OnCo

Adrenocortical carcinoma: lines of therapy

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4 standard-of-care settings across 3 lines and 1 biomarker subgroup. Rows come from the cancer page's standard of care; the grid places each on its line and subgroup.

LineAll comers
Early / localised1
Advanced, first line2
Second line1

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersLocalised (ENSAT I-III)Open en bloc adrenalectomy by an experienced surgeon with locoregional lymphadenectomy; adjuvant mitotane for high-risk (Ki-67 >10%, stage III, R1) for 2-5 years; adjuvant radiotherapy for R1.91

Advanced, first line

SubgroupSettingApproachProducts and trialsEvidence
All comersAdvanced, aggressiveEDP-M (etoposide, doxorubicin, cisplatin + mitotane) ×6-8 with surgery for responders; streptozocin-mitotane second line.81
All comersAdvanced, indolentMitotane monotherapy (target level 14-20 mg/L) with glucocorticoid replacement; local therapies (ablation, radiotherapy) for oligometastases.43

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersProgressive after chemotherapyPembrolizumab, cabozantinib, gemcitabine-capecitabine; control hormone excess; clinical trials.98

Lines and subgroups are parsed from the setting text of each standard-of-care row and can misclassify an unusual phrasing; the row’s own setting is always shown. Guideline chips reflect the NCCN category and ESMO-MCBS grade recorded on the cancer page, checked on its stated date. Not medical advice.