Is Mitotane a chemotherapy drug or a targeted drug treatment?

Mitotane is a classic drug mainly used to treat adrenocortical cancer (ACC). Its mechanism of action is different from traditional chemotherapy and modern targeted drugs. Strictly speaking, mitotane is not a molecularly targeted drug, nor is it a typical chemotherapy drug. It is closer to a selective adrenocortical cytotoxic drug. It reduces adrenal hormone secretion by directly destroying the mitochondrial function of adrenocortical cells and inhibiting steroid synthesis, while inducing tumor cell apoptosis. Therefore, it has anti-tumor effects and can also improve symptoms related to hypercortisolemia.

In clinical applications, mitotane is often used as adjuvant therapy after surgery or in patients with unresectable advanced adrenocortical cancer. For locally advanced or metastatic ACC, mitotane can be used alone or in combination with chemotherapy drugs, such as with classic chemotherapy regimens such as etoposide and vinorelbine, to enhance the anti-tumor effect. Mitotane monotherapy is characterized by a slow onset of action, requiring weeks to months to reach the effective range of blood concentration, but it has a significant effect on adrenal gland function suppression and tumor growth control.

The pharmacological properties of mitotane are significantly different from those of chemotherapy drugs and targeted drugs. Traditional chemotherapy drugs kill rapidly proliferating tumor cells by blocking DNA synthesis or cell division, while targeted drugs act on specific molecular pathways or mutation targets. Mitotane specifically acts on the metabolism and hormone synthesis mechanism of adrenocortical cells. Its anti-tumor effect is closely related to the tissue specificity of the tumor source, rather than broad-spectrum cytotoxicity or single molecule targeting. Therefore, mitotane is classified as an adrenocortical cell-selective drug rather than conventional chemotherapy or targeted drugs.

In general, mitotane plays a dual role in the treatment of adrenocortical cancer: it can inhibit hormone secretion and improve symptoms, and it can control tumor growth through cytotoxicity. Its clinical value is mainly reflected in the adjuvant treatment after surgery, the control of advanced or metastatic ACC and the synergistic effect of combined chemotherapy. During use, blood drug concentration, liver function and hormone levels need to be closely monitored to ensure efficacy and safety. Although mitotane is not a traditional chemotherapy or targeted drug, it is still an important and irreplaceable drug in the treatment of ACC.

Keyword tags: mitotane, adrenocortical cancer, targeted chemotherapy, drug classification, clinical application

Reference:https://reference.medscape.com/drug/lysodren-mitotane-342258