It is generally recommended to take mitotane for several courses of treatment

Mitotane is one of the most important systemic therapeutic drugs currently used in the treatment of adrenocortical cancer (ACC). Its treatment cycle schedule is not administered according to a fixed "course" like traditional chemotherapy, but is more similar to a long-term maintenance treatment model. The efficacy of mitotane needs to be achieved by gradually establishing a stable blood concentration. Usually the target blood concentration is 14-20 mg/L. This process may require weeks or even months to adjust the dose. Therefore, in actual clinical practice, the treatment cycle is not measured in units of "several courses of treatment", but continuity, individualization and drug monitoring are emphasized.

Generally speaking, in adjuvant treatment after ACC surgery, mitotane is recommended to be taken for 2 years or even longer, especially among people with a high risk of postoperative recurrence, such as those with high Ki-67 index, unclear tumor boundaries or vascular invasion. For patients with metastatic or unresectable advanced adrenocortical cancer, mitotane is often used as long-term maintenance therapy, and its duration of use depends more on efficacy response and individual tolerance. In the early stages of treatment, doctors will gradually increase the dose and regularly monitor the blood mitotane concentration. Once the treatment window is reached, the original dose will be maintained and dynamically adjusted according to the patient's condition and adverse reactions.

It should be noted that mitotane has slow metabolism and strong tissue accumulation. Adverse reactions such as gastrointestinal symptoms, neuropsychiatric abnormalities, and adrenal gland function suppression may gradually appear in the later stages of treatment. Therefore, the treatment course is not divided into traditional cycles of 3-4 weeks, but an individualized plan is developed based on the condition and monitoring results. Some patients may need to take life-long medication, especially those with persistent tumor burden or a higher risk of recurrence.

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