Advanced Adrenocortical Carcinoma Managed with Gemcitabine Plus Capecitabine as Second-Line Chemotherapy: A Case Report

Yamana A1, Hashimoto K1*, Kyoda Y1, Ogasawara T1, Wanifuchi A1, Kobayashi K1, Tanaka T1, Murase K2, Takada K2 and Masumori N1

1Department of Urology, Sapporo Medical University School of Medicine, Japan
2Department of Medical Oncology, Sapporo Medical University School of Medicine, Japan

^*Correspondance to: Kohei Hashimoto 

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Abstract:

Background: Patients with advanced Adrenocortical Carcinoma (ACC) have a poor prognosis. A Randomized-Control Trial (RCT) showed the efficacy and safety of mitotane plus a combination of Etoposide, Doxorubicin, and Cisplatin (EDP-M) for first-line therapy in patients with advanced ACC. However, second-line therapy has not been determined yet. Here, we report advanced ACC that was treated successfully with a combination of Gemcitabine, Capecitabine and Mitotane (Gem/ Cape-M) as second-line therapy following EDP-M therapy. Case Report: A 44-year-old woman who presented headache, palpitations, night sweats, acne, beard, menopause, edema, moon face, stretch marks on the abdomen and hypertension was diagnosed with ACC, stage T3N0M0, and underwent right adrenalectomy. Her high level of serum Dehydroepiandrosterone Sulfate (DHEA-S) of 757 μg/dL immediately decreased to 4 μg/dL after surgery. However, she developed lung and liver metastases and local recurrence with an increase of the serum DHEA-S level to 349 μg/dL 6 months after surgery. She received EDP-M as firstline chemotherapy, but the sites of metastases appeared to progress after 3 cycles. As second-line chemotherapy, Gem/Cape-M was chosen. She showed a Partial Response (PR) after 3 cycles of the treatment. Sixteen cycles of the treatment were delivered in 13 months and a partial response was maintained with a decrease of the DHEA-S level to 9 μg/dL. Grade 4 neutropenia and grade 3 thrombocytopenia were observed. Conclusion: We reported a long-lasting durable response to Gem/Cape-M following failed EDP-M for advanced ACC. It is suggested that Gem/Cape-M can be an option as second-line therapy for advanced ACC after EDP-M.

Keywords:

Adrenocortical carcinoma; Capecitabine; Gemcitabine; Second-line

Cite the Article:

Yamana A, Hashimoto K, Kyoda Y, Ogasawara T, Wanifuchi A, Kobayashi K, et al. Advanced Adrenocortical Carcinoma Managed with Gemcitabine Plus Capecitabine as Second-Line Chemotherapy: A Case Report. Ann Clin Case Rep. 2024; 9: 2579..