Arlt W, Reincke M, Siekmann L, Winkelmann W, Allolio B
Department of Internal Medicine, Julius-Maximilians-University, Würzburg, Germany.
Clin Endocrinol (Oxf). 1994 Sep;41(3):299-307. doi: 10.1111/j.1365-2265.1994.tb02549.x.
No satisfactory treatment for adrenocortical carcinoma (ACC) is available. We investigated the efficacy and toxicity of suramin in the treatment of metastatic ACC since suramin has been recently reported to be active as a single agent therapy for patients with ACC and prostatic carcinoma.
We collected data on 9 patients with metastatic ACC treated with suramin in four centres in Germany between 1987 and 1992.
Nine patients (5 women, 4 men; age range 32-67 years) were included. Biochemical evidence of steroid excess was found in 6/9, in three leading to clinical symptoms (hypertension, hyperglycaemia, hirsutism, gynaecomastia).
Tumour responses were assessed by radiological and biochemical evaluation. Other investigations included regular measurements of blood cell counts, coagulation, hepatic and renal function parameters, and serum suramin concentrations.
The patients received cumulative doses ranging from 8.2 to 30.2 g suramin over periods of 1-15 months. 3/9 achieved a partial response, 2/9 disease stabilization and 4/9 experienced progressive disease. Tumour responses were transient. Suramin treatment was without direct influence on steroid excess. Serious side-effects included coagulopathy (6/9), thrombocytopenia (6/9), polyneuropathy (2/9) and allergic skin reactions (4/9); the death of two patients was possibly related to suramin therapy. Both toxicity and tumour response were strongly associated with serum level or cumulative dose of suramin.
(1) Suramin is of antineoplastic efficacy in the treatment of metastatic adrenocortical carcinoma. (2) The clinical use of suramin is limited by a narrow therapeutic window with the risk of serious and possibly lethal toxicity at one extreme, and loss of efficacy at the other. Strict monitoring of suramin serum levels is mandatory aiming at levels between 200 and 250 mg/l. Suramin should not be considered as first-line treatment for metastatic adrenocortical carcinoma. (3) To improve treatment options in adrenocortical carcinoma as well as for further investigation on the usefulness of suramin, controlled prospective trials are urgently needed.
目前尚无令人满意的肾上腺皮质癌（ACC）治疗方法。由于最近有报道称苏拉明作为单一药物疗法对ACC和前列腺癌患者有效，我们研究了苏拉明治疗转移性ACC的疗效和毒性。
我们收集了1987年至1992年间在德国四个中心接受苏拉明治疗的9例转移性ACC患者的数据。
纳入9例患者（5例女性，4例男性；年龄范围32 - 67岁）。9例中有6例存在类固醇过量的生化证据，其中3例导致临床症状（高血压、高血糖、多毛症、男性乳房发育）。
通过影像学和生化评估评估肿瘤反应。其他检查包括定期测量血细胞计数、凝血功能、肝肾功能参数以及血清苏拉明浓度。
患者在1至15个月的时间内接受了累积剂量为8.2至30.2 g的苏拉明治疗。9例中有3例获得部分缓解，2例病情稳定，4例病情进展。肿瘤反应是短暂的。苏拉明治疗对类固醇过量无直接影响。严重副作用包括凝血病（6/9）、血小板减少症（6/9）、多发性神经病（2/9）和过敏性皮肤反应（4/9）；2例患者死亡可能与苏拉明治疗有关。毒性和肿瘤反应均与苏拉明的血清水平或累积剂量密切相关。
（1）苏拉明在治疗转移性肾上腺皮质癌方面具有抗肿瘤疗效。（2）苏拉明的临床应用受到狭窄治疗窗的限制，一端存在严重且可能致命毒性的风险，另一端则存在疗效丧失的风险。必须严格监测苏拉明血清水平，目标是维持在200至250 mg/l之间。苏拉明不应被视为转移性肾上腺皮质癌的一线治疗方法。（3）为了改善肾上腺皮质癌的治疗选择以及进一步研究苏拉明的有效性，迫切需要进行对照前瞻性试验。
