SFEIES24 Poster Presentations Adrenal & Cardiovascular (40 abstracts)
Management and outcomes of patients treated with mitotane for adrenocortical carcinoma in a tertiary adrenal tumour centre in Ireland
Maria Tomkins 1,2 , Merah Al-Busaidy 2 , Darran Mc Donald 1,2 , Julie Martin-Grace 1,2 , Claire Carthy 2 , Amar Agha 2 , Arnold Hill 3 , Neal Dugal 3 , William Robb 3 , Michael W. O’Reilly 1,2 & Mark Sherlock 1,2
1Academic Division of Endocrinology, Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 2Department of Endocrinology, Beaumont Hospital, Dublin, Ireland; 3Department of Surgery, Beaumont Hospital, Dublin, Ireland
Adrenocortical carcinoma (ACC) is a rare aggressive tumour with median overall survival of 3-4years. Mitotane may be recommended for use in ACC in an adjuvant or palliative setting. It requires close clinical surveillance and therapeutic drug monitoring due to adverse effects and toxicity potential. This audit reviewed the management practices in patients with ACC prescribed mitotane therapy from 2010 to 2023 in Beaumont Hospital compared to the 2018 ESE/ENSAT clinical practice guidelines. The cohort consisted of 24 patients (54% female), with a median age at diagnosis of 32years (IQR 33-60) and median follow up 5.5years (IQR 2-8) receiving adjuvant (75%) and palliative (25%) mitotane therapy. Median tumour size at presentation was 10cm (IQR 6.4-17.2). Ki67 index was <10% in 56%, median Weiss score was 5/9 (IQR 4-7). Therapeutic target range mitotane was reached in 88% of patients for a median time of 7months (IQR 2-11), with median duration of therapy 16months (IQR 9-25). Treatment-related adverse events included abnormal thyroid function (83%), nausea (67%), diarrhoea (46%) and dyslipidaemia (92%) with 41% requiring statin therapy. Mitotane was transiently paused during the treatment period in 67% of patients due to adverse effects and discontinued completely in 17% due to hepatotoxicity. Median maximum total daily dose of mitotane was 6 mg (IQR 4.75-6). Median total daily dose of hydrocortisone was 50 mg (IQR 50-60). Of patients who completed mitotane therapy, adrenal function recovered in (n = 7/13) 54% after a median time of 13 months (IQR 11-36). Progressive disease occurred in 5 patients and 5 patients died during follow up. Disease stage at diagnosis was predictive of mortality [ENSAT stage IV HR 41.8 (CI 2.6–4008)]. Recommended standards are being met in the management of ACC with mitotane in Beaumont Hospital. This audit highlights the challenges and need for close monitoring of patients with ACC on mitotane.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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