A Study of Combination Chemotherapy and Surgical Resection in the Treatment of Adrenocortical Carcinoma: Continuous Infusion Doxorubicin, Vincristine and Etoposide With Daily Mitotane Before and After Surgical Resection

Biopsy-proven primary or recurrent adrenocortical carcinoma considered surgically resectable at presentation or potentially resectable following an initial response to chemotherapy. Potentially resectable disease includes primary lesion, nodal metastases, and liver and lung metastases if limited in size and number. Patients for whom surgical resection is considered unlikely may be entered at the discretion of the investigator. Measurable disease at presentation required. A life expectancy of at least 3 months and a performance status (Karnofsky scale) of 70 percent or greater. Prior chemotherapy is allowed, however, the patient should not have received chemotherapy four weeks before presentation. Patients who have received prior doxorubicin may be enrolled provided they meet all other entry criteria and have an ejection fraction greater than 40 percent determined by MUGA scan. Prior mitotane therapy is allowed. A dose of 3 gm/day should have been tolerated for at least one week. Patients do not need to be off mitotane therapy prior to starting this protocol. WBC greater 3,000/mm(3); Platelet count greater than 100,000/mm(3); Creatinine clearance greater than 50 ml/min; bilirubin less than 1.5 mg/dl; serum transaminase less than 2 times normal. Patient should be a good surgical candidate. Must sign an informed consent and be geographically accessible to return for follow up treatment. No presence of a second malignancy, other than squamous cell carcinoma of the skin. No active systemic infection. Must not be currently receiving treatment which cannot be discontinued with the following agents: diltiazem, nicardipine, phenothiazines, phenytoin, terfenadine or verapamil. No positive serology for HIV. No positive pregnancy test.