MKI67 and adrenal cortex carcinoma: For patients with very high-risk diseases, including those with Ki-67 staining ≥20%, extensive vascular invasion, or vena cava thrombus, the authors discuss and often favor off-label platinum-based chemotherapy in addition to adjuvant mitotane, although the benefits of chemotherapy in this setting have yet to be demonstrated.8 This will be answered in the ongoing Adiuvo-2 trial (NCT03583710), a phase III trial of mitotane with or without cisplatin and etoposide after surgical resections in patients with high-risk ACC.