ECE2019 Poster Presentations Adrenal and Neuroendocrine Tumours 1 (60 abstracts)
Management of mitotane for advanced adrenocortical carcinoma: a survey in Italy
Soraya Puglisi 1 , Laura Saba 1 , Paola Perotti 1 , Anna Calabrese 1 , Vittoria Basile 1 , Giorgio Arnaldi 2 , Salvatore Cannavò 3 , Antonio Stigliano 4 , Letizia Canu 5 , Paola Loli 6 , Rosario Pivonello 7 , Pasqualino Malandrino 8 , Giuseppe Badalamenti 9 , Massimo Torlontano 10 , Silvia Della Casa 11 , Carla Scaroni 12 & Massimo Terzolo 1
1Internal Medicine, Department of Clinical and Biological Sciences, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Italy; 2Division of Endocrinology, Department of Clinical and Molecular Sciences (DISCLIMO), Polytechnic University of Marche, Ancona, Italy; 3Department of Human Pathology of Adulthood and Childhood ‘G. Barresi’, University of Messina, Messina, Italy; 4Endocrinology, Department of Clinical and Molecular Medicine, Sant’Andrea Hospital, Sapienza University of Rome, Rome, Italy; 5Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; 6Endocrinology, Hospital Niguarda Ca’ Granda, Milan, Italy; 7Endocrinology Unit, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy; 8Endocrinology Division, Department of Clinical and Experimental Medicine, ARNAS Garibaldi, University of Catania, Catania, Italy; 9Department of Oncology, University-Hospital ‘Paolo Giaccone’, University of Palermo, Palermo, Italy; 10Endocrinology Unit, Hospital ‘Casa Sollievo della Sofferenza’, IRCCS, San Giovanni Rotondo, Italy; 11Division of Endocrinology and Metabolic Diseases, University-Hospital Gemelli, IRCSS, Catholic University of the Sacred Heart, Rome, Italy; 12Endocrinology Unit, Department of Medicine DIMED, University-Hospital of Padua, Padua, Italy.
Background and objective: Mitotane is the main option of treatment for advanced adrenocortical carcinoma (ACC). However, limited evidence is available regarding practical management of mitotane treatment and its eventual combination with chemotherapy or radiotherapy. The aim of the study is to do a survey on the use of mitotane for advanced ACC in expert Italian centers, analyzing data of the LYSOSAFE database.
Methods: Retrospective analysis of patients with advanced ACC treated with mitotane for ≥3 months and with at least 2 measurements of plasma mitotane levels during follow-up reported in the LYSOSAFE database. Data are expressed as median and interquartile ranges.
Results: We identified 90 patients (F/M=61/29, age 50, 36–59 years). One group of 29 patients have been previously treated with adjuvant mitotane, while 61 patients started de novo palliative mitotane. Median duration of palliative treatment was 28 months (14–47) with a median dose of 2.5 g/day (2.0–3.0). Achievement of mitotane levels >14 mg/l required 7 months (3–11) from the start of therapy, considering that only 2 patients had values in range during adjuvant therapy. The palliative treatment was discontinued in 64 patients, of which 50 for death and 9 for ACC progression, without any discontinuation for toxicity. A group of 21 patients received only mitotane, while 69 patients were treated with a combination of mitotane and other treatments (22 patients underwent 1 chemotherapy treatment, 21 patients 2 chemotherapy treatments and 26 patients >3 radiotherapy and/or chemotherapy treatments). The most common drug used in combination with mitotane was cisplatin (61/69 patients). Twenty-one patients had no mitotane level >14 mg/l, while the remaining 69 had mitotane in range in 35% (25–50%) of the measurements, and 18 patients had more than 50% of mitotane levels in range. At the end of the follow-up (39, 24–65 months), 59/90 patients were dead.
Conclusions: In Italy, mitotane therapy of advanced ACC is usually done in combination with chemotherapy. However, toxicity of the treatment remains acceptable, and most patients are able to achieve the therapeutic range, although with significant fluctuations of mitotane levels during follow-up. Mitotane is often continued as background treatment in addition to different chemotherapy regimens for quite a long period of time.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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