Sustained Remission with the Kinase Inhibitor Sorafenib in Stage IV Metastatic Adrenocortical Carcinoma

ObjectiveTo report our experience using kinase in- hibition therapy with sorafenib in a patient with advanced adrenocortical carcinoma.MethodsWe describe the clinical,laboratory, and ra- diologic findings of the study patient and discuss the clini- cal course with sorafenib therapy.ResultsA 56-year-old woman presented with rapid development of virilization, cushingoid features, hyper- tension, weight gain, and abdominal distension. An 8-cm left adrenal lesion was found on computed tomography, re- moved 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 regres- sion and eventual resolution of bilateral metastatic lung lesions, reduction in size of the hepatic lesion, normaliza- tion of androgen hypersecretion, and marked clinical im- provement. The radiologic and biochemical remission on sorafenib has continued for 28 months.ConclusionMultiple kinase inhibitors such as sorafenib provide targeted oncologic treatment and may be effective in treating advanced adrenal cancer. (Endocr Pract. 2010;16:441-445)