Retrospective analysis of BUCEN score prognostic value in Russian population of patients with advanced adrenocortical carcinoma treated with platinum-based chemotherapy in combination with mitotane

Introduction. Currently, the algorithm for selecting first-line treatment for advanced adrenocortical carcinoma (ACC) is not clearly defined; the choice between mitotane monotherapy and its combination with platinum-based chemotherapy remains controversial. In a large retrospective study (n = 439), the BUCEN scoring system was proposed as a predictor of treatment response, which could help determine first-line therapy [9]. Our study aimed to evaluate the prognostic value of the BUCEN scores in the Russian population of patients with advanced ACC, treated with a combination of platinum-based chemotherapy and mitotane.
Materials and Methods. This retrospective single-center study included patients aged ≥ 18 years with advanced ACC and pre-assessed BUCEN scores who received platinum-based chemotherapy in combination with mitotane at the N. N. Blokhin National Medical Research Center of Oncology between 2016 and 2025.
Result. The study included 63 patients with BUCEN scores of 0–2 (n = 31; 49.2 %) and ≥ 3 (n = 32; 50.8 %). Fifty patients (79.4 %) received etoposide + cisplatin + doxorubicin (EDP), 5 patients (7.9 %) received etoposide + cisplatin (EP), and 8 (12.7 %) received etoposide + carboplatin (EC). Therapeutic serum levels of mitotane were achieved in 42 patients (66.7 %). The objective response rate (ORR), disease control rate (DCR) at ≥ 6 months, and DCR at ≥ 12 months were 20.6 %, 62.3 %, and 26.3 %, respectively. A BUCEN score of 0–2 was associated with an improved ORR (p = 0.03), a DCR at ≥ 6 months (p < 0.01), and a DCR at ≥ 12 months (p = 0.03). A multivariate analysis revealed that non-anthracycline regimens in patients with BUCEN ≥ 3 were associated with a statistically significant decrease in progression-free survival (PFS) and overall survival (OS). A statistically significant OS improvement was observed in patients with recurrence-free survival of ≥ 12 months post-adrenalectomy (p = 0.04).
Conclusion. The BUCEN scoring system is reproducible, simple to use, and could be applied for the stratification of patients with advanced ACC. Implementation of this system in clinical practice to pre-select patients for mitotane monotherapy as a first-line treatment requires prospective validation. The significantly poorer outcomes in the EP / EC group may partly reflect patient characteristics, as these regimens were used in those with contraindications to anthracyclines or cisplatin. However, based on our data, we do not recommend non-anthracycline regimens in patients without contraindications to EDP chemotherapy.

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