SFEBES2008 Poster Presentations Endocrine tumours and neoplasia (31 abstracts)
Thalidomide therapy for metastatic adrenal carcinoma
Kashinath Dixit 1 , Alaaeldin Shablak 2 , Koshy Jacob 3 , David Walmsley 3 , Robert Hawkins 2 & Peter Trainer 1
Departments of 1Endocrinology and 2Medical Oncology, Christie Hospital, Manchester, UK; 3Department of Diabetes and Endocrinology, Royal Lancaster Infirmary, Lancaster, UK.
Adrenocortical carcinoma are rare, highly vascular tumours with a generally poor prognosis. We have studied the use of the antiangiogenic drug, thalidomide (TH), in 6 patients with metastatic adrenocortical carcinoma (5 patients had adrenalectomy and one patient was inoperable#). The response to thalidomide treatment is summarized in the following Table. Assuming the residual/metastatic tumours to have a spheroidal form, the tumour volume (V) was calculated using the equation, V=[4/3πab(a+b)/2]×1/8] where a=maximum and b=minimum tumour diameter.
| Sex | Age at ▲ (year) | Size of primary tumor (cm) | Hormones secreted | TV pre-TH (cm3) | TH dose and duration (months) | TV on TH (cm3) | Other Rx | Outcome |
| F# | 22 | 16X18 | Androgens | 2556 | 50 mg | 117 | Nil | Stable |
| Cortisol | 38m | 9 | ||||||
| F | 53 | 16X14X12 | Nil | 0.65 | 50 mg | 0.3 | Nil | Stable |
| 10 m | 3 | |||||||
| M | 58 | 20X15 | Androgens | 15.13 | 50 mg | 127 | M | Alive with disease |
| 3 m | ||||||||
| Estrogen | 100 mg | 0.78 | ||||||
| 6 m | ||||||||
| 200 mg | ||||||||
| 2 m | ||||||||
| M | 45 | 8X9X10 | Cortisol | 3.1 | 50 mg | 6.1 | M | Alive with good Rx response |
| 3 m | 5 | |||||||
| 100 mg | 0 | |||||||
| 3 m | ||||||||
| M | 34 | 8X12X10 | Cortisol | 623.67 | 50 mg | 148 | M | Died of disease |
| Estrogen | 4m | 7.4 | C | |||||
| M | 33 | 18X12 | Cortisol | 4.17 | 50 mg | Nil | Died of acute liver failure | |
| 2 m | ||||||||
| TV, cumulative volume of all residual/metastatic tumours; M, mitotane; C, chemotherapy. | ||||||||
The patient who died of acute liver failure was a known alcohol and recreational drug abuser. There has been no response in two men. One man had complete resolution of metastatic disease on higher dose of TH+mitotane. Both women have responded well on thalidomide monotherapy. We conclude that thalidomide therapy is certainly worth further investigation in patients with metastatic adrenocortical carcinoma, especially in combination with mitotane.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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