COMMON TRADE NAME(S):

Mitoxantrone injection, NOVANTRONE(r) (USA)

CLASSIFICATION:

intercalating agent-antitumour antibiotic, cytotoxic

Special pediatric considerations are noted when applicable, otherwise adult provisions apply.

MECHANISM OF ACTION:

Mitoxantrone is a synthetic anthracenedione that is structurally similar to doxorubicin and daunorubicin.2,4 It was synthesized with the goal to reduce anthracycline side effects, particularly cardiotoxicity.5 Mitoxantrone inhibits DNA repair by inhibiting topoisomerase II4,6 which results in fragmentation of DNA.7 Mitoxantrone is an immunosuppressive agent4,6 that may also generate free radicals, inhibit protein kinase C, cause electrostatic DNA cross-links, and induce apoptosis.2 Although maximally cytotoxic in the S-phase, mitoxantrone is not cell cycle phase-specific.2,8 Cross-resistance with anthracyclines has been demonstrated.2

PHARMACOKINETICS:

Oral Absorption poor 6
Distribution extensive tissue distribution; 3X greater AUC in patients with severe hepatic dysfunction
cross blood brain barrier? not to an appreciable extent
volume of distribution 6 14 L/kg; distributes into pleural fluid, kidney, thyroid, liver, heart, and red blood cells
plasma protein binding 6 >95%; 76% to albumin
Metabolism hepatic, pathways undetermined
active metabolite(s) no information found
inactive metabolite(s) 9 yes
Excretion urine 2,6 6-11%; 65% unchanged
feces 6 25%; 65% unchanged
terminal half life 23-215 h; prolonged by hepatic impairment
clearance 10 10.9-37.4 L/hr/m 2
Elderly decreased clearance

Adapted from standard reference4 unless specified otherwise.

USES:

Primary uses: Other uses:
*Leukemia, including acute non-lymphocytic *Breast cancer
Prostate cancer 11 *Hepatoma
* Lymphoma
Pediatric sarcoma 6

*Health Canada approved indication

SPECIAL PRECAUTIONS:

Contraindications:

history of hypersensitivity reaction to anthracyclines or mitoxantrone4 severe hepatic impairment4; safety in patients with hepatic impairment has not been established4; reduced dosage has been used4 Caution: when used in combination regimens, the initial dose should be reduced by 2-4 mg/m2 below the recommended dose for single-agent usage4 Cardiac toxicity is a risk of mitoxantrone therapy that may be manifested by acute or delayed events4; see paragraph following the Side Effects table for more information. Risk factors for developing mitoxantrone-induced cardiotoxicity include4: high cumulative dose (>100 mg/m2); if exceeded, monitor for evidence of cardiac toxicity prior to each subsequent dose previous therapy with other anthracyclines or anthracenediones prior or concomitant radiotherapy to the mediastinal/pericardial area pre-existing heart disease [left ventricular ejection fraction (LVEF) <50% or a clinically-significant reduction in LVEF] concomitant use of other cardiotoxic drugs Carcinogenicity: Studies not preformed to date.4 Acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) have been reported when used alone but more so when used with other antineoplastic agents and/or radiation.4 Mutagenicity: Mutagenic in microbial mutagenicity tests.4 Mitoxantrone is clastogenic in mammalian in vivo chromosome tests; at doses approximating clinical use levels, the clastogenic effect is reversible.4 Fertility: Amenorrhea and a typically reversible reduction in spermatogenesis have been reported.4,9,12 At the highest tolerated doses allowing evaluation of reproduction in rats, mitoxantrone had no effect on fertility.4 Pregnancy: FDA Pregnancy Category D.6 There is positive evidence of human fetal risk, but the benefits from use in pregnant women may be acceptable despite the risk (e.g., if the drug is needed in a life-threatening situation or for a serious disease for which safer drugs cannot be used or are ineffective).

Breastfeeding 4

is not recommended due to secretion into breast milk.

SIDE EFFECTS:

The table includes adverse events that presented during drug treatment but may not necessarily have a causal relationship with the drug. Because clinical trials are conducted under very specific conditions, the adverse event rates observed may not reflect the rates observed in clinical practice. Adverse events are generally included if they were reported in more than 1% of patients in the product monograph or pivotal trials, and/or determined to be clinically important.13

ORGAN SITE SIDE EFFECT Mitoxantrone is typically well tolerated at standard doses. 4
Clinically important side effects are in bold, italics
allergy/immunology allergic reactions; including anaphylaxis (<1%) 6
blood/bone marrow/ febrile neutropenia anemia (5-75%) 6
leukopenia (9-100%) 6 ; nadir typically occurs on day 10 with recovery by day 21
myelosuppression ; dose-limiting; severe myelosuppression is rare
thrombocytopenia (33-39%) 6
cardiovascular (arrhythmia) arrhythmia (3-18%) 6 ; including sinus bradycardia
ECG changes 6 (11%) 6
ORGAN SITE SIDE EFFECT Mitoxantrone is typically well tolerated at standard doses. 4
Clinically important side effects are in bold, italics
cardiovascular (general) cardiomyopathy
CHF (2-5%) 4,6 ; may occur during and months to years after treatment; deaths have occurred
decreased left ventricular ejection fraction ( < 13%) 4,6 ; may occur during and months to years after treatment
hypertension 6 (4%) 6
hypotension
ischemia 6 (5%) 6
myocardial infarction
constitutional symptoms diaphoresis 6 (9%) 6
fatigue ( < 39%) 6
fever (6-78%) 6
weight changes (13-17%) 6
dermatology/skin extravasation hazard: irritant 14 ; rare cases of tissue necrosis have been reported; reversible blue discolouration of the skin has occurred with extravasation
alopecia * (15-61%, severe 1%) 4,6 ; typically mild; case reports of selective alopecia of white but not dark hair 9
bruising 6 (6-11%) 6
nail pigmentation
onycholysis (11%) 6
gastrointestinal emetogenic potential: low to low- moderate 15
anorexia (22-25%) 6
constipation (10-16%) 6
diarrhea * (4-47%) 6,9
dyspepsia 6 (5-14%) 6
nausea and vomiting * (10-35%, severe 4%) 4,9 typically mild and transient
stomatitis/mucositis * (4-54%, severe <1%) 4,6,9 ; typically occurs within 1 week of treatment 9
ulcers 6 (10%) 6
hemorrhage gastrointestinal bleed (2-16%) 6
hemorrhage * (6%) 6
hepatobiliary/pancreas hepatic toxicity * (<1%) 9 ; severe impairment reported in leukemic patients
infection infection *; including urinary tract (7-32%), 6 upper respiratory tract (7-53%), 6 pneumonia (9%) 6
lymphatics edema (10-31%) 6
metabolic/laboratory hyperglycemia 6 (10-31%) 6 ; likely related to concurrent steroid administration 13
hyperuricemia
hypocalcemia (10%) 6
ORGAN SITE SIDE EFFECT Mitoxantrone is typically well tolerated at standard doses. 4
Clinically important side effects are in bold, italics
hypokalemia (7-10%) 6
hyponatremia 6 (9%) 6
increased blood urea nitrogen (22%)
increased liver enzymes ( < 37%) 6,9
increased serum creatinine (13%) 6
proteinuria 6 (6%) 6
musculoskeletal weakness (24%) 6
neurology anxiety (5%) 6
confusion
depression 6 (5%) 6
drowsiness
paraesthesia
seizures 6 (2-4%) 6
ocular/visual blue discolouration of the sclera (<1%); reversible
blurred vision 6 (3%) 6
conjunctivitis 6 (5%) 6
pain headache (6-13%) 6
pain 6 (8-41%) 6 ; including abdominal pain (9-15%), 6 back pain 6 (8%), 6 myalgia 6 (5%), 6 arthralgia 6 (5%) 6
pulmonary cough 6 (5-13%) 6
dyspnea (6-18%) 6
rhinitis/sinusitis 6 (5-6%) 6
renal/genitourinary blue-green colouration of urine (6-11%) 6 ; typically occurs for 24h after treatment
hematuria 6 (11%) 6
renal toxicity (8%) 6
secondary malignancy AML and MDS (~1-2%) 4,6
sexual/reproductive function amenorrhea (28-53%), 6 menstrual disorder 6 (26-61%) 6
impotence 6 (7%) 6
reduction in spermatogenesis; typically reversible 4,9,12
syndromes tumour lysis syndrome (<1%)

Adapted from standard reference4 unless specified otherwise. *In leukemic patients, due to higher doses used, the side effects profile may differ; the following toxicities have been reported6,8: diarrhea, 9-13% increased incidence of bleeding and infection; sepsis, 31-34% moderate nausea or vomiting, 8% moderate or severe alopecia, 11 % moderate or severe stomatitis/mucositis, 9-29% moderate or severe jaundice or hepatitis, 8% Cardiotoxicity may manifest as EKG changes, an asymptomatic decrease in LVEF, cardiomyopathy, and symptomatic congestive heart failure (CHF).4,6 Evaluation of LVEF is recommended4: prior to initiating therapy if signs and symptoms of CHF develop in patients with risk factors; see paragraph in the Special Precautions section for more information prior to all doses received after a cumulative dose of 100 mg/m2 is reached Cardiotoxicity is cumulative across all anthracyclines and anthracenediones and is thought to be due to in part to free radical damage.2,16 Irreversible CHF may occur during therapy or months to years afterwards; deaths have occurred. At the cumulative dose of 140 mg/m2, the incidence of symptomatic CHF and moderate or severe decline in LVEF are 2.6 and 13 percent respectively.4 Like the anthracyclines, mitoxantrone-induced heart failure responds to standard medical therapy.4 Hyperuricemia may result from cell lysis by cytotoxic chemotherapy and may lead to electrolyte disturbances or acute renal failure.17 It is most likely with highly proliferative tumours of massive burden, such as leukemias, high- grade lymphomas, and myeloproliferative diseases. The risk may be increased in patients with preexisting renal dysfunction, especially ureteral obstruction. Suggested prophylactic treatment for high-risk patients18: aggressive hydration: 3 L/m2/24 hr with target urine output > 100 mL/hr if possible, discontinuation of drugs that cause hyperuricemia (e.g., thiazide diuretics) or acidic urine (e.g., salicylates) monitoring of electrolytes, calcium, phosphate, renal function, LDH, and uric acid q6h x 24-48 hours electrolyte replacement as required allopurinol 600 mg po initially, then 300 mg po q6h x 6 doses, then 300 mg po daily x 5-7 days Urine should be alkalinized only if the uric acid level is elevated, using sodium bicarbonate IV or PO titrated to maintain urine pH > 7. Rasburicase (FASTURTEC(r)) is a novel uricolytic agent that catalyzes the oxidation of uric acid to a water-soluble metabolite, removing the need for alkalinization of the urine.19It may be used for treatment or prophylaxis of hyperuricemia, 0.2 mg/kg IV daily for up to 7 days; however, its place in therapy has not yet been established.

INTERACTIONS:

AGENT EFFECT MECHANISM MANAGEMENT
quinolones (e.g., ciprofloxacin) 20 delayed, moderate, possible; the antimicrobial effect of quinolones may be decreased quinolone absorption decreased due to alteration of the intestinal mucosa monitor for response to quinolone therapy, adjust quinolone dose as necessary

SUPPLY AND STORAGE:

Injection4

: Hospira Healthcare Corporation supplies mitoxantrone as a 2 mg/mL dark blue solution in 10 and 12.5 mL single-use vials. Store at room temperature; do not freeze. Protect from light.

Novopharm Limited supplies mitoxantrone as a 2 mg/mL dark blue solution in 10 mL single-use vial. Store at room temperature; do not freeze. Protect from light.8 Pharmaceutical Partners of Canada supplies mitoxantrone as a 2 mg/mL dark blue solution in 10 mL single-use vial. Store at room temperature; do not freeze.7 Product is not light- sensitive.21

For basic information on the current brand used at the BC Cancer Agency, see Chemotherapy Preparation and Stability Chart in Appendix.

SOLUTION PREPARATION AND COMPATIBILITY:

For basic information on the current brand used at the BC Cancer Agency, see Chemotherapy Preparation and Stability Chart in Appendix.

Additional information: 4,7,8

should be diluted to at least 50 mL prior to use

Compatibility:

consult detailed reference

PARENTERAL ADMINISTRATION:

BCCA administration guideline noted in bold , italics
Subcutaneous 4 not recommended
Intramuscular 4 not recommended
Direct intravenous not recommended; has been used 6,22-24
Intermittent infusion 2,4 slowly (over 3-5 minutes ; typically given over 15-30 minutes ) into tubing of running IV
Continuous infusion 1,6 has been used
Intraperitoneal 4,9 has been used
Intrapleural 25 investigational
Intrathecal 4 not recommended; neuropathy and neurotoxicity including paralysis, seizures, and bowel and bladder dysfunction have occurred
Intra-arterial 4 not recommended; local/regional neuropathy which may be irreversible has been reported
Intravesical 26,27 investigational

DOSAGE GUIDELINES:

Refer to protocol by which patient is being treated. Numerous dosing schedules exist and depend on disease, response, and concomitant therapy. Guidelines for dosing also include consideration of absolute neutrophil count (ANC). Dosage may be reduced, delayed or discontinued in patients with bone marrow depression due to cytotoxic/radiation therapy or with other toxicities.

Adults:

BCCA usual dose noted in bold, italics
Cycle Length:
Intravenous: 3 -4 weeks 2,4,6,11 : 12 -14 mg/m 2 IV for one dose on day 1 (total dose per cycle 12-14 mg/m 2 )
induction 4 : 12 mg/m 2 IV once daily for 5 consecutive days starting on day 1 (total dose 60 mg/m 2 )

Cycle Length: induction and re- induction2,4: BCCA usual dose noted in bold, italics 10-12 mg/m2 IV once daily for 2-3 consecutive days starting on day 1 (total dose per cycle 20-36 mg/m2) consodildation:2,4: 12 mg/m2 IV once daily for 2 consecutive days starting on day 1 (total dose per cycle 24 mg/m2)

Suggested maximum cumulative dose4: 100 mg/m2; see cardiotoxicity paragraph following the Side Effects table

Concurrent radiation:

has been used

28-31

Dosage in myelosuppression:

modify according to protocol by which patient is being treated or the product

monograph; if no guidelines available, refer to Appendix 6 "Dosage Modification for Myelosuppression" Dosage in renal failure: safety and effectiveness have not been established4; limited renal excretion, adjustment likely not required2 Dosage in hepatic failure: consider dosage adjustment6; no dosing details found, contraindicated in severe hepatic impairment4

Dosage in dialysis:

extensive tissue binding; unlikely cleared by dialysis; supplemental dose not

required

6,32

Children:

Cycle Length: Intravenous: safety and effectiveness have not been established4; has been used1,4,33 n/a1,33: 8-12 mg/m2 IV once daily for 3-5 consecutive days starting on day 1 (total dose 24-60 mg/m2) n/a1: 0.4 mg/kg/day IV once daily for 3-5 consecutive days starting on day 1 (total dose 1.2-2.0 mg/kg) n/a1: 12 mg/m2 IV once daily for 2-3 consecutive days starting on day 1 (total dose 24-36 mg/m2) 3-4 weeks1: 18-20 mg/m2 IV for one dose on day 1 (total dose per cycle 18-20 mg/m2)

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  4. Hospira Healthcare Corporation. Mitoxantrone Injection, USP Product Monograph. Saint-Laurent, Quebec; 13 June 2007.

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