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Review
. 2024 Sep 6;29(9):747-760.
doi: 10.1093/oncolo/oyae084.

A review of mitotane in the management of adrenocortical cancer

Jaydira Del Rivero  1 , Tobias Else  2 , Julie Hallanger-Johnson  3 , Katja Kiseljak-Vassiliades  4 , Nitya Raj  5 , Diane Reidy-Lagunes  5 , Sandy Srinivas  6 , Jill Gilbert  7 , Anand Vaidya  8 , Emily Aboujaoude  9 , Irina Bancos  10 , Antonio Tito Fojo  11
Affiliations
Review

A review of mitotane in the management of adrenocortical cancer

Jaydira Del Rivero et al. Oncologist. .

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.

Keywords: adrenocortical carcinoma; mitotane; rare tumors.

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Conflict of interest statement

Tobias Else serves on the advisory board for HRA Pharma. Julie Hallanger-Johnson was a consultant for HRA Pharma. Katja Kiseljak-Vassiliades reported a consultant/advisory relationship with HRA Pharma. Nitya Raj reported research funding (to institution) from ITM, Camarus AB, and Corcept Therapeutics; Scientific Advisory Board for Ipsen Pharma, HRA Pharma, Progenics Pharmaceuticals, and AAA; and honoraria from ITM. Jill Gilbert was on the scientific advisory board for HRA Pharma in 2021. Anand Vaidya reported consulting/advisory relationships with HRA Pharma, Corcept, and Mineralys. Irina Bancos reported consulting/advisory relationships with HRA Pharma, Corcept, Recordati, Sparrow, Neurocrine, Adrenas, Spruce, and Diurnal; and research funding from Recordati. All participants in the HRA Pharma Rare Diseases US Adrenocortical Carcinoma Advisory Board received a small honorarium for their time.

Figures

Figure 1.
Figure 1.
Similarities in the molecular structures of DDT, DDD, and Mitotane.
See this image and copyright information in PMC

References

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