[Adrenocortical carcinomas: therapeutic advances in 2011]

Area of Science:

• Oncology
• Endocrinology
• Pharmacology

Context:

• Adrenocortical cancer (ACC) is a rare and aggressive endocrine malignancy with a poor prognosis.
• Complete surgical resection is the only potentially curative treatment for ACC.
• Limited effective adjuvant therapies exist, necessitating research into optimizing current treatments and exploring novel approaches.

Purpose:

• To review the current management strategies for adrenocortical cancer (ACC).
• To discuss the role and limitations of adjuvant therapies, including mitotane, chemotherapy, and radiotherapy.
• To highlight emerging targeted therapies and ongoing clinical trials for advanced or progressive ACC.

Summary:

• Complete surgical resection is the cornerstone of curative treatment for adrenocortical cancer (ACC).
• Adjuvant mitotane therapy can improve disease-free survival, but optimal therapeutic concentrations and patient selection require further investigation due to potential side effects.
• For unresectable or progressive disease, etoposide, doxorubicin, and cisplatin (EDP) chemotherapy is effective, while tyrosine kinase inhibitors show limited efficacy, possibly due to interactions with mitotane.

Impact:

• This review provides a comprehensive overview of current and emerging treatment paradigms for adrenocortical cancer.
• It emphasizes the need for multidisciplinary expertise in managing ACC and highlights areas for future research, particularly in targeted therapies.
• Understanding treatment efficacy and optimizing drug concentrations are crucial for improving outcomes in patients with this rare malignancy.