Adrenocortical Carcinoma

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

Level of Evidence: Phase II

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

Level of Evidence: Phase II

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"