Chemotherapy for Adrenal Cancer

Certain types of drugs are given to treat cancer. These drugs, known as chemotherapy, are typically given into a vein or by mouth (in pill form). Because chemo enters the bloodstream and can reach throughout the body, it is commonly given to patients whose cancer has spread (metastasized) to organs beyond the adrenal gland or after surgery to prevent the cancer from coming back.

Mitotane

Mitotane is the drug most often used for people with adrenal cancer. It blocks hormone production by the adrenal gland and destroys both cancer and healthy cells in the adrenal gland. Mitotane can be given as:

• Adjuvant therapy:  Mitotane can be given after surgery, after all the visible cancer has been removed. This is meant to kill any cells that were left behind but were too small to see. Giving the drug this way is intended to prevent or delay the cancer's return.
• Therapy for unresectable, recurrent, or metastatic disease: If the cancer has not been completely removed by surgery or has come back, mitotane may be used to shrink the cancer in 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 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 of Mitotane

Mitotane can also keep the other normal 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 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.

Other common side effects are abdominal discomfort, nausea, vomiting, diarrhea, depression, dizziness, rash, and high cholesterol.

Other chemo drugs used for adrenal cancer

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

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

Possible side effects of chemo for adrenal cancer

Chemo kills cancer cells but also damages some normal cells, which can cause side effects. These depend on the type, dose, and length of drugs given. Some common side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Loss of hair
• 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)

Some drugs can have specific side effects. For example, drugs such as cisplatin can cause nerve damage (peripheral neuropathy). This can sometimes lead to symptoms (mainly in the hands and feet), such as pain, burning or tingling sensations, sensitivity to cold, or weakness. In most people, these goes away or gets better once treatment is stopped, but it might last a long time in others.

Be sure to report any side effects you notice during chemo to your cancer care team so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced or treatment may need to be delayed or stopped to keep the side effects from getting worse.