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

• Published in: Cancers Vol. 15; no. 18; p. 4491
• Main Authors: Turla, Antonella, Laganà, Marta, Abate, Andrea, Cremaschi, Valentina, Zamparini, Manuel, Chittò, Matteo, Consoli, Francesca, Alberti, Andrea, Ambrosini, Roberta, Tamburello, Mariangela, Grisanti, Salvatore, Tiberio, Guido Alberto Massimo, Sigala, Sandra, Cosentini, Deborah, Berruti, Alfredo
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 01.09.2023; MDPI
• Subjects: Acetates; Acetic acid; adrenocortical carcinoma; Anorexia; Antimitotic agents; Antineoplastic agents; Cancer; Cancer patients; Carcinoma; Care and treatment; Chemotherapy; Cisplatin; Cytotoxicity; Development and progression; Disease; Doxorubicin; Etoposide; Hyperglycemia; Immunotherapy; Informed consent; Medical care; Medical prognosis; megestrol acetate; Metastases; Metastasis; Patients; Progestational hormones; Progestin; Quality management; Statistical analysis; Survival; Thromboembolism; Toxicity; Tumors
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers15184491

(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.