What Is Mitoxantrone (Novantrone<sup>®</sup>)?
Novantrone® (mitoxantrone) is a chemotherapy treatment option that has antineoplastic properties (meaning that it acts to prevent or halt the development and growth of tumors). It is indicated for use with corticosteroids in individuals with advanced hormone refractory prostate cancer (prostate cancer that is at a later stage and/or has spread to other parts of the body and does not respond to hormone therapy). Mitoxantrone is administered as an intravenous infusion and is typically administered once every 3 weeks in patients with prostate cancer.
In some cases, mitoxantrone may be used with other hormone therapies. Individuals taking mitoxantrone should also be monitored for changes in blood cell counts, heart problems including congestive heart failure, and the development of acute myelogenous leukemia (AML).1
How does mitoxantrone work?
Mitoxantrone’s active ingredient has antineoplastic properties, meaning that it acts to prevent tumor growth and development. Mitoxantrone does this by inhibiting a key component of the DNA replication and damage repair process, as well as by inserting itself into DNA to cause strand breaks. When a parent cell is unable to replicate its DNA successfully, it cannot split into two daughter cells, and the cell line will die off. Additionally, when DNA damage becomes too great, the cell will eventually become too faulty and will die. When a cell manually kills itself because of a faulty cellular process it is called apoptosis. Chemotherapies cause cancer cells to stop dividing and undergo apoptosis, thus, slowing or halting the growth of a cancerous mass.
Cancerous cells are rapidly dividing while most other cells in our body aren’t, or are doing so at a slower rate. This property is what increases the chances of chemotherapies targeting cancer cells. However, there are still a few kinds of cells in our body that divide rapidly, such as hair cells or cells that line our intestines, which explains the common side effects of hair loss or gastrointestinal disruption while on certain chemotherapy medications. Blood cells, including important white blood cells, red blood cells, and platelets also divide on a somewhat regular basis, making it important to closely monitor someone on chemotherapy to make sure their blood cell counts aren’t dangerously low. If a person’s blood cell count dips below a certain threshold, they may be unable to receive chemotherapy until the issue has resolved.
Additionally, steroids like prednisone may be used with certain chemotherapies to increase their effectiveness when it comes to targeting and killing cancer cells as well as to help with pain management and other side effects.2
What are the possible side effects of mitoxantrone?
Multiple clinical trials evaluated the safety and efficacy of mitoxantrone across many different conditions. The most common side effects of mitoxantrone include fatigue, diarrhea, vomiting, swelling, hair thinning, nausea, bladder infections, and mouth sores. Many of these side effects, including hair loss, are generally reversible and will be remedied when the medication is stopped. Your provider will be able to determine what side effects may be longer-lasting in nature. This is not an exhaustive list of all potential side effects of mitoxantrone. Talk to your healthcare provider or pharmacist for further information.
Things to note about mitoxantrone
Several rare but more serious side effects can accompany mitoxantrone including potentially developing a heart condition or congestive heart failure. Alert your provider immediately if you notice any of the following symptoms:
- Trouble breathing
- Swelling of your legs or ankles
- Uneven or fast heartbeat
Additionally, there is a risk of developing very low white and red blood cell and platelet counts while taking mitoxantrone. Your doctor will monitor you for any signs of this, however, it is important to self monitor for any signs of infection, shortness of breath, fatigue, unusual bruising, or bleeding. Individuals with a blood cell count that is deemed to be too low to be able to handle the continuation of treatment will need to stop taking mitoxantrone until their blood cell count rises. A decrease in white blood cell count can also increase your chance of developing a serious infection. Alert your provider immediately if you notice any signs of infection including:
- Sore throat
- Pain with urination
- An increase in urination frequency
- Unusual bleeding or bruising
There is also a risk of developing certain blood disorders while taking mitoxantrone, including the possibility of developing another type of cancer called Acute Myeloid Leukemia (AML) when receiving mitoxantrone treatment. Mitoxantrone may also cause changes in liver function. Alert your provider immediately if you are experiencing stomach or abdominal pain, dark urine, or yellowing of the eyes or skin. Your doctor will monitor you for any signs of these conditions, and it is also important to disclose to them all other medications you are currently taking before beginning treatment.
Before starting mitoxantrone talk to your provider if you:
- Have any problems with your liver or kidneys
- Have any heart conditions or blood flow or clotting problems
- Have anemia
- Have low white blood cell counts, red blood cell counts, or platelet counts
- Have any infections
- Have unusual or unexpected bleeding
- Have previously been treated with mitoxantrone or any other chemotherapy
- Have had radiation treatment to the chest area
- Are allergic to mitoxantrone or any of its ingredients, or have any other allergies
- Have any other medical conditions
- Are currently taking any other medications (prescription and over-the-counter), vitamins, or herbal supplements
You should also contact your provider if you notice any signs of an allergic reaction to the medication, including chest pain or difficulty breathing. Mitoxantrone may also change the color of your urine or the whites of your eyes to a blue-green color for the first few days after each infusion. It is also important to consult the prescribing information for any other medications taken with mitoxantrone, including prednisone.
Mitoxantrone is administered as an intravenous infusion. A typical injection of mitoxantrone takes under an hour to administer and is given once every 3 weeks, however, this treatment and infusion schedule can change based on your specific case and provider. Your provider will determine the appropriate dosage and administration schedule for you, including your length of treatment. They will also determine the appropriate dosage and administration schedule of any other medications taken with mitoxantrone, such as prednisone. Patients should talk to their doctor if they have any questions, or if they have questions regarding their mitoxantrone regimen.
It is important to follow your provided schedule exactly as instructed, and not to stop taking any accompanying medications on your own. The dose of your mitoxantrone can be adjusted as needed, and may need to be discontinued if your blood cell count is too low or if the side effects of treatment become too severe.1
These are not all the possible side effects of mitoxantrone. Patients should talk to their doctor about what to expect with treatment with mitoxantrone.