Alfredo Berruti, MD, University of Brescia, Brescia, Italy, talks on standard adjuvant therapy for patients with adrenocortical carcinoma. Adjuvant therapy is the standard for patients with adrenocortical carcinoma at high-risk of relapse following surgery. Patients with adrenocortical carcinoma at low-intermediate risk are a minority. The results of the Ajuvo trial showed this patient population have a far better survival outcome and do not benefit from adjuvant mitotane. This interview took place at the American Society of Clinical Oncology (ASCO) Genitourinary Cancers Symposium 2022 in San Francisco, CA.

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#pathology #Tumorsofadrenalglands #Adrenocorticaltumors

Leonardo Rojas

Adrenal glands tumours tend to be very small, especially the benign ones the malignant ones tend to be large, that is how we differentiate between benign and malignant tumours so typically a tumor more than 5 or 6 cms in size has to be considered malignant unless otherwise proven, so we need to excise the tumour. But smaller size tumours can be left alone and very often these benign adrenal tumours are recognized incidentally. So when you go for a scan for some other reason, that is unrelated to the Adrenal gland, you may find out on an ultrasound or a CT scan that there is a small tumor. So this is called as an incidnetalomas. So typically a benign adrenal tumours are asymptomatic, that is what you have to keep in mind, whatever symptom you may get may not be related to the adrenal gland tumour itself. You need to see if your adrenal gland tumour is giving you any trouble, you need to look at your blood pressure and if it is easy to control the blood pressure because blood pressure can be elevated even without adrenal gland tumour. Most people who have high blood pressure do not have adrenal gland tumour. But is your blood pressure difficult to control. If it this is difficult to control with multiple drugs then the tumor could be responsible for your blood pressure and we need to look at this carefully. Do you have features of Cushing’s syndrome? Cushing’s syndrome can be diagnosed easily by your endocrinologist by just looking at you. So if there is a good index of suspicion, we do a test called as the screening test. The usual screening test that we do is a 24 hour collection for cortisol or we do an overnight dexamethasone suppression test, by these tests we come to know whether you have cortisol excess. If you have cortisol excess, you will have all the symptoms of Cushing’s syndrome like rounding of face outing on weight in the belly, having stretch marks in your skin, thinning out of skin, weak bones fractures, all these can be features of adrenal tumors which are benign. But if any adrenal tumors are producing symptoms, they need to be removed. If any adrenal tumor is producing symptom unrelated to it, then probably removing it may to help it. So typically the link between the symptom and the adrenal tumour is a difficult one to make. It is best left to a specialist. It is best to visit an endocrinologist if you have a benign adrenal tumour that has been discovered.

Postdoctoral fellow, Katie Basham shares the research being done around adrenal cortical carcinoma to find better treatment options.

Matthew Campbell, MD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the potential role of immunotherapy in treating adrenocortical carcinoma. Combining immunotherapy with targeted therapies has demonstrated promising efficacy in kidney and thyroid cancer, and clinical trials investigating mitotane and pembrolizumab in adrenocortical carcinoma are currently underway. This interview took place at the European Society for Medical Oncology (ESMO) 2022 Congress in Paris, France.