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Adrenal Cortical Carcinoma: Mitotane and Beyond

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Adrenal Disorders

Part of the book series: Contemporary Endocrinology ((COE))

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Abstract

Adrenocortical carcinoma (ACC) is an aggressive tumor with a short life expectancy and severe impact on quality of life. Due to the rarity of ACC, progress in the development of treatment options beyond surgery has been limited.

Postoperative treatment with mitotane for adjuvant purposes is currently recommended in many expert centers for patients at elevated risk of recurrence. Lacking data from prospective trials, evidence in favor of adjuvant mitotane comes from retrospective studies that have shown a benefit in recurrence-free survival in treated patients. The management of patients with recurrent and metastatic disease is challenging, and the prognosis is often poor. Mitotane monotherapy may be used in patients with a low tumor burden and/or less aggressive disease, while cytotoxic chemotherapy is the treatment of choice for progressing tumors. No effective target therapy emerged from preclinical studies.

At our center, we recommend adjuvant mitotane treatment in all patients bearing ACC at high risk of recurrence. Patients with low-risk tumors are encouraged to enter the ADIUVO trial. We use a monitored mitotane approach trying to reach and maintain a mitotane level of 14–20 mg/L. For treatment of advanced ACC, we stratify patients according to their prognostic factors and consequently apply mitotane or mitotane plus EDP. In a number of patients, who are elderly or present with impaired clinical conditions, we choose a simplified scheme with mitotane and cisplatin.

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Authors and Affiliations

  1. Division of Internal Medicine 1, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, Orbassano, 10043, Torino, Italy

    Silvia De Francia Ph.D., Paola Perotti Ph.D., Vittoria Basile M.D., Antonina Germano Ph.D. & Massimo Terzolo M.D.

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  1. Silvia De Francia Ph.D.
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  2. Paola Perotti Ph.D.
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  3. Vittoria Basile M.D.
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  4. Antonina Germano Ph.D.
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  5. Massimo Terzolo M.D.
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Correspondence to Massimo Terzolo M.D. .

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  1. Div of Endocrinology and Bone Diseases, Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Alice C. Levine

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De Francia, S., Perotti, P., Basile, V., Germano, A., Terzolo, M. (2018). Adrenal Cortical Carcinoma: Mitotane and Beyond. In: Levine, A. (eds) Adrenal Disorders. Contemporary Endocrinology. Humana Press, Cham. https://doi.org/10.1007/978-3-319-62470-9_13

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