Common brand names

• Novantrone

How it is administered

Mitoxantrone is given as an intravenous (IV) infusion, meaning it is delivered directly into a vein. The medication comes as a concentrate that must be diluted before use. It is not given by mouth, subcutaneous, intramuscular, or intrathecal routes. The infusion typically lasts about 5 to 15 minutes and is administered by a healthcare professional in a clinic or hospital setting.

How it works

Mitoxantrone works by interfering with the DNA in cancer cells. It is a DNA-reactive agent that binds to DNA, causing crosslinks and strand breaks, which prevents the cells from growing and dividing. It also inhibits an enzyme called topoisomerase II, which is necessary for DNA repair and replication. This action leads to the death of both actively dividing and non-dividing cells, making it effective against various types of blood cancers.

Additionally, mitoxantrone can suppress the immune system by inhibiting the proliferation of B cells, T cells, and macrophages, and by reducing the secretion of certain immune signaling molecules. This dual action helps control abnormal cell growth in blood cancers and can also reduce inflammation in certain autoimmune diseases.

Who should take it

Mitoxantrone is used in adults as part of combination chemotherapy for the initial treatment of acute nonlymphocytic leukemia (ANLL), which includes myelogenous, promyelocytic, monocytic, and erythroid acute leukemias. It is also used in combination with corticosteroids for advanced hormone-refractory prostate cancer and for reducing disability and relapses in certain types of multiple sclerosis.

For blood cancers, mitoxantrone is typically prescribed when a physician determines that the potential benefits outweigh the risks, especially in newly diagnosed or relapsed cases. It is important that mitoxantrone is administered by healthcare providers experienced in chemotherapy.

Who should not take it

Mitoxantrone should not be used in patients who have had a previous allergic reaction (hypersensitivity) to mitoxantrone. It is also not recommended for patients with severe liver impairment, as the drug is cleared more slowly and can accumulate to toxic levels. Patients with pre-existing myelosuppression (low blood cell counts due to previous treatments) should not receive mitoxantrone unless the potential benefit justifies the risk of further bone marrow suppression.

Mitoxantrone should not be given by routes other than intravenous infusion. It must not be administered intrathecally (into the spinal canal) due to the risk of severe neurological damage. Women who are pregnant or may become pregnant should avoid this medication due to the risk of harm to the unborn baby.

Commonly used with

In blood cancers, mitoxantrone is commonly used in combination with other chemotherapy drugs such as cytarabine for acute nonlymphocytic leukemia. In advanced prostate cancer, it is often combined with corticosteroids like prednisone or hydrocortisone.

The combination is chosen by your healthcare team based on your specific diagnosis and treatment goals.

Commonly tested with

Mitoxantrone has been tested in clinical trials with cytarabine for leukemia and with corticosteroids (prednisone or hydrocortisone) for prostate cancer. In multiple sclerosis, it has been studied in combination with methylprednisolone.

These combinations are designed to enhance the effectiveness of treatment and are based on evidence from clinical studies.