. 2011 Dec 9;2(6):363–371. doi: 10.1007/s12672-011-0094-2

Table 3.

Therapeutic management strategy of advanced ACC, used at the Institut Gustave Roussy, as a function of tumor response, plasma mitotane levels, and prognostic parameters

Plasma mitotane	RECIST: objective response	RECIST: stabilization	RECIST: progression
<14 or >14 mg/L^a at only one measurement	Increase mitotane^b	Increase mitotane^b	Increase mitotane^b
<14 or >14 mg/L^a at only one measurement	Locoregional options^c	Combined chemotherapy (high-risk group) and or locoregional therapies (intermediate-risk group)	Combined chemotherapy or clinical trials

>14 mg/L at two measurements 3 months apart	Maintain mitotane^b	Maintain mitotane^b	Discuss withdrawal of mitotane therapy
>14 mg/L at two measurements 3 months apart	Locoregional options^c	Combined chemotherapy or trials (high-risk group) and or locoregional therapies (intermediate-risk group)	Chemotherapy or clinical trials

^aConsider results of plasma mitotane within the three previous months

^bIn case of good tolerance

^cLocoregional options include liver embolization, radiofrequency ablation, external radiotherapy, and surgery of the primary tumor and metastases to be discussed case by case