Role of consolidative surgery after chemotherapy in recurrent/metastatic adrenal cortical cancer (ACC): Princess Margaret Cancer Centre experience

BACKGROUND: Recurrent/Metastatic (R/M) ACC is aggressive with few effective treatment options. The role of surgery after chemotherapy remains unclear. Moreover, prognostic factors in R/M ACC are not well defined. METHODS: R/M ACC patients treated at Princess Margaret Cancer Centre (2002-2019) were retrospectively reviewed. Descriptive statistics were used to summarize clinical characteristics. OS was estimated by Kaplan-Meier method. Cox regression analysis was used to compute prognostic variables. RESULTS: Among 83 patients with metastatic ACC [36.2% de novo and 63.8% recurrent], 49 (59.0%) received systemic therapy (ST) with which 15 (30.6%) had a partial response (PR) and 8 (16.3%) had stable disease (SD). 9 (18.4%) had surgery after ST (combined therapy group); 6 (66.6%) were rendered disease free with surgery. The median OS was 26 months (20.4-40.5) for entire cohort (f/up 18 months). OS for patients having combined therapy was 31.2 months (21.4-63.3) vs 24.7 months (17.7-35.2), p = 0.48 for patients receiving systemic therapy alone. Being disease free after surgery was associated with better OS [39.6 (24.8-not reached), vs 23.5 months (21.4-not reached), p = 0.02]. CONCLUSIONS: Selected patients with R/M ACC may achieve long term survival with surgery after chemotherapy. These data highlight the potential role for multimodal therapy in managing such patients.