World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Case Report

Volume 6, Number 6, December 2015, pages 485-490

Clinical Case of Metastatic Adrenocortical Carcinoma With Unusual Evolution: Review the Literature

Figures

Figure 1. CT scan of adrenocortical carcinoma showing necrotic right adrenal mass in close proximity to the body/tail of pancreas and third portion of the duodenum (white arrow).

Figure 2. CT scan 6 months after mitotane treatment showing reduction in size of the adrenal mass.

Figure 3. CT scan after surgical oncology showing right radical adrenalectomy and total omentectomy.

Tables

**Table 1.** Cytotoxic Chemotherapy Plus Mitotane in ACC [24-27]
Drug	Study phase/n	Clinical benefit
M/EDP: mitotane + etoposide, doxorubicin and cisplatin; SM: streptozotocin + mitotane.
Cisplatin + etoposide followed by mitotane [24]	II/47	ORR: 11% Median OS: 10 months
M/EDP [25]	II/28	ORR: 53.5% CR: two patients PR: 13 patients
SM [26]	II/22	ORR: 36.4%
M/EDP vs. SM [27]	III/304	ORR: 23.2 vs. 9.2% PFS: 5.0 vs. 2.1 months OS: 14 vs. 12 months

**Table 2.** Cytotoxic Chemotherapy in ACC [31-41]
Drug	Target	Study phase/n	Clinical benefit
VEGF: vascular endothelial growth factor; EGFR: epidermal growth factor receptor; IGF-1R: insulin growth factor 1 receptor; mTOR: mammalian target of rapamycin; PDGFR: platelet-derived growth factor receptor.
Sunitinib [32]	VEGF pathway	II/35	Five patients with SD
Sorafenib + paclitaxel [33]	VEGF pathway + chemotherapy	II/9	No benefit
Bevacizumab + capecitabina [34]	VEGF pathway + chemotherapy	II/10	No benefit
Erlotinib + gemcitabina [35]	EGFR pathway + chemotherapy	II/10	One patient with SD
Gefitinib [36]	EGFR pathway	II/19	No benefit
Figitumumab [37]	IGF-1R pathway	II/14	Eight patients with SD
Cixutumumab [38]	IGF-1R pathway	II/10	One patient with SD
Cixutumumab + temsirolimus [39]	IGF-1R pathway + mTOR pathway	I/10	Four patients with SD
Everolimus [40]	mTOR pathway	II/4	No benefit
Imatinib [41]	c-ABL, PDGFR and c-Kit pathway	II/4	No benefit
Linsitinib [31]	Dual inhibitor of IGFR and IR tyrosine kinase	III/139	No benefit