Is mitotane a chemotherapy drug or a special anti-cancer drug?

Mitotane is usually classified as a special type of chemotherapy drug, mainly used to treat adrenal cortical cancer (ACC). Although mitotane does not directly inhibit cell division like traditional cytotoxic chemotherapy drugs, it achieves anti-tumor effects by destroying the function and structure of adrenocortical cells, so it is also included in clinical chemotherapy treatment plans.

Mitotane is derived from an organic compound calledDDT. It has selective toxicity and can specifically destroy adrenal tissue and cause tumor cell apoptosis. According to the classification ofoverseastreatment guidelines, mitotane is classified as part of adrenal-targeted therapy, but in actual treatment, it is often used in combination with other classic chemotherapy drugs such as etoposide, doxorubicin, and cisplatin (EDP regimen) to enhance the efficacy. Although its mechanism is different from traditional cytotoxic drugs, in the ACC treatment guidelines, mitotane is listed alongside chemotherapy drugs and is considered part of the standard treatment.

The use of mitotane requires strict monitoring of blood drug concentration. It is usually recommended to maintain the plasma concentration between14-20 mg/L, because its efficacy is closely related to blood drug concentration. In terms of side effects, patients often experience nausea, vomiting, fatigue, neurological symptoms, and adrenal gland function suppression, and some patients require long-term replacement hormone therapy.

Therefore, despite the different biological properties of mitotane, it is still regarded as an important chemotherapeutic agent in clinical practice, especially occupying a central position in treatment strategies for locally advanced or metastatic adrenocortical carcinoma. For patients with unresectable or high risk of postoperative recurrence, mitotane's role as adjuvant therapy has also been widely recognized and is listed as a recommended drug in international cancer treatment guidelines.

Reference materials:https://go.drugbank.com/drugs/DB00648