streptozotocin + mitotane

Streptozotocin + mitotane (Sz-M) is a combination chemotherapy regimen primarily utilized for the treatment of advanced, locally advanced, or metastatic adrenocortical carcinoma (ACC). Streptozotocin is a small molecule alkylating agent of the nitrosourea class that induces DNA damage through alkylation and cross-linking; it is particularly noted for its toxicity toward endocrine cells. Mitotane is an adrenolytic agent that acts by causing mitochondrial destruction in the adrenal cortex and inhibiting steroidogenesis, specifically targeting enzymes like CYP11B1 and CYP11A1. This combination was a key experimental arm in the Phase 3 FIRM-ACT (First International Randomized trial in Locally Advanced and metastatic Adrenocortical Carcinoma Treatment) trial, which was led by the Collaborative Group for Adrenocortical Carcinoma Treatment. Although the trial found that Sz-M had a lower objective response rate and shorter progression-free survival compared to the EDP-M regimen (etoposide, doxorubicin, cisplatin, and mitotane), Sz-M remains a therapeutic option, often used as a second-line treatment or in patients who cannot tolerate platinum-based therapies.

Brand names

ZanosarLysodren

Other names

streptozocin + mitotanestreptozotocin-Collaborative Group for Adrenocortical Carcinoma Treatment-adrenocortical carcinoma