Nebennierenrinde und Glucocorticoide

Allolio, Bruno; Arlt, Wiebke; Bornstein, S. R.; Reincke, Martín

doi:10.1007/978-3-642-56784-1_3

Cited by 1 publication

(1 citation statement)

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“…Suramin is an antitrypanosomal agent that accumulates in the primate adrenal cortex. In vitro the drug induces cytotoxic effects and down-regulates steroid production [46][47][48]. In pilot studies one patient was subject to the most dreaded side effect, acute demyelinating neuropathy, and another died of thrombocytopenic hemorrhage.…”

Section: Single-agent Chemotherapymentioning

confidence: 99%

Cytotoxic treatment of adrenocortical carcinoma

et al. 2001

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Adrenocortical carcinoma (ACC) is a rare, aggressive tumor that is often detected in an advanced stage. Medical treatment with the adrenotoxic drug mitotane has been used for decades, but critical prospective trials on its role in residual disease or as an adjuvant agent after surgical resection are still lacking. The concept of a critical threshold plasma level of the drug must be confirmed in controlled studies. Because individual responsiveness cannot be predicted, the use mitotane is still advised for nonresectable disease. In case of cortisol or other steroid overproduction, several drugs (e.g., ketoconazole or aminoglutethimide) may be used. Chemotherapy with single agents (e.g., doxorubicin or cisplatin) have been disappointing, with low response rates (< 30%) and a short response duration. Part of this refractoriness may be explained by the fact that ACC tumors express the multidrug-resistance gene MDR-1. Chemotherapy with multiple agents has been tested in smaller series and has resulted in significant side effects. The best results were achieved by the combination of etoposide, doxorubicin, and cisplatin associated with mitotane, achieving a response rate of 54%, including individual complete responses. To be able to make progress in treating advanced ACC disease, adjuvant multicenter trials must be encouraged. When mitotane-based therapies are used, monitored drug levels are mandatory.

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Section: Single-agent Chemotherapymentioning

confidence: 99%