Phase II study of cabazitaxel as second-third line treatment in patients with metastatic adrenocortical carcinoma

M Laganà, S Grisanti, R Ambrosini, D Cosentini, A Abate, M Zamparini, V D Ferrari, A Gianoncelli, A Turla, L Canu, M Terzolo, G A M Tiberio, S Sigala, A Berruti, M Laganà, S Grisanti, R Ambrosini, D Cosentini, A Abate, M Zamparini, V D Ferrari, A Gianoncelli, A Turla, L Canu, M Terzolo, G A M Tiberio, S Sigala, A Berruti

Abstract

Background: Adrenocortical carcinoma (ACC) is a rare and aggressive malignancy with a poor prognosis. No efficacious treatment options are currently available for patients with advanced metastatic disease with disease progression to standard etoposide, doxorubicin, cisplatin and mitotane (EDP-M) therapy. We assessed the activity and tolerability of cabazitaxel as a second/third-line approach in metastatic ACC.

Patients and methods: Patients included in this single-center, phase II study (ClinicalTrials.gov identifier NCT03257891) had disease progression to a cisplatin-containing regimen (such as EDP) plus mitotane, plus/minus a further chemotherapy line. Cabazitaxel was administered intravenously at 25 mg/m2 on day 1 of a 21-day cycle, for a maximum of six cycles. The primary endpoint was a disease control rate after 4 months.

Results: From March 2018 to September 2019, 25 eligible patients were enrolled. A disease control rate after 4 months was obtained in six patients (24%). No patients attained a disease response according to RECIST 1.1, 9 patients (36%) had stable disease and 16 patients (64%) progressive disease. Median progression-free survival and overall survival were 1.5 months (range 0.3-7 months) and 6 months (range 1-22.2 months), respectively. Cabazitaxel therapy was well tolerated and only three (12%) patients developed grade 3 toxicity which were nausea in one patient (4%) and anemia in two patients (8%).

Conclusions: Cabazitaxel has a manageable toxicity profile but is poorly active as second/third-line treatment in advanced ACC patients. These results do not support further evaluation of cabazitaxel in this setting.

Keywords: adrenocortical cancer; advanced; cabazitaxel; pretreated.

Conflict of interest statement

Disclosure The authors have declared no conflicts of interest.

Copyright © 2022 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Figures

Figure 1
Figure 1
(A) Tumor response according to RECIST. (B) Tumor response according to Choi.
Figure 2
Figure 2
(A) Overall survival. (B) Progression-free survival.
Figure 3
Figure 3
Variation of cabazitaxel concentration according to mitotane. Dashed line: mitotane blood concentration under median; continuous line: mitotane blood concentration above median. CI, confidence interval.

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