SUSTAINED REMISSION WITH THE KINASE INHIBITOR SORAFENIB IN STAGE IV METASTATIC ADRENOCORTICAL CARCINOMA

Objective: To report our experience using kinase inhibition therapy with sorafenib in a patient with advanced adrenocortical carcinoma. Methods: We describe the clinical, laboratory, and radiologic findings of the study patient and discuss the clinical course with sorafenib therapy. Results: A 56-year-old woman presented with rapid development of virilization, cushingoid features, hypertension, weight gain, and abdominal distension. An 8-cm left adrenal lesion was found on computed tomography, removed surgically, and confirmed as adrenal carcinoma on pathologic examination. Postoperative scanning revealed metastases to both lungs and the liver that were confirmed by fine-needle biopsy, thus establishing stage IV disease. Treatment with the adrenolytic agent mitotane failed to halt disease progression. A trial of sorafenib resulted in regression and eventual resolution of bilateral metastatic lung lesions, reduction in size of the hepatic lesion, normalization of androgen hypersecretion, and marked clinical improvement. The radiologic and biochemical remission on sorafenib has continued for 28 months. Conclusion: Multiple kinase inhibitors such as sorafenib provide targeted oncologic treatment and may be effective in treating advanced adrenal cancer. (Endocr Pract. 2010;16:441-445)