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Cancers & treatments·Sequencing

Advanced and metastatic adrenocortical carcinoma (ENSAT stage IV or unresectable): lines of therapy

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5 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
Second line1
Other settings3

Early / localised

SubgroupSettingApproachProducts and trialsEvidence
All comersLow-burden, indolent diseaseMitotane alone, with resection, thermal ablation or stereotactic radiotherapy of limited metastases.
MitotaneThermal ablation (RFA, microwave, cryo)SBRT / SABR (stereotactic radiotherapy)Adrenalectomy
43

Second line

SubgroupSettingApproachProducts and trialsEvidence
All comersHigh-burden or progressive disease, first lineEtoposide, doxorubicin and cisplatin with mitotane (EDP-M, FIRM-ACT).
EtoposideDoxorubicinCisplatinMitotaneCytotoxic chemotherapy
94

Other settings

SubgroupSettingApproachProducts and trialsEvidence
All comersAll patientsMitotane from diagnosis with glucocorticoid replacement; adrenal enzyme inhibitors (metyrapone, osilodrostat, ketoconazole) for cortisol excess; thromboprophylaxis and infection vigilance.
Mitotane
43
All comersAfter EDP-MGemcitabine with capecitabine; cabozantinib; pembrolizumab, especially for mismatch-repair-deficient tumours; streptozocin-mitotane; clinical trials.
GemcitabineCapecitabineCabozantinibPembrolizumabImmune checkpoint inhibitorsSmall-molecule kinase inhibitors
99
All comersTrialsRelacorilant with checkpoint inhibition for cortisol-secreting tumours; cabozantinib with immunotherapy; radiolabelled CYP11B tracers.
RelacorilantCabozantinibPembrolizumab
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.