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Mitotane

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Abstract: Mitotane use in inoperable adrenal cortical carcinoma

Mitotane (1-10 g/d) was admin to 115 patients (35 men, 65 women; 89/115 in 41-60 yr age range, and 15/115 <21 yr old, 5 boys, 10 girls) with inoperable adrenal cortical carcinoma. Beginning treatment dose was 1-6 g/d in 80% of patients; max dose was 5-10 g/d for 72%, and maintenance dosages ranged from 0.5-20 g/d. Duration of therapy ranged from 21 d to 36 mo. (mean 7 mo), with regression of tumor, absence of clinical benefit, and adverse reaction being primary reasons for discontinuing mitotane. Decreased steroid excretion >30% was seen in 52/61 patients with elevated pretreatment urinary steroid excretion levels. Tumor regression in 46/75 patients occurred 10 d to 19 mo. (mean 4 wk) after start of therapy, with 34/36 patients showing tumor regression also showing a steroid response. Mean duration of tumor regression was 6 mo and mean patient survival was 8.4 mo. (range 21 d to 41.3 mo). A definite clinical response occurred in 54%, questionable response in 5%, and no response in 41%. Toxic reactions seen in 91/109 patients were: gastrointestinal, neuromyal, dermal, and leukopenia (4/109). On autopsy, the tumor-free adrenal gland was atrophied in 15/21 cases.

References

Lubitz JA, Freeman L, Okun R. Mitotane use in inoperable adrenal cortical carcinoma. JAMA; 223(10):1109-1112 1973.

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