Mitotane With or Without Cisplatin and Etoposide After Surgery in Treating Patients With Stage I-III Adrenocortical Cancer With High Risk of Recurrence
This phase III trial studies how well mitotane alone works compared to mitotane with cisplatin and etoposide when given after surgery in treating patients with adrenocortical cancer that has a high risk of coming back (recurrence). Cortisol can cause the growth of adrenocortical tumor cells. Antihormone therapy, such as mitotane, may lessen the amount of cortisol made by the body. Drugs used in chemotherapy, such as cisplatin and etoposide, work in different ways to stop the growth of tumor cells, either by killing the cells, by stopping them from dividing, or by stopping them from spreading. It is not yet known whether mitotane alone or mitotane with cisplatin and etoposide after surgery works better in treating patients with adrenocortical carcinoma.
Eligibility
Sex
ALL
Min age
18 Years
Max age
—
Healthy volunteers
No
Inclusion Criteria:
* Have a histologically confirmed diagnosis of ACC (Weiss score of \>= 3). (LinWeiss-Bisceglia system will be used for oncocytic ACC).
* Have a high risk of relapse defined as: Stage I-III ACC (according to the European Network for the Study of Adrenal Tumors \[ENSAT\] classification) within 90 days of surgical resection of primary tumor with curative intent with either microscopically complete resection (R0, defined as no evidence of microscopic residual disease according to surgical reports, histopathology, and perioperative imaging), microscopically positive margins (R1), or undetermined margins (RX, based on surgical or pathological reports without unequivocal evidence of metastasis in the perioperative imaging). Each participating center will determine the pathological stages and resection margins AND Ki67 \> 10% (to be determined by an experienced pathologist in each participating center and preferably via quantitative imaging analysis).
* Have perioperative imaging (computed tomography \[CT\] with contrast, magnetic resonance imaging \[MRI\] of the chest/abdomen/pelvis, or fluorodeoxyglucose positron emission tomography \[FDG-PET\] CT) without unequivocal evidence of disease within 8 weeks before randomization. Patients with indeterminate non-specific nodules (\< 1 cm for soft tissue lesions and \< 1.5 cm in the short dimension for lymph nodes) will be permitted to participate in this study.
* Have an Eastern Cooperative Oncology Group (ECOG) performance status 0-2.
* Be able to comply with the protocol procedures.
* Provide written informed consent.
Exclusion Criteria:
* The time between primary surgery and randomization \> 90 days.
* Gross residual disease after surgery (R2 resection)
* High suspicion for metastatic disease on perioperative imaging
* They have undergone repeated surgery for recurrence of disease.
* They have a history of recent or active prior malignancy, except for cured non-melanoma skin cancer, cured in situ cervical carcinoma, breast ductal carcinoma in situ, or other treated malignancies where there has been no evidence of disease for at least 2 years.
* They have renal insufficiency (estimated glomerular filtration rate \[GFR\] \< 50 mL/min/1.73 m\^2).
* They have significant liver insufficiency (serum bilirubin \> 2 times the upper normal range)
* They have significant liver insufficiency (serum alanine aminotransferase \[ALT\] or aspartate aminotransferase \[AST\] \> 3 times the upper normal range)
* Impaired bone marrow reserve (neutrophils \< 1000/mm\^3)
* Impaired bone marrow reserve (platelets \< 100,000/mm\^3)
* Pregnancy or breast feeding.
* They have known congestive heart failure (ejection fraction \< 45%). The extent of cardiac testing will depend on the judgment of the local principal investigator (PI). In general, in patients with a history of cardiac disease, it is recommended to obtain a baseline two-dimensional echocardiogram as standard of care to document ejection fraction. In patients without prior cardiac disease, a baseline electrocardiogram (EKG) is sufficient if there is no evidence of acute ischemic changes or prior evidence of myocardial infarction. If EKG results are abnormal (ischemic changes, significant arrhythmia, or suggestion of prior myocardial infarction), a two-dimensional echocardiogram will be obtained to assess ejection fraction. Cardiac imaging and EKG may not be needed in patients assigned to mitotane who do not have prior cardiac history and have low suspicion for cardiac symptoms to reflect standards of clinical practice. Similarly, utilizing cardiac imaging and EKG within the past 12 months is permitted if there is no suspicion for cardiac issues.
* They have preexisting grade 2 peripheral neuropathy.
* They underwent previous or current treatment with mitotane or other antineoplastic drugs for ACC.
* They underwent previous radiotherapy for ACC.
* They have any other severe acute or chronic medical or psychiatric condition or laboratory abnormality that would, in the judgment of the investigator, pose excess risk associated with study participation or administration of the involved drugs or that, in the judgment of the investigator, would make the patient inappropriate for entry into this study.
Primary outcome measure(s)
Recurrence-free survival (RFS) — From the time of randomization up to 2 years Starting from the date of randomization until documentation of radiological evidence of local recurrence, radiological evidence of distant recurrence, or death from any cause (whichever occurs first), RFS will be compared using the log-rank test between the two arms.
Local recurrence of adrenocortical carcinoma (ACC) — Up to 6 months
Distant recurrence of ACC — Up to 6 months
Trial sites (33)
Facility
City
Region
Status
University of Michigan Comprehensive Cancer Center
Ann Arbor
Michigan
Recruiting
Siteman Cancer Center at Washington University
St Louis
Missouri
Active Not Recruiting
M D Anderson Cancer Center
Houston
Texas
Recruiting
Institut de Cancérologie de l'Ouest (ICO)
Angers
France
Active Not Recruiting
CHU Angers, Hôpital Larrey
Angers
France
Recruiting
CHU Besançon, Hôpital Jean Minjoz
Besançon
France
Recruiting
CHU Brest, Hôpital La Cavale Blanche
Brest
France
Active Not Recruiting
Centre Georges François Leclerc
Dijon
France
Recruiting
Lyon HCL
Lyon
France
Recruiting
HCL Hôpital Louis Pradel
Lyon
France
Not Yet Recruiting
Marseille Hôpital Nord
Marseille
France
Recruiting
Marseille Hôpital de la Conception
Marseille
France
Recruiting
CHU Nantes, Hôpital René et Guillaume Laënnec
Nantes
France
Active Not Recruiting
CHU Nantes, Hôpital René et Guillaume Laënnec
Nantes
France
Recruiting
Hôpital Cochin, AP-HP
Paris
France
Recruiting
Hôpital Cochin, AP-HP
Paris
France
Active Not Recruiting
Hôpital Cochin
Paris
France
Recruiting
Hôpital COCHIN
Paris
France
Active Not Recruiting
CHU Bordeaux - Hôpital Haut Lévèque
Pessac
France
Recruiting
CHU Poitiers
Poitiers
France
Recruiting
CHU Reims
Reims
France
Recruiting
HUS, Hôpital Hautepierre
Strasbourg
France
Not Yet Recruiting
Strasbourg HUS Hautepierre
Strasbourg
France
Active Not Recruiting
CHU Toulouse, Hôpital Larrey
Toulouse
France
Recruiting
CHU Toulouse, Hôpital Rangueil
Toulouse
France
Active Not Recruiting
Gustave Roussy
Villejuif
France
Recruiting
LMU Klinikum München
Munich
Germany
Recruiting
Universitätsklinikum Würzburg
Würzburg
Germany
Recruiting
Maria Sklodowska-Curie National Research Institute of Oncology
Gliwice
Poland
Active Not Recruiting
Sahlgrenska University Hospital
Gothenburg
Sweden
Recruiting
Skånes Universitetssjukhus
Lund
Sweden
Recruiting
Karolinska University Hospital
Stockholm
Sweden
Recruiting
Akademiska Sjukhuset
Uppsala
Sweden
Recruiting
Official registry record
This page summarises publicly available registry data for informational purposes — not medical advice. Eligibility is determined by each study team; patients should discuss participation with their clinician.
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