Plasma Concentration of o,p'DDD (Mitotane), o,p'DDA and o,p'DDE as Predictors of Tumor Response in Adrenocortical Carcinoma: Results of a Retrospective European Network for the Study of Adrenal Tumors (ENS@T) Multicentre Study.

Combination Chemotherapy in Advanced Adrenocortical Carcinoma

“…Several small studies have suggested that the antineoplastic activity of mitotane monotherapy is increased at blood drug levels of 14 mg per liter or higher. 8,9,24 In our study, only 54 patients had such blood mitotane levels at the time of enrollment, with a similar distribution in the two study groups. Thus, any antitumor activity of mitotane is unlikely to have been a major confounder of the observed first-line efficacy of the EDP-mitotane regimen.…”

Management of adjuvant mitotane therapy following resection of adrenal cancer

“…Mitotane monitoring is a key for an appropriate management of adjuvant treatment giving the possibility to guide dose adjustments and target mitotane concentrations that have been associated with a therapeutic effect. Indeed, plasma mitotane levels >14 mg/l have been found to predict tumor response and improve survival in patients with advanced ACC [15,16,25]. Preliminary results of our group demonstrated that the concept of a relationship between plasma concentrations of mitotane and its efficacy is applicable also to disease-free patients who are treated by means of adjuvant therapy [26].…”

Ribonucleotide Reductase Large Subunit (RRM1) Gene Expression May Predict Efficacy of Adjuvant Mitotane in Adrenocortical Cancer

“…A single study reported that a low immunohistochemical expression of excision repair cross-complementation group 1 (ERCC1) correlated to objective response and OS in ACC patients treated with platinum-based chemotherapy (19). With regard to mitotane treatment, attainment of drug levels in the target range of 14 to 20 mg/L is the only factor predicting efficacy that has been convincingly shown (20)(21)(22).…”