Mitotane and ketoconazole are not recommended to be used together to treat hypera­drenocorticism as the adrenolytic effects of mitotane may be inhibited by ketoconazole’s inhibition of cytochrome P450 enzymes.
Mitotane and metyrapone may be effective as single drugs, or used in combination with radiotherapy.
How long is your boyfriend taking mitotane?

Hi,

Thanks for the information. He's resumed taking mitotane at the end of December, so I'm not sure how long it's supposed to take to work. Can he take ketoconazole or metyraphone instead of mitotane if he has adrenal cortical cancer? Are these drugs effective for cancer-related Cushing's syndrome?

Have the doctors achieved the maximum tolerated dose of mitotane for your boyfriend?
Was he suggested radiotherapy?

Usually, clinical benefits (reduction in tumor mass, reduction in pain, weakness or anorexia and reduction of symptoms and signs due to excessive steroid production) are observed after 3 months at the maximum tolerated dose and if there are no benefits, it is considered a clinical failure.

Usage of metyrapone and ketoconazole for the correction of hypercortisolemia in Cushing’s syndrome is well established and they are often used preoperatively (mitotane is indicated in the treatment of inoperable adrenal cortical carcinoma, so, I guess that's why he wasn't suggested metyrapone and ketoconazole) Sorry, if I'm making unbiased conclusions.

Best wishes for you and your boyfriend!
Marija

The doctor's haven't put him up to the maximum dose yet, and so perhaps increasing the dose will help, along with more time. Are benefits seen below the maximum dose? And if they are, when do they start to show up? He's not getting worse necessarily, but he's not getting any better either, so I don't know if the mitotane is just not working, of if the dose needs to be increased, or more time is needed.


Thank you for your help so far and your well wishes, I really appreciate it

Tracy