A review of mitotane in the management of adrenocortical cancer

Author:

Del Rivero Jaydira1ORCID,Else Tobias2ORCID,Hallanger-Johnson Julie3ORCID,Kiseljak-Vassiliades Katja4ORCID,Raj Nitya5,Reidy-Lagunes Diane5ORCID,Srinivas Sandy6,Gilbert Jill7,Vaidya Anand8ORCID,Aboujaoude Emily9,Bancos Irina10ORCID,Tito Fojo Antonio11ORCID

Affiliation:

1. Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health , Bethesda, MD 20892 , United States

2. Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School , Ann Arbor, MI 48104 , United States

3. Endocrine Oncology Program, H. Lee Moffitt Cancer Center , Tampa, FL 33612 , United States

4. Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus Aurora , CO 80309 , United States

5. Memorial Sloan Kettering Cancer Center, New York , NY 10065 , United States

6. Stanford University School of Medicine , Stanford, CA 94305 , United States

7. Division of Hematology and Oncology, Vanderbilt University School of Medicine , Nashville, TN 37203 , United States

8. Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School , Boston, MA 02115 , United States

9. Rutgers University , Piscataway, NJ 08854 , United States

10. Division of Endocrinology, Diabetes, Metabolism and Nutrition and Department of Laboratory Medicine and Pathology, Mayo Clinic , Rochester, MN 55905 , United States

11. Columbia University , New York, NY 10027 , United States

Abstract

Abstract Importance Mitotane (Lysodren, o,p'-DDD [1-(o-chlorophenyl)-1-(p-chlorophenyl)-2,2-dichloroethane)] is currently the only United States Food and Drug Administration and European Medicines Agency-approved product for the treatment of adrenocortical carcinoma. Observations Mitotane is challenging to administer; however, its toxicities (specifically adrenal insufficiency) are well known, and the management of adverse consequences has established approaches. While often viewed through the prism of a cytotoxic agent, it can also interfere with hormone production making it a valuable asset in managing functional ACC. A recently completed prospective trial has shed some light on its use in the adjuvant setting, but further clarity is needed. Many think mitotane has a role in the advanced or metastatic setting, although prospective data are lacking and retrospective analyses are often difficult to interpret. Conclusions and relevance When used carefully and thoughtfully, especially in patients with hormonal excess, mitotane is an important component of the treatment armamentarium for ACC.

Publisher

Oxford University Press (OUP)

Reference62 articles.

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5. Severe adrenal cortical atrophy (cytotoxic) and hepatic damage produced in dogs by feeding 2,2-bis(parachlorophenyl)-1,1-dichloroethane (DDD or TDE);Nelson;Arch Pathol (Chic),1949

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