The drug mitoxantrone belongs to the group of cytostatic drugs. The drug is administered to treat cancer as well as multiple sclerosis.
What is mitoxantrone?
The cytostatic drug mitoxantrone belongs to the anthracenidione group. It is used to treat malignant cancer and multiple sclerosis. In medicine, the active ingredient also goes by the names mitoxantrone hydrochloride, mitoxantronum, or mitoxantroni hydrochloridum PhEur. The drug was approved in the mid-1980s. In Germany, mitoxantrone is offered as a monopreparation under the trade names Novantron, Haemato-tron and Onkotrone. Furthermore, different generics are on the market.
Pharmacologic Action
Mitoxantrone has the property of destroying cancer cells. However, the way in which this occurs has not yet been conclusively clarified. The cytostatic drug causes damage to DNA (genetic material), resulting in the inhibition of DNA assembly and subsequent death of the cell. Cancer cells are particularly affected by this process, as their division is faster than in healthy cells. Mitoxantrone is able to exert its effect against growing cells on the one hand and against cells in a resting state on the other. Its effect does not depend on the status of cell division. Within the cell cycle, the cytostatic drug unfolds in the phase in which the genetic material of the new cell is assembled. Damage to the genetic material by mitoxantrone occurs in different ways. Thus, the cytostatic drug ensures that the assembly of the genetic material is inhibited. After their knotting, the breaking of DNA strands takes place. In addition, an excess of RNA is produced. These are molecules that are responsible for the procurement of building blocks of the genetic material. In this way, several identical DNA chains are formed, which in turn leads to the death of the cell. Mitoxantrone can have a negative effect not only on cancer cells, but also on bacteria, viruses and parasites. Thus, the immune defense of the human body can be supported. In contrast to anthracyclines, which are often used to treat cancer, mitoxantrone has only a slight tendency to produce free radicals within the tissue. The same applies to the oxidation of blood lipids. These processes ensure that anthracyclines have a harmful effect on the functions of the human heart. Thus, mitoxantrone has fewer side effects than the anthracyclines in this regard. Since mitoxantrone is administered intravenously, its bioavailability is 100 percent. There is a protein formation of 78 percent. Tissue distribution of the cytostatic drug is highly pronounced after intravenous administration. Metabolism of the drug occurs via multiple cytochrome P450 enzymes. Excretion occurs via urine and stool.
Medicinal use and application
Mitoxantrone is suitable for several indications. These include various cancers such as advanced breast cancer associated with the formation of metastases (daughter tumors), acute myeloid leukemia (blood cancer), malignant lymphoma (non-Hodgkin’s syndrome), and advanced prostate cancer that cannot be treated with hormones. Except for breast cancer, mitoxantrone is always given together with other anticancer agents. In the case of prostate cancer, it may also be combined with low-dose glucocorticoids. This is intended to provide relief from pain that cannot be provided by analgesics or radiation. Another area of application for mitoxantrone is multiple sclerosis (MS). The cytostatic drug is used to treat secondary chronic multiple sclerosis. It is also suitable for combating relapsing-remitting MS, which progresses rapidly. Studies have shown that mitoxantrone significantly reduces the relapse rate. Mitoxantrone is always administered by intravenous infusion. Ondansetron may also be given for possible nausea, which is also given intravenously.
Risks and side effects
The administration of mitoxantrone is not infrequently associated with undesirable side effects. In most cases, there is hair loss, nausea, vomiting, fever, feelings of weakness, and fatigue. Female patients fail to have menstrual periods, while males experience inadequate spermatogenesis.Other possible side effects include a deficiency of white blood cells, cardiac arrhythmias, inflammation of the oral mucosa, hypersensitivity reactions, breathing problems, decreased pumping capacity of the heart, liver function disorders, bluish discolored urine, abdominal pain, constipation, loss of appetite, and diarrhea. Less frequently, cardiac muscle weakness, myocardial infarction, platelet deficiency, gastrointestinal bleeding, chest pain, refusal of food, anemia (anemia), and bluish discoloration of veins and nails are seen. A contraindication to mitoxantrone is hypersensitivity to the drug. Careful consideration of the risks and benefits of treatment is required if the patient has infections, severe renal or hepatic dysfunction, marked cardiac disease, or a deficiency of all blood cells. The same applies in the case of previous treatment with anthracyclines, as these can affect the heart. Use of the cytostatic drug should also be refrained from during pregnancy. In addition, consistent contraception is recommended during mitoxantrone therapy. Thus, the genetic material can be damaged by the mitoxantrone, which has a negative effect on the development of the child. Likewise, breastfeeding of the baby must be avoided during treatment with the cytostatic drug. Men are also advised to use contraception during mitoxantrone treatment for up to six months after the end of therapy. There is no treatment of children. There is an increased risk of side effects when mitoxantrone and other anticancer drugs are administered together. In the case of combination with other cytostatic drugs, blood cancer or bone marrow damage may sometimes occur.
