Chemotherapy for Adrenal Cancer

Chemotherapy (chemo) is the use of certain types of drugs to treat cancer. Typically, the drugs are given into a vein or by mouth (in pill form). These drugs enter the bloodstream and reach throughout the body, making this treatment useful for cancer that has spread (metastasized) to organs beyond the adrenal gland. Chemo does not work very well for adrenal cancer, so it is most often used for adrenal cancer that has become too widespread to be removed with surgery (although it is very unlikely to cure the cancer).

Mitotane

Mitotane is the drug most often used for people with adrenal cancer. It blocks hormone production by the adrenal gland and also destroys both adrenal cancer cells and healthy adrenal tissue. This drug can also suppress the usual adrenal steroid hormone production from your other, normal adrenal gland. This can lead to low levels of cortisol and other hormones, which can make you feel weak and sick. If this occurs, you'll need to take steroid hormone pills to bring your hormone levels up to normal. Mitotane can also alter levels of other hormones, such as thyroid hormone or testosterone. If that occurs, you'd need drugs to replace these hormones as well.

Sometimes mitotane is given for a period of time after surgery has removed all the (visible) cancer. This is called adjuvant therapy and is meant to kill any cells that were left behind but were too small to see. Giving the drug this way may prevent or delay the cancer's return. .

If the cancer has not been completely removed by surgery or has come back, mitotane will shrink the cancer in some patients. On average, the response lasts about a year, but it can be longer for some patients.

Mitotane is particularly helpful for people with adrenal cancers who have problems caused by excessive hormone production. Even when it doesn't shrink the tumor, mitotane can reduce abnormal hormone production and relieve symptoms. Most patients with excess hormone production are helped by mitotane.

This drug can cause major side effects. The most common are nausea, vomiting, diarrhea, rashes, confusion, and sleepiness. Sometimes lower doses of the drug can still be effective and cause fewer side effects.

This drug is taken as a pill 3 to 4 times a day. Like other types of chemo, treatment with mitotane needs to be supervised closely by a doctor.

Other chemo drugs used for adrenal cancer

Drugs are sometimes combined with mitotane to treat advanced adrenal cancer. The drugs used most often are:

• The combination of cisplatin, doxorubicin (Adriamycin), and etoposide (VP-16) plus mitotane
• Streptozocin plus mitotane

Chemo drugs used less often, include:

• Paclitaxel (Taxol)
• 5-fluorouracil (5-FU)
• Vincristine (Oncovin)

These drugs may be given in different combinations and are often given with mitotane.

Chemo drug side effects

Chemotherapy drugs kill cancer cells but also damage some normal cells, which can cause some side effects. Side effects from chemo depend on the type of drugs, their doses, and how long treatment lasts. Common side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• Hand and foot rashes
• Mouth sores
• Diarrhea
• Increased risk of infection (due to a shortage of white blood cells)
• Problems with bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
• Anemia, fatigue, or shortness or breath (due to low red blood cell counts)

Along with the risks above, some chemo drugs can cause other side effects.

Ask your health care team what side effects you can expect based on the specific drugs you will get. Be sure to tell your doctor or nurse if you do have side effects, as there are often ways to help with them. For example, drugs can be given to help prevent or reduce nausea and vomiting.