7230 Complete Nine Years Disease Free Survival In A Patient With Metastatic Adrenocortical Carcinoma Following Systemic Chemotherapy Including Streptozotocin And Mitotane
Notice bibliographique
Résumé
Abstract Disclosure: L.M. Martel: None. H.J. Olney: None. A. Lacroix: None. Background: Metastatic adrenocortical carcinoma (ACC) in adults carries a very poor prognosis with rare complete remissions (CR) following local and systemic therapies. Combined therapy with mitotane and etoposide, doxorubicin, cisplatin (EDP) provided better response rate than mitotane and streptozotocin (N Engl J Med. 366: 2189, 2012). We report a patient with stage 4 ACC in long-term CR following systemic therapy which included 21 cycles of second-line streptozotocin and mitotane (SM) within the FIRM-ACT trial (NCT00094497). Clinical Case: A 56 y.o. male, presented acute left flank pain at a regional hospital. CT scans showed a 9.6 cm, 31 HU heterogeneous left adrenal mass and a 1.4 cm superior right lung nodule and centimetric mediastinal adenopathy. Hormonal testing revealed normal urinary metanephrines, cortisol after 1-mg DST, ARR, DHEAS and testosterone levels. In Aug 2014, left adrenalectomy, nephrectomy, splenectomy and partial pancreatectomy were complicated by infections, pulmonary emboli and myocardial infarction. Pathology confirmed a 15 cm, 750 gr, poorly differentiated ACC (Weiss 8/9; pT3, Ki-67 not reported). Two months later, the right 1.5 cm lung nodule, 2 new subcentimetric lung nodules and single mediastinal and retroperitoneal adenopathy presented high SUV uptake on an FDG-PET scan. At referral to our center, EBUS biopsy confirmed metastatic ACC in a mediastinal lymph node. Mitotane and hydrocortisone were introduced in Nov 2014 and EDP in December 2014. Maximal mitotane dose was 6 gr daily, but was reduced to maintain mitotanemia within therapeutic range. In Feb 2015, a 4.6 cm post-surgical adrenal bed mass was present, but later imaging showed decreasing size of lesions in the adrenal bed, mediastinal and lung nodules. Following responsive disease at 3 cycles, restaging imaging at 6 cycles of EDP, showed a mixed response. Second line chemotherapy with SM was also indicated by cardiac toxicity (LVEF decreased to 34%). During and after 21 SM cycles, restaging CT and FDG-PET scans showed CR of abdominal lesions in February 2016 and of thoracic lesions in December 2021. The patient continues Mitotane (1.5 g/d twice weekly and 1 g/d x 5 days weekly) at therapeutic levels with acceptable tolerance. Annual FDG-PET and CT thorax, abdomen and pelvis, last in October 2023, show no evidence of recurrence.Complications of therapy other than cardiac include adequately replaced adrenal and thyroid insufficiencies, osteoporotic vertebral fractures and peripheral neuropathy treated with antalgic medication. Conclusion: This case illustrates that, although rare, complete long-term remission of advanced metastatic ACC can occur in patients receiving systemic combination chemotherapy including SM and should be considered in patients with advanced ACC when EDP does not achieve a stable response and can be continued until toxic limitations, in our case peripheral neuropathy. Presentation: 6/2/2024
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».