Systemic chemotherapy (chemo) is giving drugs 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 in adrenal cancer, so it is most often used for adrenal gland cancer that has become too widespread to be removed with surgery. Chemo does not cure adrenal cancer.
The drug most often used for people with adrenal cancer is called mitotane. Mitotane blocks hormone production by the adrenal gland and also destroys both adrenal cancer cells and healthy adrenal tissue. This drug can 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 will 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 would 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 return of the cancer.
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 one year, but 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. About 80% of patients with excess hormone production are helped by mitotane. This drug can cause major side effects, however. 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 a pill and is taken 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
Other chemo 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
Some other chemo drugs are used less often, such as:
These drugs may be given in different combinations and are often given with mitotane.
Chemotherapy drugs kill cancer cells but also damage some normal cells, which can cause some side effects. Careful attention must be given to avoid or minimize chemo side effects. Side effects from chemo depend on the type of drugs, the amount taken, and the length of treatment. Common side effects might include:
- Nausea and vomiting
- Loss of appetite
- Loss of hair
- Hand and foot rashes
- Mouth sores
- Low blood counts
Because chemotherapy can damage the blood-producing cells of the bone marrow, patients may have low blood cell counts. This can lead to:
- Increased risk of infection (due to a shortage of white blood cells)
- Bleeding or bruising after minor cuts or injuries (due to a shortage of blood platelets)
- Anemia (due to low red blood cell counts)
Most side effects disappear once treatment is stopped. Hair will grow back after treatment ends, though it might look different. There are good treatments for many of the side effects of chemotherapy. For example, very good drugs are available to prevent or reduce nausea and vomiting.
Some chemo side effects can last a long time or even be permanent. For example, doxorubicin can damage the heart muscle over time. Your health care team will watch the dose of this drug closely, to make sure that the dose isn't high enough to cause this damage. Cisplatin and paclitaxel can both cause nerve damage (called neuropathy), leading to painful tingling and numbness in the hands and feet. This tends to get better after chemo stops, but it might not go away completely.
More information about chemotherapy can be found in our document A Guide to Chemotherapy.
Last Revised: 02/25/2015