Endocrine Journal
Online ISSN : 1348-4540
Print ISSN : 0918-8959
ISSN-L : 0918-8959
ORIGINAL
Japanese single-institution analysis of mitotane for patients with adrenocortical carcinoma
Akihiro Ohmoto, Yasuyuki Shigematsu, Naoki Fukuda, Xiaofei Wang, Tetsuya Urasaki, Naomi Hayashi, Yasuyoshi Sato, Kenji Nakano, Mayu Yunokawa, Makiko Ono, Yoshinobu Komai, Noboru Numao, Takeshi Yuasa, Junji Yonese, Junichi Tomomatsu, Kentaro Inamura, Shunji Takahashi
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Keywords: Adrenocortical carcinoma, Chemotherapy, Mitotane, Japanese cohort
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2021 Volume 68 Issue 12 Pages 1383-1390

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Abstract

Adrenocortical carcinoma (ACC) is a rare malignancy with a poor prognosis. While mitotane is the only agent approved for ACC, clinical data are scarce, especially in the Asian population. We reviewed 10 patients with ACC who received mitotane as a single agent or in combination with other agents in our institution. Patient characteristics, clinical outcomes, and toxicities were analyzed. Mitotane was administered to 2 patients as an adjuvant therapy and to 8 patients for systemic control. In the latter 8 patients, 1 patient had locally advanced disease and 1 had metastatic disease at the time of initial diagnosis, whereas the other 6 patients experienced metastatic relapse at mitotane initiation. The administered regimen was mitotane alone in 7 patients, and mitotane plus cytotoxic chemotherapy in 3 patients. The initial daily mitotane dose was 3.0 g in 2 patients, 1.5 g in 7 patients, and 1.0 g in 1 patient. The median duration of treatment was 3.7 (range, 0.7–22.1) months. In 8 systemic cases, the median overall survival from chemotherapy initiation was 7.2 months, and only 1 patient survived over 1 year. The median interval from mitotane termination to death in systemic cases was 2.8 months, and the cause was progressive disease in 4 patients and toxicity (hallucination, mycobacteriosis, or liver injury) in 3 patients. As a second-line regimen, 2 systemic cases and 1 adjuvant case were enrolled in clinical trials. Our analysis exhibited extremely poor prognosis under mitotane-based regimens, and further treatment strategies are warranted to improve outcomes.

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