Abstract

Mitotane (DDD) is prescribed in adrenocortical renal carcinoma. Its principal metabolite, dichlorodiphenylethene (DDE), can accumulate in fat tissues and from a toxicological point of view, is probably more interesting than the other metabolite dichlorodiphenylacetate (DDA). Therapeutic Drug Monitoring (TDM) of DDD plasma concentrations is required to combine therapeutic efficacy with acceptable toxicity. Therefore, we developed a simple and fast HPLC-UV method to monitor plasma concentrations after a liquid–liquid extraction of plasma calibration samples, quality controls, and anonymous plasma samples with unknown DDD and DDE concentrations. Samples were injected into an HPLC instrument and peaks of mitotane (DDD), DDE and aldrin (internal standard, IS) were resolved by a stationary phase C18 column (250 mm × 4.6 mm, 5 μm), maintained at 35 °C. Mobile phase, made by water/acetonitrile (10/90, v/v), was pumped at a flow of 1.0 mL/min, and absorbance was monitored at a wavelength of 226 nm. Average recovery was 95% for all analytes, and the method was linear for both DDD (r2 = 0.9988, range 1–50 mg/L) and DDE (r2 = 0.9964, range 1–40 mg/L). The values of limit of detection and quantitation were 0.102 and 0.310 mg/L for DDD and 0.036 and 0.108 mg/L for DDE, respectively. The retention time values of DDD, DDE and IS were 7.06, 9.42 and 12.60 min, respectively. The method was successfully validated according to FDA guidelines and finally adopted for routine TDM.

Highlights

  • Mitotane (1-chloro-2-[2,2-dichloro-1-(4-chlorophenyl)ethyl] benzene), known as o,p0 -DDE and mitotane (DDD), was isolated in 1940 from the insecticide, dichlorodiphenyltrichloroethane (DDT), and finds its selective use in the treatment of adrenocortical carcinoma (AC), against which the drug is effective alone or in combination with other pharmacological agents [1]

  • In advanced adrenocortical carcinoma, there are two dose regimens: a low-dose starting regimen, and a high-dose starting regimen

  • The choice of acetonitrile clinical (ACN), instead of using other solvents, was dependent on both the better deproteinization obtained with ACN and its presence in the mobile phase

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Summary

Introduction

Mitotane (1-chloro-2-[2,2-dichloro-1-(4-chlorophenyl)ethyl] benzene), known as o,p0 -DDD, was isolated in 1940 from the insecticide, dichlorodiphenyltrichloroethane (DDT), and finds its selective use in the treatment of adrenocortical carcinoma (AC), against which the drug is effective alone or in combination with other pharmacological agents [1]. The administration of mitotane may be associated with neurological and gastrointestinal toxicities that may require a decrease in daily dosage or the discontinuation of therapy [4]. In the latter case, the patient may lose the therapeutic benefit of the drug. Further dose adjustments are guided by the results of mitotane monitoring [5]

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