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. 2023 Sep 9;15(18):4491.
doi: 10.3390/cancers15184491.

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

Antonella Turla  1 , Marta Laganà  1 , Andrea Abate  2 , Valentina Cremaschi  1 , Manuel Zamparini  1 , Matteo Chittò  1 , Francesca Consoli  1 , Andrea Alberti  1 , Roberta Ambrosini  3 , Mariangela Tamburello  2 , Salvatore Grisanti  1 , Guido Alberto Massimo Tiberio  4 , Sandra Sigala  2 , Deborah Cosentini  1 , Alfredo Berruti  1
Affiliations

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

Antonella Turla et al. Cancers (Basel). .

Abstract

(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.

Keywords: adrenocortical carcinoma; chemotherapy; megestrol acetate.

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Conflict of interest statement

A.B. received research funds for ACC studies from Janssen, Sanofi, Novartis. All the other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Comparison of progression-free survival (PFS) in patients treated with EDP-M plus megestrol acetate versus patients treated with EDP-M alone. The continuous line indicates cases, the dotted line indicates controls. p = 0.798.
Figure 2
Figure 2
Overall survival (OS) comparison of patients treated with EDP-M plus megestrol acetate and patients treated with EDP-M chemotherapy alone. The continuous line indicates cases, the dotted line indicates controls. p = 0.777.
See this image and copyright information in PMC

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