Systemic chemotherapy (chemo) uses drugs that 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 or metastasized to organs beyond the adrenal gland. It is only used for adrenal gland cancer that has become widespread. Chemo does not cure adrenal cancer. It is most often used for adrenal cancer that has spread or come back after surgery

The drug most often used for people with adrenal cortical carcinoma is a drug called mitotane. Mitotane blocks hormone production by the adrenal gland and also destroys adrenal cancer cells. Some studies have shown that starting mitotane treatment when all of the cancer is thought to be gone may 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 about 30% of patients. On average, the response lasts about one year. But the response time can be longer for some patients.

Mitotane is particularly helpful for people with adrenal carcinomas who are suffering from the effects of 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 secretion are helped by mitotane. This drug can cause major side effects, however. The most common are nausea, vomiting, diarrhea, rashes, and sleepiness. Sometimes lower doses of the drug can still be effective and cause fewer side effects. This drug comes as a pill and is taken 3 to 4 times a day.

Giving mitotane after the cancer is completely removed with surgery may help keep the cancer from growing back. This approach is called adjuvant chemotherapy. It works well for other types of cancer, but has not been studied well in adrenal cortex cancer.

Some of the other chemo drugs used to treat adrenal cortical cancer are:

• cisplatin
• doxorubicin (Adriamycin)
• paclitaxel (Taxol)
• 5-fluorouracil (5-FU)
• vincristine
• etoposide

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 increase the chance 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), and 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 may look different. There are good treatments for many of the temporary side effects of chemotherapy. For example, very good drugs called antiemetics are available to prevent or reduce nausea and vomiting.

Some chemo side effects may 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, leading to painful tingling and numbness in the hands and feet.

Last Medical Review: 03/20/2009
Last Revised: 03/20/2009