Difference between revisions of "Adrenocortical Carcinoma"

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(Adrenal gland tumors, adrenocortical carcinoma - adjuvant therapy)
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===Regimen #1, Wängberg et al. 2010===
 
===Regimen #1, Wängberg et al. 2010===
Level of Evidence:
 
<span
 
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border-style:solid;">Phase II</span>
 
 
 
''Patients started on adjuvant mitotane within 4 weeks of their surgical resection.''
 
''Patients started on adjuvant mitotane within 4 weeks of their surgical resection.''
 
*[[Mitotane (Lysodren)]] 2000 mg PO per day (frequency not specified, such as whether the total daily dose was divided into a few doses throughout the day); within the first 2 to 3 months, [[Mitotane (Lysodren)]] dose was adjusted to achieve a target therapeutic drug level of 14 to 20 mg/L
 
*[[Mitotane (Lysodren)]] 2000 mg PO per day (frequency not specified, such as whether the total daily dose was divided into a few doses throughout the day); within the first 2 to 3 months, [[Mitotane (Lysodren)]] dose was adjusted to achieve a target therapeutic drug level of 14 to 20 mg/L
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===Regimen #2, Haak et al. 1994===
 
===Regimen #2, Haak et al. 1994===
Level of Evidence:
 
<span
 
style="background:#EEEE00;
 
padding:3px 6px 3px 6px;
 
border-color:black;
 
border-width:2px;
 
border-style:solid;">Phase II</span>
 
  
 
''Haak et al. 1994 concluded that "mitotane treatment in adrenocortical carcinoma is effective only when high
 
''Haak et al. 1994 concluded that "mitotane treatment in adrenocortical carcinoma is effective only when high
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*Hydrocortisone (Cortef) 30 to 120 mg per day or Fludrocortisone (Florinef) 0.1 to 0.4 mg per day
 
*Hydrocortisone (Cortef) 30 to 120 mg per day or Fludrocortisone (Florinef) 0.1 to 0.4 mg per day
 
*Metoclopramide (Reglan) and Loperamide (Imodium) prn "gastrointestinal side-effects"
 
*Metoclopramide (Reglan) and Loperamide (Imodium) prn "gastrointestinal side-effects"
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===References===
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# Vassilopoulou-Sellin R, Guinee VF, Klein MJ, Taylor SH, Hess KR, Schultz PN, Samaan NA. Impact of adjuvant mitotane on the clinical course of patients with adrenocortical cancer. Cancer. 1993 May 15;71(10):3119-23. [http://onlinelibrary.wiley.com/doi/10.1002/1097-0142%2819930515%2971:10%3C3119::AID-CNCR2820711037%3E3.0.CO;2-8/abstract link to original article] [http://www.ncbi.nlm.nih.gov/pubmed/8490842 PubMed]

Revision as of 03:01, 30 October 2013

Adrenal gland tumors, adrenocortical carcinoma - adjuvant therapy

Mitotane (Lysodren)

There is limited and controversial clinical trial information about adjuvant mitotane use. See the references for additional case series and expert recommendation articles.

Regimen #1, Wängberg et al. 2010

Patients started on adjuvant mitotane within 4 weeks of their surgical resection.

  • Mitotane (Lysodren) 2000 mg PO per day (frequency not specified, such as whether the total daily dose was divided into a few doses throughout the day); within the first 2 to 3 months, Mitotane (Lysodren) dose was adjusted to achieve a target therapeutic drug level of 14 to 20 mg/L

2 to 3-year course

Regimen #2, Haak et al. 1994

Haak et al. 1994 concluded that "mitotane treatment in adrenocortical carcinoma is effective only when high serum levels [trough of at least 14 mg/L] can be achieved."

  • Mitotane (Lysodren) 1000 to 2000 mg PO QID (total dose per day: 4000 to 8000 mg), with target mitotane trough of above 14 mg/L

2-year course "if resection was judged to be complete or for 1 year after apparent disappearance of the tumour"

Supportive medications:

  • Hydrocortisone (Cortef) 30 to 120 mg per day or Fludrocortisone (Florinef) 0.1 to 0.4 mg per day
  • Metoclopramide (Reglan) and Loperamide (Imodium) prn "gastrointestinal side-effects"

References

  1. Vassilopoulou-Sellin R, Guinee VF, Klein MJ, Taylor SH, Hess KR, Schultz PN, Samaan NA. Impact of adjuvant mitotane on the clinical course of patients with adrenocortical cancer. Cancer. 1993 May 15;71(10):3119-23. link to original article PubMed