Recovery of adrenal function after stopping mitotane in patients with adrenocortical carcinoma
Authors' conclusion
Our study demonstrates that adrenal recovery occurs in most patients after stopping mitotane, particularly when followed up in specialized centers, but not in all. Elimination time of mitotane after treatment discontinuation is very long but individually quite variable.
Study context
- Population
- Patients with adrenocortical carcinoma (ACC) adjuvantly treated with mitotane for ≥12 months, disease-free at mitotane stop, minimum follow-up ≥1 year36 women
- Participants
- 56 patients
- Outcome
- Adrenal recovery
Methodological detailsCox regression analyses for predictive factors, Median mitotane treatment 25 months; average daily dose 2.8 g
- Cox regression analyses for predictive factors
- Median mitotane treatment 25 months; average daily dose 2.8 g
Main finding
As reported in the abstract
Full adrenal recovery
32
57%
Median time to adrenal recovery
26 months
95% CI = 19.6–32.4
Adrenal insufficiency persisting >5 years after discontinuation
4 patients
7.1%
Observational data: associations, not effects.
Further findings
Predictors of adrenal recovery
- Mitotane peak ≥ 27 mg/L, longer time to adrenal recovery: HR (95% CI), P
- 0.2 (0.1-0.8), P = .03
- Recovery in reference vs non-reference centers
- 27/38 (71%) vs 5/18 (28%); HR = 4.51 (95% CI = 1.71-11.89), P = .002
- Other investigated factors not associated with adrenal function after discontinuation
Median time after discontinuation until mitotane levels dropped below 5 mg/L, below 2 mg/L and below detection limit
Days
- Below 5 mg/L
- 152 (IQR 114-202)
- Below 2 mg/L
- 280 (192-370)
- Below detection limit
- 395 (227-546)
Original publication
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