What Is the Optimal Duration of Adjuvant Mitotane Therapy in Adrenocortical Carcinoma? An Unanswered Question

Abstract

A relevant issue on the treatment of adrenocortical carcinoma (ACC) concerns the optimal duration of adjuvant mitotane treatment. We tried to address this question, assessing whether a correlation exists between the duration of adjuvant mitotane treatment and recurrence-free survival (RFS) of patients with ACC. We conducted a multicenter retrospective analysis on 154 ACC patients treated for ≥12 months with adjuvant mitotane after radical surgery and who were free of disease at the mitotane stop. During a median follow-up of 38 months, 19 patients (12.3%) experienced recurrence. We calculated the RFS after mitotane (RFSAM), from the landmark time-point of mitotane discontinuation, to overcome immortal time bias. We found a wide variability in the duration of adjuvant mitotane treatment among different centers and also among patients cared for at the same center, reflecting heterogeneous practice. We did not find any survival advantage in patients treated for longer than 24 months. Moreover, the relationship between treatment duration and the frequency of ACC recurrence was not linear after stratifying our patients in tertiles of length of adjuvant treatment. In conclusion, the present findings do not support the concept that extending adjuvant mitotane treatment over two years is beneficial for ACC patients with low to moderate risk of recurrence.

The Overall Survival and Progression-Free Survival in Patients with Advanced Adrenocortical Cancer Is Increased after the Multidisciplinary Team Evaluation

“…Moreover, they explained the significant difference in OS rates due to the multidisciplinary structure of tertiary centers as compared to the individual hospital’s case volume. The finding of the greater survival benefit after 2010 was thought to be secondary to the emerging research on the use of mitotane [ 25 ], especially in the adjuvant setting [ 26 ], and the corresponding increase in the use of adjuvant systemic therapies.…”

Management of Patients With Glucocorticoid-Related Diseases and COVID-19

“…Another important factor that might increase the risk of contracting SARS-CoV-2 in ACC patients is mitotane ( Figure 3 ), which is usually used over long periods of time in ACC patients ( 144 ). In fact, all reported ACC cases were receiving mitotane when they tested positive for SARS-CoV-2 ( 126 ).…”

Special Issue: Present and Future of Personalised Medicine for Endocrine Cancers

“…The aim of this Special Issue entitled “Present and Future of Personalised Medicine for Endocrine Cancers” was to offer an overview of exciting new research in the area of endocrine tumours that may set the stage for an innovative personalised management and future precision medicine modalities for individualised care. This issue encompasses nine publications on basic, translational and clinical research in different types of endocrine malignancies, including thyroid cancer [ 8 , 9 , 10 , 11 ], adrenocortical neoplasms [ 12 , 13 , 14 ], pheochromocytoma/paraganglioma [ 15 ] and pituitary tumours [ 16 ].…”

“…From a different point of view, Koot and team underlined the importance of considering patients’ needs, preferences and values in enabling us to improve doctor–patient communication and to develop decision support tools in DTC [ 8 ]. Basile et al performed a multicentre retrospective analysis on ACC patients treated with adjuvant mitotane, showing that extending the duration of the treatment over two years is not beneficial for patients with low to moderate risk of recurrence [ 13 ]. Finally, Duhamel and colleagues reported two case reports and a review of the literature on the efficacy of immunotherapy in aggressive pituitary tumours [ 16 ].…”