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Adrenocortical Carcinoma — SCE Medical Oncology MCQ

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HardOncological EmergenciesAdrenocortical CarcinomaSCE Medical Oncology

A 62-year-old woman presents with a new right adrenal mass (5 cm) found on staging CT for lung cancer. Biopsy shows adrenocortical carcinoma. She has no evidence of cortisol or androgen excess. PET shows no other metastases. After surgical resection with R0 margins, what adjuvant therapy is standard?

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Correct answer: D — Mitotane ± cisplatin-based chemotherapy for high-risk disease

For resected adrenocortical carcinoma (ESC) at high risk of recurrence (Ki-67 >10%, stage III-IV, R1 margins, large tumours), adjuvant mitotane is recommended for at least 2-3 years with target plasma levels 14-20 mg/L. Adjuvant cisplatin-etoposide-doxorubicin + mitotane may be considered for very high-risk cases. Glucocorticoid and mineralocorticoid replacement is required during mitotane therapy. The ADIUVO-2 trial is evaluating adjuvant mitotane in intermediate-risk ESC.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer