Mitoxantrone (Novantrone)

General information

Class/mechanism: Synthetic antineoplastic anthracenedione, intercalates into DNA, causing crosslinking and strand breaks. Mitoxantrone inhibits topoisomerase II, which helps to uncoil and repair damaged DNA. It also has been observed to interfere with RNA and has activity against resting and proliferating cells. In vitro, it has been observed to interfere with antigen presentation; inhibit B-cell, T-cell, and macrophage proliferation; and decrease secretion of interferon gamma, tumor necrosis factor-alpha (TNF-α), and interleukin-2 (IL-2).
Route: IV
Extravasation: irritant (usually), vesicant (rare)

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Acute lymphocytic leukemia
• Acute myeloid leukemia
• Acute promyelocytic leukemia
• Chronic lymphocytic leukemia (CLL) and Small lymphocytic lymphoma (SLL)
• Diffuse large B-cell lymphoma
• Follicular lymphoma
• Hodgkin lymphoma
• Mantle cell lymphoma
• Marginal zone lymphoma
• Prostate cancer

Patient drug information

• Mitoxantrone (Novantrone) package insert PDF page 36-41
• Mitoxantrone (Novantrone) patient drug information (Chemocare)
• Mitoxantrone (Novantrone) patient drug information (UpToDate)

History of changes in FDA indication

• 12/23/1987: Initial FDA approval for the initial treatment of acute nonlymphocytic leukemia (ANLL)
• 11/13/1996: Approved in combination with corticosteroids as initial chemotherapy for the treatment of patients with pain related to advanced hormone-refractory prostate cancer.