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Is There a Role for Low Doses of Mitotane (o,p',DDD) as Adjuvant Therapy in Adrenocortical Carcinoma?—Authors’ Response

Bnai Zion Medical Center Haifa, 31048, Israel

We thank Drs. Barzon et al. for their letter (above) with regard to our above mentioned paper (1). This allows us to reemphasis the main point in our study, which was probably not clear enough. The most important issue we see in the adjuvant treatment with mitotane in adrenocortical carcinoma is the low dose of 1.5–2.0 g. This dose is well tolerated by our patients, who conduct normal life style, including vacations abroad. It is therefore not relevant to speak about "side-effects of mitotane, which significantly worsen quality of life of patients" with regard to our patients. Barzon’s group used 4.0–8.0 g mitotane, which cannot be considered a low dose and indeed causes severe side effects. Surprisingly as it might seem, we think that the therapeutic effect of low doses might be better than that of high doses. This because of a much higher compliance in taking the low dose treatment regularly. Because of the severe side effects, we find it hard to believe that patients continue taking 8.0 g mitotane regularly for years and a treatment not taken regularly is probably less effective than one taken constantly, though in a lower dose. Even so, we tend to disagree with Barzon’s et al. conclusion of the ineffectiveness of treatment in their group. Although they show (in Fig. 1 of their letter) that recurrence of disease was not effected by high-dose mitotane treatment, survival rate was 73% (8 out of 11) in the treatment group and only 47% (7 out of 15) in the no-treatment group. How can these data not show a beneficial effect of treatment?

Since sending our paper, we have had two more patients with adrenocortical carcinoma (17 cm, 1500 g, and 12 cm, 760 g) on the same mode of mitotane treatment for about one year now. All patients are doing well.

In conclusion, we agree that our patient group is small. We are sure that this mode of treatment will not prove to be 100% successful. However, we are also sure that low-dose mitotane treatment in adrenocortical carcinoma is beneficial and well tolerated by patients, without significant side effects, and without any complications.

Footnotes

Address correspondence to: Gabriel Dickstein, M.D., Division of Endocrinology, Bnai Zion Medical Center, Haila, 31048 Israel.

Received January 11, 1999.

References

1. Dickstein G, Shechner C, Arad E, Best L-A, Nativ O. 1998 Is there a role for low doses of mitotane (o,p’-DDD) as adjuvant therapy in adrenocortical carcinoma? J Clin Endocrinol Metab. 83:3100–3103.[Abstract/Free Full Text]

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