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The results of five clinical trials using different ICIs are heterogeneous and overall disappointing with objective response in only 17 (14%) of 121 treated patients ( The tumour microenvironment of ACC has been reported to be depleted of T lymphocytes giving rise to the notion of ACC as an immunologically “cold” tumour entity ( Recently, our group has used clinical data of steroid hormone secretion together with IHC for T cell markers in 146 ACC tumours and found an immunosuppressive effect of clinical GC excess on T cell infiltration ( The Wnt/β-catenin pathway has been suggested as an additional cause for an immunologically silent tumour microenvironment in several types of cancer ( CTNNB1 itself or by mutations in the upstream pathway gene ZNRF3 ( Established roles of canonical Wnt/β-catenin signalling include proliferation, apoptosis, migration and tissue homeostasis ( Figure 1