Trade Name: Novantrone ^®
Other Name: DHAD

Drug Type:

Mitoxantrone is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  Mitoxantrone is classified as an "antitumor antibiotic."  (For more detail, see "How Mitoxantrone Works" section below).

What Mitoxantrone Is Used For:

• Advanced prostate cancer not responding to hormone treatment - used in combination with steroids.
• Acute myelogenous leukemia (AML)
• Breast cancer
• Non-Hodgkin's lymphoma

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Mitoxantrone Is Given:

• As an injection into the vein (intravenous, IV).
• Mitoxantrone may be an irritant.  An irritant is a chemical that can cause inflammation of the vein through which it is given.  If Mitoxantrone escapes from the vein it can cause tissue damage.  The nurse or doctor who gives Mitoxantrone must be carefully trained.  If you experience pain or notice redness or swelling at the IV site while you are receiving Mitoxantrone, alert your health care professional immediately. 
• The amount of Mitoxantrone that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose and schedule.

Side Effects:

Important things to remember about the side effects of Mitoxantrone:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration. 
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of Mitoxantrone.
• The side effects of Mitoxantrone and their severity depend on how much Mitoxantrone is given.  In other words, higher doses may produce more severe side effects.

The following side effects are common (occurring in greater than 30%) for patients taking Mitoxantrone:

• Low blood counts. Your white and red blood cells and platelets may temporarily decrease. This can put you at increased risk for infection, anemia and/or bleeding.

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts. Onset: 7 - 10 days
Nadir: 10 -14 days
Recovery: 21 days

• Nausea and vomiting
• Fever
• Increases in blood tests measuring liver function.  These return to normal once treatment is discontinued (see liver problems).

These side effects are less common side effects (occurring in about 10-29%) of patients receiving Mitoxantrone:

• Weakness 
• Mouth sores
• Hair loss
• Diarrhea 
• Abnormal EKG, Heart rhythm abnormalities (arrhythmia) (see heart problems).
• Low blood pressure.
• Blue/green discoloration of whites of eyes and/or urine for 1-2 days after treatment.

Mitoxantrone Delayed Effects:

A serious but uncommon side effect of Mitoxantrone can be interference with the pumping action of the heart.  You can receive only up to a certain amount of Mitoxantrone during your lifetime.  This "lifetime maximum dose" may be lower if you have heart disease risk factors such as radiation to the chest, advancing age, and use of other heart-toxic drugs.  Your doctor may check your heart function before you may take any Mitoxantrone and will monitor your heart periodically during your treatment.  

• There is a slight risk of developing a blood cancer such as leukemia years after taking Mitoxantrone.  Talk to your doctor about this risk.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Diarrhea (4-6 episodes in a 24-hour period)
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools or urine
• Extreme fatigue (unable to carry on self-care activities)
• Mouth sores (painful redness, swelling or ulcers)
• Yellowing of the skin or eyes
• Shortness of breath. Swelling of the feet or ankles.  Sudden weight gain. 
• Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting Mitoxantrone treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.). Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking Mitoxantrone.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Mitoxantrone may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking Mitoxantrone. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking Mitoxantrone.

Self-Care Tips:

• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. 
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest. 
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

A baseline heart evaluation may be performed before starting treatment, and a heart function test may be done as your doctor prescribes.  You will be checked regularly by your doctor while you are taking Mitoxantrone, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How Mitoxantrone Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Mitoxantrone is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.  There are several types of antitumor antibiotics:

• Anthracyclines:  Doxorubicin, Daunorubicin, Mitoxantrone, and Idarubicin.
• Chromomycins:  Dactinomycin and Plicamycin.
• Miscellaneous:  Mitomycin and Bleomycin.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org