Gossypol Acetic Acid in Treating Patients With Recurrent, Metastatic, or Primary Adrenocortical Cancer That Cannot Be Removed By Surgery

Inclusion Criteria:

* Histologically or cytologically confirmed adrenocortical carcinoma

  * Recurrent, metastatic, or primary unresectable disease
* Measurable disease, defined as ≥ 1 lesion accurately measured in ≥ 1 dimension as ≥ 2.0 cm by conventional techniques or ≥ 1.0 cm by spiral CT scan
* No adrenocortical tumors that, in the Principal Investigator's opinion, are potentially resectable by surgical excision alone
* No symptomatic or progressive brain metastases

  * Patients with treated brain metastases ≥ 6 months prior to study who are clinically and radiographically stable or improved and are off steroids are eligible
  * Must undergo an MRI of the brain or CT scan of the head with contrast ≤ 4 weeks prior to study
* Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2 or Karnofsky PS 60-100%
* Life expectancy ≥ 12 weeks
* White blood cell count (WBC) ≥ 3,000/mm3
* Absolute neutrophil count (ANC) ≥ 1,500/mm3
* Platelet count ≥ 100,000/mm3
* Total bilirubin \< 1.5 mg/dL
* Aspartate aminotransferase (AST) and Alanine aminotransferase (ALT) ≤ 2.5 times upper limit of normal
* Serum creatinine ≤ 1.7 mg/dL or creatinine clearance ≥ 40 mL/min
* Able to take oral medications on a regular basis
* Not pregnant or nursing
* Negative pregnancy test
* Fertile patients must use effective contraception prior to, during, and for ≥ 1 month after completion of study treatment
* No HIV positivity
* No uncontrolled intercurrent illness including, but not limited to, any of the following:

  * Ongoing or active infection
  * Symptomatic congestive heart failure
  * Unstable angina pectoris
  * Cardiac arrhythmia
  * Psychiatric illness or social situation that would limit compliance with study requirements
* No condition or disease that significantly affects gastrointestinal (GI) function or impairs the ability to swallow and retain oral medications including, but not limited to, any of the following:

  * GI tract disease or a requirement for IV alimentation
  * Prior resection of the stomach or small bowel or surgical procedures affecting absorption
  * Active peptic ulcer disease
  * Malabsorption syndrome
  * Ulcerative colitis
  * Inflammatory bowel disease
  * Partial or complete small bowel obstruction
* No other malignancy within the past 2 years except nonmelanoma skin cancer or in situ cervical cancer
* No symptomatic hypercalcemia \> grade 2
* No history of allergic reactions attributed to compounds of similar chemical or biological composition to R-(-)-gossypol acetic acid
* Fully recovered from prior surgical procedures and recovered to ≤ grade 1 from adverse events due to previous treatments
* No prior racemic gossypol or R-(-)-gossypol acetic acid
* More than 4 weeks since prior chemotherapy, biologic therapy, major surgery, or radiotherapy (≥ 6 weeks for carmustine or mitomycin C)
* Prior and concurrent mitotane and ketoconazole allowed for patients with hormonal excess
* More than 4 weeks since prior and no concurrent treatment with another investigational agent
* No concurrent prophylactic use of hematopoietic growth factors (e.g., filgrastim \[G-CSF\], sargramostim \[GM-CSF\], interleukin-11) during the first course of study treatment
* Not requiring routine use of platelet transfusions to maintain ANC or platelet count above required thresholds

Exclusion Criteria:

* No concurrent combination antiretroviral therapy for HIV-positive patients