably combine with immunotherapies. Here we describe three cases of patients with advanced ACC who were treated with HDR-BT and the CPI pembrolizumab. None of the tumors were positive for established response markers to CPI. All patients were female, had progressed on EDP-M and received external beam radiation therapy for metastatic ACC. Pembrolizumab was initiated 7 or 23 months after brachytherapy in two cases and prior to brachytherapy in one case. Best response of lesions treated with brachytherapy was complete (n=2) or partial response (n=1) that was ongoing at last follow up after 23, 45 and 4 months, respectively. Considering all sites of tumor, response was complete and partial remission in the two patients with brachytherapy prior to pembrolizumab. The third patient developed progressive disease with severe Cushing’s syndrome and died due to COVID-19. Immune-related adverse events of colitis (grade 3), gastroduodenitis (grade 3), pneumonitis (grade 2) and thyroiditis (grade 1) occurred in the two patients with systemic response. HDR-BT controlled metastases locally. Sequential combination with CPI therapy may enhance an abscopal antitumoral effect in non-irradiated metastases in ACC. Systematic studies are required to confirm this preliminary experience and to understand underlying mechanisms.

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