A review of mitotane in the management of adrenocortical cancer.

Katja Kiseljak-Vassiliades, Diane Reidy-Lagunes, Sandy Srinivas, Jaydira Del Rivero, Jill Gilbert, Tobias Else, Anand Vaidya, Irina Bancos, Julie Hallanger-Johnson, Nitya Raj, Emily Aboujaoude, Antonio Tito Fojo

Journal: The oncologist 2024;29(9):747-760

PMID: 39037424

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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.

Published by Oxford University Press 2024. This work is written by (a) US Government employee(s) and is in the public domain in the US.

Address: Developmental Therapeutics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, United States.; Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48104, United States.; Endocrine Oncology Program, H. Lee Moffitt Cancer Center, Tampa, FL 33612, United States.; 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.; Memorial Sloan Kettering Cancer Center, New York, NY 10065, United States.; Stanford University School of Medicine, Stanford, CA 94305, United States.; Division of Hematology and Oncology, Vanderbilt University School of Medicine, Nashville, TN 37203, United States.; Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States.; Rutgers University, Piscataway, NJ 08854, United States.; Division of Endocrinology, Diabetes, Metabolism and Nutrition and Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, United States.; Columbia University, New York, NY 10027, United States.

DOI: 10.1093/oncolo/oyae084

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https://antibodies.cancer.gov/detail/CPTC-KRT5-1

MeSH Terms: Mitotane, Humans, Adrenal Cortex Neoplasms, Adrenocortical Carcinoma, Antineoplastic Agents, Hormonal