Quinkler Marcus, Hahner Stefanie, Wortmann Sebastian, Johanssen Sarah, Adam Patrick, Ritter Christian, Strasburger Christian, Allolio Bruno, Fassnacht Martin
Clinical Endocrinology, Charité Campus Mitte, Charité University Medicine Berlin, Germany.
J Clin Endocrinol Metab. 2008 Jun;93(6):2057-62. doi: 10.1210/jc.2007-2564. Epub 2008 Mar 11.
Adrenocortical carcinoma (ACC) is a rare malignancy with poor prognosis. In advanced disease, mitotane given as monotherapy or combined either with etoposide, doxorubicin, and cisplatin or with streptozotocin is the recommended first-line therapy. However, many patients have progressive disease despite treatment with these regimens.
Our objective was to evaluate the efficacy of the epidermal growth factor receptor inhibitor erlotinib plus gemcitabine as salvage therapy in ACC patients with very advanced ACC.
DESIGN/SETTING: The study consisted of case series collected from different centers (primary care and referral centers) in Germany in 2006-2007.
Patients registered with the German ACC Registry with progressive ACC after two to four previous systemic therapies were offered treatment with erlotinib and gemcitabine. Oral erlotinib (100 mg/d) was administered on a daily basis and gemcitabine (800 mg/m(2)) iv every 14 d.
We evaluated tumor response according to response evaluation criteria in solid tumors (RECIST) criteria after 12 wk of treatment.
Ten patients have been treated with erlotinib and gemcitabine. Only one in 10 patients experienced a minor response (progression-free survival 8 months), whereas eight patients had progressive disease at the first staging. One patient had to stop therapy after the first administration of gemcitabine due to cerebral seizure. Nine of 10 patients had died after a median of 5.5 months after treatment initiation. In addition to the seizure, one patient experienced severe pneumonia (grade III), and in one, gemcitabine administration had been delayed due to prolonged neutropenia. All other adverse events were mild (grade I-II).
Salvage chemotherapy using erlotinib plus gemcitabine has very limited to no activity in patients with very advanced ACC.
肾上腺皮质癌（ACC）是一种预后较差的罕见恶性肿瘤。在晚期疾病中，米托坦单药治疗或与依托泊苷、阿霉素和顺铂联合使用或与链脲佐菌素联合使用是推荐的一线治疗方法。然而，许多患者尽管接受了这些方案的治疗，仍出现疾病进展。
我们的目的是评估表皮生长因子受体抑制剂厄洛替尼联合吉西他滨作为挽救疗法对极晚期ACC患者的疗效。
设计/地点：该研究包括2006 - 2007年从德国不同中心（初级保健和转诊中心）收集的病例系列。
在德国ACC登记处登记的、在之前接受两到四次全身治疗后疾病进展的ACC患者接受厄洛替尼和吉西他滨治疗。口服厄洛替尼（100 mg/天），吉西他滨（800 mg/m²）静脉注射，每14天一次。
我们根据实体瘤疗效评价标准（RECIST）标准在治疗12周后评估肿瘤反应。
10例患者接受了厄洛替尼和吉西他滨治疗。10例患者中只有1例出现轻微反应（无进展生存期8个月），而8例患者在首次分期时疾病进展。1例患者在首次给予吉西他滨后因癫痫发作不得不停止治疗。10例患者中有9例在开始治疗后中位5.5个月死亡。除癫痫发作外，1例患者出现严重肺炎（III级），1例患者因长期中性粒细胞减少导致吉西他滨给药延迟。所有其他不良事件均为轻度（I - II级）。
使用厄洛替尼联合吉西他滨的挽救化疗对极晚期ACC患者的活性非常有限或无活性。
