etoposide + doxorubicin + cisplatin + mitotane + megestrol acetate

This is a combination chemotherapy regimen used primarily for the treatment of advanced adrenocortical carcinoma (ACC). It consists of the standard EDP-M regimen (etoposide, doxorubicin, cisplatin, and mitotane) with the addition of megestrol acetate, a synthetic progestin. The standard dosing includes etoposide 100 mg/m² on days 2-4, doxorubicin 40 mg/m² on day 1, cisplatin 40 mg/m² on days 3-4, mitotane (continuous administration), and megestrol acetate 320 mg daily. Progestins like megestrol acetate have shown cytotoxic activity both in vitro and in vivo on ACC cells, and the addition to the standard EDP-M regimen was hypothesized to improve tolerability and efficacy.