title: Metronomic chemotherapy may be active in heavily pre-treated patients with metastatic adreno-cortical carcinoma.
abstract: OBJECTIVE
  The potential benefit of further chemotherapy approaches in patients with adrenocortical carcinoma (ACC) showing progressive disease after 2 chemotherapy lines is actually unknown. This study provides explorative information on the activity of metronomic chemotherapy in heavily pre-treated ACC patients.
  
  
  METHODS
  We tested the activity of cytotoxic treatments administered on a metronomic schedule in metastatic ACC patients showing disease progression after treatment with gemcitabine and capecitabine scheme.
  
  
  RESULTS
  Eight patients out of 28 consecutively enrolled in that trial were treated with several metronomic cytotoxic regimens. Six of them showed disease progression, but 2 patients obtained a clear benefit. The first patient was treated with oral etoposide (50 mg daily) as the 6th-line therapy and obtained a partial response lasting 24 months, while the second patient obtained a partial response lasting 10 months with metronomic oral cyclophosphamide (50 mg daily) as the 5th chemotherapy line. Both patients had sex hormone secreting tumors and were bearing a rather indolent ACC.
  
  
  CONCLUSIONS
  The administration of several chemotherapy lines in advanced ACC patients cannot be routinely recommended outside prospective clinical trials. Few patients with indolent tumors, however, may benefit from this approach. According to our experience, oral cyclophosphamide and oral etoposide may be used in this setting.
authors.affiliation: Medical Oncology, Azienda Ospedaliera San Luigi, Department of Clinical and Biological Sciences, University of Turin, Orbassano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Ferrero
authors.forename: P
authors.initials: P
authors.lastname: Sperone
authors.forename: A
authors.initials: A
authors.lastname: Ardito
authors.forename: G
authors.initials: G
authors.lastname: Rossi
authors.forename: S
authors.initials: S
authors.lastname: Del Buono
authors.forename: A M
authors.initials: AM
authors.lastname: Priola
authors.forename: S
authors.initials: S
authors.lastname: Bracarda
authors.forename: E
authors.initials: E
authors.lastname: Taberna
authors.forename: M
authors.initials: M
authors.lastname: Terzolo
authors.forename: A
authors.initials: A
authors.lastname: Berruti
mesh_terms: D059250:Administration, Metronomic; D000306:Adrenal Cortex Neoplasms / Q000188:drug therapy* / Q000473:pathology; D018268:Adrenocortical Carcinoma / Q000188:drug therapy* / Q000556:secondary; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage*; D017024:Chemotherapy, Adjuvant; D003520:Cyclophosphamide / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D016879:Salvage Therapy; D016896:Treatment Outcome
chemical_list: D005047:Etoposide; D003520:Cyclophosphamide