Chemotherapy for Adrenal Cancer

Chemo (chemotherapy) is the use of drugs to treat cancer. These drugs are usually given into a vein (IV) or taken by mouth and can reach and destroy cancer cells anywhere in the body. This makes chemo a useful tool for adrenal cancers that have spread to other parts of the body.

For more information on neuroblastoma, see Chemotherapy for Neuroblastoma.

When is chemo used for adrenal cancer?

Not everyone with an adrenal cancer will need chemo, but there are a few situations in which chemo might be recommended:

• After surgery to lower the chance of cancer coming back.
• To manage cancer spread, recurrence, or symptoms for adrenal cancers that have spread to other parts of the body or come back after surgery.
• Instead of surgery if surgery is not an option. It might be used alone or in combination with other treatments.

Which chemo drugs are used to treat adrenal cancer?

The types of chemotherapies used to treat adrenal cancer depend on the type of adrenal cancer you have.

Adrenocortical carcinoma

The most commonly used medicine to treat people with adrenocortical carcinoma is called mitotane. In cases where adrenocortical carcinoma can’t be removed with surgery or has spread, other chemotherapy medicines may be used as well.

Mitotane

Mitotane (Lysodren) might be recommended for adrenocortical carcinoma that was removed with surgery but has a higher risk of coming back. Or it might be recommended for cancers that can’t be removed with surgery or have spread.

Mitotane can help people with adrenal cancers that produce extra hormones. Even when it doesn't shrink the tumor, mitotane can reduce excess hormone production and relieve symptoms. Most people with this problem are helped by mitotane.

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

Possible side effects

Mitotane can keep the adrenal gland from producing steroid hormones. This can lead to low levels of cortisol and other hormones, which can make you feel weak and sick. If this happens, you'll need to take steroid replacement medicine to bring your hormone levels up to normal.

Mitotane can also change levels of other hormones, such as thyroid hormone or testosterone. If that occurs, you'd need drugs to replace these hormones as well.

Other common side effects include:

• Belly pain
• Nausea and vomiting
• Diarrhea
• Depression
• Dizziness
• Rash
• High cholesterol

Other chemo drugs used for adrenocortical carcinoma

Other chemo drugs are sometimes combined with mitotane to treat advanced adrenocortical carcinoma. The drugs used most often in combination with mitotane are:

• Carboplatin or Cisplatin
• Etoposide (VP-16)
• Doxorubicin (Adriamycin)

Malignant pheochromocytoma

Pheochromocytomas that have spread might also be treated with chemotherapy medications, especially if other treatments have not been successful. Chemo drugs used for pheochromocytomas include:

• Temozolomide
• Cyclophosphamide
• Vincristine
• Dacarbazine

Possible side effects of chemo

Chemo drugs affect cells that grow fast. While cancer cells grow fast, other healthy cells in the body do too. These cells include blood-forming cells, hair cells, and cells that line the gut.

The damage caused by chemo drugs to fast-growing healthy cells results in side effects. The side effects of chemo depend on the type and dose of drugs given and the length of time they are taken.

Common chemo side effects

• Hair loss
• Mouth sores
• Loss of appetite
• Nausea and vomiting
• Diarrhea or constipation

Low blood cell counts

Chemo can damage the bone marrow, where new blood cells are made. This can lead to low blood cell counts, which can result in:

• Increased chance of infections (from having too few white blood cells)
• Easy bruising or bleeding (from having too few blood platelets)
• Fatigue (from having too few red blood cells)

Managing chemo side effects

Most of these side effects tend to go away after treatment is finished. There are often ways to lessen these side effects. For example, drugs can be given to help prevent or reduce nausea and vomiting. Be sure to let your care team know if you have side effects so they can help you manage them.

Chemotherapy can also have some longer-term side effects. For more on the possible long-term effects of treatment, see After Adrenal Cancer Treatment.

More information about chemotherapy

For more general information about how chemotherapy is used to treat cancer, see Chemotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.