Endocrine and Diabetes Unit, Department of Internal Medicine I, University Hospital of Würzburg, University of Würzburg, Oberdürrbacher Strasse 6, 97080 Würzburg, Germany.
Eur J Endocrinol. 2010 Feb;162(2):349-56. doi: 10.1530/EJE-09-0804. Epub 2009 Nov 10.
No standard therapy for advanced adrenocortical carcinoma (ACC) is established by any randomized trial but a consensus conference 2003 recommended mitotane as monotherapy or combined with etoposide, doxorubicin and cisplatin or with streptozotocin as first-line systemic therapy. However, there is no evidence for any therapy beneficial in patients failing these therapies. Therefore, we evaluated the effects of the anti-VEGF antibody bevacizumab plus capecitabine as salvage therapy in ACC.
Patients registered with the German ACC Registry with refractory ACC progressing after cytotoxic therapies were offered treatment with bevacizumab (5 mg/kg body weight i.v. every 21 days) and oral capecitabine (950 mg/m(2) twice daily for 14 days followed by 7 days of rest) in 2006-2008. Evaluation of tumour response was performed by imaging according to response evaluation criteria in solid tumours every 12 weeks.
Ten patients were treated with bevacizumab plus capecitabine. None of them experienced any objective response or stable disease. Two patients had to stop therapy after few weeks due to hand-foot syndrome, and three patients died on progressive disease within 12 weeks. Other adverse events were mild (grade I-II). Median survival after treatment initiation was 124 days.
Bevacizumab plus capecitabine has no activity in patients with very advanced ACC. Hence, this regimen cannot be recommended as a salvage therapy.
没有标准的治疗方法被确立用于治疗晚期肾上腺皮质癌（ACC），但 2003 年的一次共识会议建议米托坦作为单一药物治疗或联合依托泊苷、多柔比星和顺铂，或与链脲佐菌素联合作为一线全身治疗。然而，对于这些治疗失败的患者，没有任何治疗方法是有益的。因此，我们评估了抗血管内皮生长因子抗体贝伐珠单抗联合卡培他滨作为 ACC 挽救性治疗的效果。
2006 年至 2008 年，德国 ACC 登记处登记的对细胞毒性治疗后进展的难治性 ACC 患者，接受贝伐珠单抗（5mg/kg 体重静脉注射，每 21 天一次）和卡培他滨（950mg/m2，每日两次，连用 14 天，然后休息 7 天）治疗。每 12 周根据实体瘤反应评估标准进行影像学评估肿瘤反应。
10 名患者接受了贝伐珠单抗联合卡培他滨治疗。他们中没有任何人经历过任何客观缓解或稳定疾病。两名患者因手足综合征在几周后停止治疗，三名患者在 12 周内死于疾病进展。其他不良事件较轻（I 级-II 级）。治疗开始后中位生存时间为 124 天。
贝伐珠单抗联合卡培他滨对非常晚期 ACC 患者无活性。因此，该方案不能作为挽救性治疗推荐。
