TY - JOUR
T1 - International consensus on mitotane treatment in pediatric patients with adrenal cortical tumors
T2 - Indications, therapy, and management of adverse effects
AU - Riedmeier, Maria
AU - Antonini, Sonir R R
AU - Brandalise, Silvia
AU - Costa, Tatiana El Jaick B
AU - Daiggi, Camila M
AU - de Figueiredo, Bonald C
AU - de Krijger, Ronald R
AU - De Sá Rodrigues, Karla Emília
AU - Deal, Cheri
AU - Del Rivero, Jaydira
AU - Engstler, Gernot
AU - Fassnacht, Martin
AU - Fernandes Luiz Canali, Gabriela C
AU - Molina, Carlos A Fernandes
AU - Gonc, Elmas Nazli
AU - Gültekin, Melis
AU - Haak, Harm R
AU - Guran, Tulay
AU - Hendriks A, Emile J
AU - Idkowiak, Jan
AU - Kuhlen, Michaela
AU - Malkin, David
AU - Meena, Jagdish Prasad
AU - Pamporaki, Christina
AU - Pinto, Emilia
AU - Puglisi, Soraya
AU - Ribeiro, Raul C
AU - Thompson, Lester D R
AU - Yalcin, Bilgehan
AU - Van Noesel, Max
AU - Wiegering, Verena
PY - 2024/3/30
Y1 - 2024/3/30
N2 - OBJECTIVE: Mitotane is an important cornerstone in the treatment of pediatric adrenal cortical tumors (pACC), but experience with the drug in the pediatric age group is still limited and current practice is not guided by robust evidence. Therefore, we have compiled international consensus statements from pACC experts on mitotane indications, therapy, and management of adverse effects. METHODS: A Delphi method with 3 rounds of questionnaires within the pACC expert consortium of the international network groups European Network for the Study of Adrenal Tumors pediatric working group (ENSAT-PACT) and International Consortium of pediatric adrenocortical tumors (ICPACT) was used to create 21 final consensus statements. RESULTS: We divided the statements into 4 groups: environment, indications, therapy, and adverse effects. We reached a clear consensus for mitotane treatment for advanced pACC with stages III and IV and with incomplete resection/tumor spillage. For stage II patients, mitotane is not generally indicated. The timing of initiating mitotane therapy depends on the clinical condition of the patient and the setting of the planned therapy. We recommend a starting dose of 50 mg/kg/d (1500 mg/m²/d) which can be increased up to 4000 mg/m2/d. Blood levels should range between 14 and 20 mg/L. Duration of mitotane treatment depends on the clinical risk profile and tolerability. Mitotane treatment causes adrenal insufficiency in virtually all patients requiring glucocorticoid replacement shortly after beginning. As the spectrum of adverse effects of mitotane is wide-ranging and can be life-threatening, frequent clinical and neurological examinations (every 2-4 weeks), along with evaluation and assessment of laboratory values, are required. CONCLUSIONS: The Delphi method enabled us to propose an expert consensus statement, which may guide clinicians, further adapted by local norms and the individual patient setting. In order to generate evidence, well-constructed studies should be the focus of future efforts.
AB - OBJECTIVE: Mitotane is an important cornerstone in the treatment of pediatric adrenal cortical tumors (pACC), but experience with the drug in the pediatric age group is still limited and current practice is not guided by robust evidence. Therefore, we have compiled international consensus statements from pACC experts on mitotane indications, therapy, and management of adverse effects. METHODS: A Delphi method with 3 rounds of questionnaires within the pACC expert consortium of the international network groups European Network for the Study of Adrenal Tumors pediatric working group (ENSAT-PACT) and International Consortium of pediatric adrenocortical tumors (ICPACT) was used to create 21 final consensus statements. RESULTS: We divided the statements into 4 groups: environment, indications, therapy, and adverse effects. We reached a clear consensus for mitotane treatment for advanced pACC with stages III and IV and with incomplete resection/tumor spillage. For stage II patients, mitotane is not generally indicated. The timing of initiating mitotane therapy depends on the clinical condition of the patient and the setting of the planned therapy. We recommend a starting dose of 50 mg/kg/d (1500 mg/m²/d) which can be increased up to 4000 mg/m2/d. Blood levels should range between 14 and 20 mg/L. Duration of mitotane treatment depends on the clinical risk profile and tolerability. Mitotane treatment causes adrenal insufficiency in virtually all patients requiring glucocorticoid replacement shortly after beginning. As the spectrum of adverse effects of mitotane is wide-ranging and can be life-threatening, frequent clinical and neurological examinations (every 2-4 weeks), along with evaluation and assessment of laboratory values, are required. CONCLUSIONS: The Delphi method enabled us to propose an expert consensus statement, which may guide clinicians, further adapted by local norms and the individual patient setting. In order to generate evidence, well-constructed studies should be the focus of future efforts.
KW - Mitotane therapy
KW - adrenal cortical carcinoma
KW - pediatric adrenal cortical cancer
KW - pediatric adrenal cortical carcinoma
KW - pediatric adrenal cortical tumor
U2 - 10.1093/ejendo/lvae038
DO - 10.1093/ejendo/lvae038
M3 - Article
SN - 0804-4643
VL - 190
SP - G15-G24
JO - European Journal of Endocrinology
JF - European Journal of Endocrinology
IS - 4
ER -