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Faron M, Lamartina L, Hescot S, Moog S, Deschamps F, Roux C, Libe R, Durand-Labrunie J, Al Ghuzlan A, Hadoux J, Baudin E. New endpoints in adrenocortical carcinoma studies: a mini review. Endocrine 2022; 77:419-424. [PMID: 35869971 DOI: 10.1007/s12020-022-03128-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 06/25/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Adrenocortical carcinoma (ACC) is a very rare and aggressive malignant disease. Therefore, overall survival (OS) has long been considered as the best endpoint. Yet, a unique endpoint is not optimal to take into account the heterogeneity in tumor profile and the diversification of therapeutic option. The purpose of this mini review was to describe endpoints used in the past, present and future in the field of ACC. METHODS Pubmed and Clinicaltrial.gov were used to identify relevant studies. RESULTS Before year 2000 only three endpoints were regularly used: OS, recurrence-free survival (RFS) and response rate. These endpoints were used because ACC was seen as a homogeneous diseases with a high recurrence rate and low rate of long-term survival. Since 2000; along with the apparition of new class of drug, progression-free survival (PFS) has been more and more used. Other endpoints as "time to chemotherapy" or "Progression-free survival 2" were used to evaluate multimodal therapies or treatment with a delayed action. Finally, there is a hope that in the near future, quality of life along with other patient-reported outcomes may be used more frequently. CONCLUSION While OS and PFS are currently the most used endpoints in ACC, new endpoints are needed to better take into account the challenges offered by different situations and treatment strategies.
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Affiliation(s)
- Matthieu Faron
- Department de Chirurgie Oncologique, Gustave Roussy Cancer Campus, Villejuif, France.
- INSERM 1018, Equipe Oncostat, Université Paris Saclay, Gif-sur-Yvette, France.
| | - Livia Lamartina
- Service d'oncologie Endocrinienne, Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Segolene Hescot
- Service de Médecine Nucléaire, Institute Curie, Saint-Cloud, France
| | - Sophie Moog
- Service d'oncologie Endocrinienne, Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Frederic Deschamps
- Service de Radiologie Interventionelle, Gustave Roussy Cancer Campus, Villejuif, France
| | - Charles Roux
- Service de Radiologie Interventionelle, Gustave Roussy Cancer Campus, Villejuif, France
| | - Rosella Libe
- Coordinator of the INCA-COMETE Network, Gustave Roussy Cancer Campus, Villejuif, France
- Service d'Endocrinologie, Cochin Hospital, Paris, France
| | | | - Abir Al Ghuzlan
- Service d'anatomopathologie, Gustave Roussy Cancer Campus, Villejuif, France
| | - Julien Hadoux
- Service d'oncologie Endocrinienne, Département d'imagerie, Gustave Roussy, Villejuif, France
| | - Eric Baudin
- Service d'oncologie Endocrinienne, Département d'imagerie, Gustave Roussy, Villejuif, France
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Hescot S, Faron M, Kordahi M, Do Cao C, Naman A, Lamartina L, Hadoux J, Leboulleux S, Pattou F, Aubert S, Scoazec JY, Al Ghuzlan A, Baudin E. Screening for Prognostic Biomarkers in Metastatic Adrenocortical Carcinoma by Tissue Micro Arrays Analysis Identifies P53 as an Independent Prognostic Marker of Overall Survival. Cancers (Basel) 2022; 14:cancers14092225. [PMID: 35565353 PMCID: PMC9099575 DOI: 10.3390/cancers14092225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 04/13/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Advanced adrenocortical carcinoma (ACC) has poor but heterogeneous prognosis. Apart from Ki67 index, no prognostic or predictive biomarker has been validated in advanced ACC, so far. We aimed at analyzing expression of a large panel of proteins involved in known altered pathways in ACC (cell cycle, Wnt/ß-catenin, methylation) to identify and prioritize potential prognostic or predictive parameters metastatic ACC population. We conducted a retrospective multicentric study. Overall survival (OS) and partial response according to RECIST 1.1 were primary endpoints. TMA was set up and 16 markers were analyzed. Modified ENSAT and GRAS parameters were characterized for prognostic adjustment. Results: We included 66 patients with a mean age at metastatic diagnosis of 48.7 ± 15.5 years. Median survival was 27.8 months. After adjustment to mENSAT-GRAS parameters, p53 and PDxK were prognostic of OS. No potential biomarker has been identified as predictive factor of response. We identified for the first time P53 as an independent prognostic marker of metastatic adrenocortical carcinoma after mENSAT-GRAS parameter adjustment. Prognostic impact of Wnt/ß-catenin alterations was not confirmed in this cohort of metastatic ACC.
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Affiliation(s)
- Segolene Hescot
- Department of Nuclear Medicine, Institut Curie, 92210 Saint Cloud, France;
| | - Matthieu Faron
- Department of Surgery, Gustave Roussy, 94805 Villejuif, France;
| | - Manal Kordahi
- Department of Pathology, Gustave Roussy, 94805 Villejuif, France; (M.K.); (J.-Y.S.)
| | - Christine Do Cao
- Department of Endocrinology, Centre Hospitalier Universitaire Lille, 59000 Lille, France;
| | - Annabelle Naman
- Department of Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France; (A.N.); (L.L.); (J.H.); (S.L.); (E.B.)
| | - Livia Lamartina
- Department of Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France; (A.N.); (L.L.); (J.H.); (S.L.); (E.B.)
| | - Julien Hadoux
- Department of Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France; (A.N.); (L.L.); (J.H.); (S.L.); (E.B.)
| | - Sophie Leboulleux
- Department of Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France; (A.N.); (L.L.); (J.H.); (S.L.); (E.B.)
| | - Francois Pattou
- Department of General and Endocrine Surgery, Centre Hospitalier Universitaire Lille, Université de Lille, 59000 Lille, France;
| | - Sébastien Aubert
- Institut of Pathology, Centre Hospitalier Universitaire Lille, 59000 Lille, France;
| | - Jean-Yves Scoazec
- Department of Pathology, Gustave Roussy, 94805 Villejuif, France; (M.K.); (J.-Y.S.)
| | - Abir Al Ghuzlan
- Department of Pathology, Gustave Roussy, 94805 Villejuif, France; (M.K.); (J.-Y.S.)
- Correspondence: ; Tel.: +33-142-114-211
| | - Eric Baudin
- Department of Endocrine Oncology, Gustave Roussy, 94805 Villejuif, France; (A.N.); (L.L.); (J.H.); (S.L.); (E.B.)
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Ambrosini R, Balli MC, Laganà M, Bertuletti M, Bottoni L, Vaccher F, Cosentini D, Di Terlizzi M, Sigala S, Grisanti S, Tiberio GAM, Berruti A, Grazioli L. Adrenocortical Carcinoma and CT Assessment of Therapy Response: The Value of Combining Multiple Criteria. Cancers (Basel) 2020; 12:cancers12061395. [PMID: 32481732 PMCID: PMC7352253 DOI: 10.3390/cancers12061395] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/22/2020] [Accepted: 05/25/2020] [Indexed: 12/19/2022] Open
Abstract
We evaluated tumor response at Computed Tomography (CT) according to three radiologic criteria: RECIST 1.1, CHOI and tumor volume in 34 patients with metastatic adrenocortical carcinoma (ACC) submitted to standard chemotherapy. These three criteria agreed in defining partial response, stable or progressive disease in 24 patients (70.5%). Partial response (PR) was observed in 29.4%, 29.4% and 41.2% of patients according to RECIST 1.1, CHOI and tumor volume, respectively. It was associated with a favorable prognosis, regardless of the criterion adopted. The concordance of all the 3 criteria in defining the disease response identified 8 patients (23.5%) which displayed a very good prognosis: median progression free survival (PFS) and overall survival (OS) 14.9 and 37.7 months, respectively. Seven patients (20.6%) with PR assessed by one or two criteria, however, still had a better prognosis than non-responding patients, both in terms of PFS: median 12.3 versus 9.9 months and OS: 21 versus 12.2, respectively. In conclusions, the CT assessment of disease response of ACC patients to chemotherapy with 3 different criteria is feasible and allows the identification of a patient subset with a more favorable outcome. PR with at least one criterion can be useful to early identify patients that deserve continuing the therapy.
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Affiliation(s)
- Roberta Ambrosini
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
- Correspondence: ; Tel.: +39-030-3995225
| | - Maria Carolina Balli
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
| | - Marta Laganà
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, Italy; (M.L.); (D.C.); (S.G.); (A.B.)
| | - Martina Bertuletti
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
| | - Luca Bottoni
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
| | - Filippo Vaccher
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
| | - Deborah Cosentini
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, Italy; (M.L.); (D.C.); (S.G.); (A.B.)
| | - Marco Di Terlizzi
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
| | - Sandra Sigala
- Section of Pharmacology, Department of Molecular and Translational Medicine, University of Brescia, 25123 Brescia, Italy;
| | - Salvatore Grisanti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, Italy; (M.L.); (D.C.); (S.G.); (A.B.)
| | - Guido Alberto Massimo Tiberio
- Surgical Unit, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, ASST Spedali Civili di Brescia, 25123 Brescia, Italy;
| | - Alfredo Berruti
- Medical Oncology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia at ASST Spedali Civili, 25123 Brescia, Italy; (M.L.); (D.C.); (S.G.); (A.B.)
| | - Luigi Grazioli
- I Radiology Unit, ASST Spedali Civili, 25123 Brescia, Italy; (M.C.B.); (M.B.); (L.B.); (F.V.); (M.D.T.); (L.G.)
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Efficacy of the EDP-M Scheme Plus Adjunctive Surgery in the Management of Patients with Advanced Adrenocortical Carcinoma: The Brescia Experience. Cancers (Basel) 2020; 12:cancers12040941. [PMID: 32290298 PMCID: PMC7226395 DOI: 10.3390/cancers12040941] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/03/2020] [Accepted: 04/08/2020] [Indexed: 01/06/2023] Open
Abstract
Etoposide, doxorubicin and cisplatin plus oral mitotane (EDP-M) comprise the reference regimen in the management of patients with adrenocortical carcinoma (ACC). In this paper, we described the outcome of 58 patients with advanced/metastatic ACC consecutively treated with EDP-M in a reference center for this rare disease in Italy. In this series, EDP-M obtained a partial response in 50% of patients; median progression free survival (PFS) and overall survival were 10.1 months (95% Confidence Interval [CI 95%] 8.1–12.8) and 18.7 months (95% CI: 14.6–22.8), respectively. EDP-M was not interrupted in five patients showing disease progression after two cycles without the appearance of new lesions and mitotane levels below the therapeutic range. In two of them, the disease remained stable at further imaging evaluations and the other three obtained a partial response. Twenty-six responding patients underwent surgery of residual disease and 13 of them became disease free. Surgery identified a pathological complete response (pCR) in four patients (7%) and Ki67 expression in post-chemotherapy tumor specimens, inferior to 15% (median value), was associated with better PFS and survival. In the present study, the EDP-M regimen is confirmed to have a limited efficacy. Early disease progression does not mean treatment inefficacy. Surgery of residual disease in partially responding patients allows for the detection of pCR in few of them and this condition is predictive of long-term survival. Ki67 expression of post-chemotherapy residual disease could be an additional prognostic factor that deserves to be studied further.
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