The objective of this study was to evaluate and compare the efficacies of conventional first-line
chemotherapies for
adrenocortical carcinoma. We reviewed the records of adult patients (> or =17 years) who had received first-line systemic
chemotherapy with serial pretreatment and posttreatment radiologic staging studies in our institution between 1980 and 2000. Overall survival (OS) and time to progression (
TTP) for different treatment groups were determined using the Kaplan-Meier method and were compared using the log-rank test. Univariate and multivariate models were fitted to different subsets of patients for OS and
TTP and used to calculate hazard ratios (HRs) with 95% confidence intervals. We identified 224 patients with a diagnosis of
adrenocortical carcinoma, 57 of whom met the inclusion criteria for further study.
Chemotherapy groups included:
mitotane (n=12),
platinum and
etoposide (n=16),
mitotane with
platinum and
etoposide (n=11),
mitotane and other cytotoxics (n=5),
platinum and
etoposide with other cytotoxics (n=3), and other miscellaneous cytotoxics (n=10). No statistically significant differences in OS (P=0.31) were noted among the treatment groups, but there was a statistically significant difference in
TTP (P=0.02) favoring
mitotane alone (
TTP=6.24 months; 95% confidence interval, 3.58-32.13). Multivariate analysis was most notable for a significantly greater OS (HR=0.49, P=0.04) and
TTP (HR=0.3, P=0.01) associated with peritoneal
metastases. Our analysis revealed no clear advantage for any single agent or combination over any of the other conventional frontline chemotherapeutic choices for
adrenocortical carcinoma. Novel agents are thus sorely needed in the treatment of this aggressive
cancer.