Mitotane levels predict the outcome of patients with adrenocortical carcinoma treated adjuvantly following radical resection
Open accessAbstract
CONTEXT: Mitotane plasma concentrations ≥ 14 mg/l have been shown to predict tumor response and better survival in patients with advanced adrenocortical carcinoma (ACC). A correlation between mitotane concentrations and patient outcome has not been demonstrated in an adjuvant setting. OBJECTIVE: To compare recurrence-free survival (RFS) in patients who reached and maintained mitotane concentrations ≥ 1 4 mg/l vs patients who did not. DESIGN AND SETTING: Retrospective analysis at six referral European centers. PATIENTS: Patients with ACC who were radically resected between 1995 and 2009 and were treated adjuvantly with mitotane targeting concentrations of 14-20 mg/l. MAIN OUTCOME MEASURES: RFS (primary) and overall survival (secondary). RESULTS: Of the 122 patients included, 63 patients (52%) reached and maintained during a median follow-up of 36 months the target mitotane concentrations (group 1) and 59 patients (48%) did not (group 2). ACC recurrence was observed in 22 patients of group 1 (35%) and 36 patients in group 2 (61%). In multivariable analysis, the maintenance of target mitotane concentrations was associated with a significantly prolonged RFS (hazard ratio (HR) of recurrence: 0.418, 0.22-0.79; P=0.007), while the risk of death was not significantly altered (HR: 0.59, 0.26-1.34; P=0.20). Grades 3-4 toxicity was observed in 11 patients (9%) and was managed with temporary mitotane discontinuation. None of the patients discontinued mitotane definitively for toxicity. CONCLUSIONS: Mitotane concentrations ≥ 14 mg/l predict response to adjuvant treatment being associated with a prolonged RFS. A monitored adjuvant mitotane treatment may benefit patients after radical removal of ACC.
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The most important prognostic factor for mitotane therapy is the mitotane plasma level.
“The most important prognostic factor is the mitotane plasma level (295).”
From Adrenocortical carcinoma (2014) · cites this paper as [295]
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Self-citation
- Authors
- Terzolo, M., Baudin, A. E., Ardito, A., Kroiss, M., Leboulleux, S., Daffara, F., Perotti, P., Feelders, R. A., deVries, J. H., Zaggia, B., De Francia, S., Volante, M., Haak, H. R., Allolio, B., Al Ghuzlan, A., Fassnacht, M., & Berruti, A.
- Affiliations
- Ospedale San Luigi Gonzaga (IT)
- Universitätsklinikum Würzburg (DE)
- Erasmus MC (NL)
- Amsterdam UMC Location University of Amsterdam (NL)
- Máxima Medisch Centrum (NL)
- Corresponding author
- Ardito, A
- ORCID
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-09
- Volume
- 169
- Issue
- 3
- Pages
- 263-270
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- OpenAlex
- W2142931016
- Cited by
- 134
- References
- 31
- Citations by year
- 2026: 5 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 11 · 2021: 13 · 2020: 13 · 2019: 19 · 2018: 8 · 2017: 11 · 2016: 8 · 2015: 17 · 2014: 11 · 2013: 3
- FWCI
- 12.75
- Type
- journal article
- Language
- en
- Open access
- green
- hdl.handle.net
- Licence
- other-oa
- Locations
- European Journal of Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion)
- Institutional Research Information System (Università degli Studi di Brescia) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- Deutsche Krebshilfe
- Regione Piemonte
- Topics
- Health Sciences › Medicine › Surgery › Adrenal and Paraganglionic Tumors
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Renal cell carcinoma treatment
- Keywords
- adrenocortical carcinoma, mitotane, plasma drug concentration, adjuvant therapy, recurrence-free survival, overall survival, treatment response prediction, drug toxicity
- MeSH terms
- Adolescent, Adrenal Cortex, Adrenal Cortex Neoplasms, Adult, Aged, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mitotane, Neoplasm Recurrence, Local, Neoplasm Staging, Retrospective Studies, Survival Analysis, Drug Monitoring, Chemotherapy, Adjuvant, Adrenocortical Carcinoma, Antineoplastic Agents, Hormonal, Young Adult
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