o,p'-DDD (mitotane) therapy of adrenal cortical carcinoma: observations on drug dosage, toxicity, and steroid replacement.
Four patients with adrenal cortical carcinoma were treated with standard doses of o,p'-DDD. Plasma levels of o,p'-DDD and its metabolites o,p'-DDA and o,p'-DDE were measured. o,p'-DDD was measurable for up to 8 months after stopping therapy, and trace levels of metabolites were detectable at 18 months. Although 2 of 3 patients with measurable disease had objective tumor response and one patient achieved a complete response, severe drug toxicity occurred in all patients and signs of adrenal insufficiency occurred in three. Low dose therapy with o,p'-DDD is suggested, together with full gluco and mineralocorticoid replacement. Measurement of o,p'-DDD and its metabolites in plasma may prove clinically useful in developing effective but less toxic dosage schedules.
D000306:Adrenal Cortex Neoplasms / Q000097:blood / Q000188:drug therapy*; D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008901:Mineralocorticoids / Q000008:administration & dosage*; D008939:Mitotane / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D012075:Remission, Spontaneous; D012894:Sleep Stages / Q000187:drug effects; D014839:Vomiting / Q000139:chemically induced
D005938:Glucocorticoids; D008901:Mineralocorticoids; D008939:Mitotane