Short-term variation in plasma mitotane levels

Mitotane is the drug of choice for treating  adrenocortical carcinoma (ACC). It  exerts an anti-neoplastic effect on ACCs and this effect  appears to be correlated with plasma levels. Therefore it is  crucial to reach and maintain the mitotane concentration above 14 mg/l. However, mitotane pharmacokinetics is poorly understood.

Kerkhofs et al. conducted a prospective case–control study to investigate the variation in plasma mitotane levels during the day and the influence of a single morning dose.

Their study shows that short-term variability in mitotane plasma levels display was greater than expected and that random sampling could yield incidentally high levels. Mitotane levels may also increase during the day even when a morning dose is skipped. They therefore recommend early-morning trough sampling as standard management in monitoring mitotane treatment.

Read full article by Kherkofs et al. (2014) European Journal of Endocrinology vol 171 issue 6 pp 677-683. DOI: 10.1530/EJE-14-0388