Role of consolidative surgery after chemotherapy in recurrent/metastatic adrenal cortical cancer (ACC): Princess Margaret Cancer Center Experience

Background Metastatic ACC is aggressive with few effective treatment options. It is unclear if surgery after chemotherapy impacts survival in recurrent/metastatic (R/M) ACC. Moreover, prognostic factors in R/M ACC are not well defined. Methods R/M ACC patients treated at Princess Margaret Cancer Center (2002–2019) were retrospectively reviewed. Descriptive statistics were used to summarize clinical characteristics. OS was estimated by Kaplan-Meier method. Cox regression analysis was used to compute prognostic variables. Results Among 83 patients with metastatic ACC [36.2% de novo and 63.8% recurrent], 49 (59.0%) received systemic therapy (ST) with which 15 (30.6%) had a partial response (PR) and 8 (16.3%) had stable disease (SD). 9 (18.4%) had surgery after ST (combined therapy group); 6 (66.6%) were rendered disease free with surgery. The median OS was 26 months (20.4–40.5) for entire cohort (f/up 18 months) with trend for better OS in patients having combined therapy (31.2 (21.4–63.3) vs 24.7 months (17.7–35.2), p = 0.48]. Being disease free after surgery was associated with better OS [39.6 (24.8-NR), vs 23.5 months (21.4-NR), p = 0.02]. Conclusions Selected patients with R/M ACC may benefit from surgery after chemotherapy. These data highlight the potential role for multimodal therapy in managing such patients. Implications for Practice: Chemotherapy remains the standard of care in advanced adrenal cortical carcinoma (ACC). However, the response to chemotherapy remains suboptimal and overall outcomes for these patients remains poor. The role of surgery for patients with advanced ACC remains uncertain. In a large cohort of patients treated at a large referral center in Canada, we observed that selected patients with advanced ACC may benefit from surgery after chemotherapy. This is especially true if surgery can lead to resection of all macroscopic disease. Based on this data, such approach can be individualised after discussion in multidisciplinary tumor boards