Mitoxantrone

Mitoxantrone
Clinical data
Trade names	Novantrone
AHFS/Drugs.com	Monograph
MedlinePlus	a608019
Routes of; administration	Mainly intravenous
ATC code	L01DB07 (WHO) ;
Legal status
Legal status	US: WARNING; In general: ℞ (Prescription only);
Pharmacokinetic data
Bioavailability	n/a
Protein binding	78%
Metabolism	Hepatic (CYP2E1)
Elimination half-life	75 hours
Excretion	Renal
Identifiers
	IUPAC name 1,4-dihydroxy-5,8-bis[2-(2-hydroxyethylamino); ethylamino]-anthracene-9,10-dione;
CAS Number	65271-80-9 ;
PubChem CID	4212;
IUPHAR/BPS	7242;
DrugBank	DB01204 ;
ChemSpider	4067 ;
UNII	BZ114NVM5P;
KEGG	D08224 ;
ChEBI	CHEBI:50729 ;
ChEMBL	ChEMBL58 ;
PDB ligand	MIX (PDBe, RCSB PDB);
CompTox Dashboard (EPA)	DTXSID4046947 ;
Chemical and physical data
Formula	C22H28N4O6
Molar mass	444.488 g·mol−1
3D model (JSmol)	Interactive image;
	SMILES O=C2c1c(c(NCCNCCO)ccc1NCCNCCO)C(=O)c3c2c(O)ccc3O;
	InChI InChI=1S/C22H28N4O6/c27-11-9-23-5-7-25-13-1-2-14(26-8-6-24-10-12-28)18-17(13)21(31)19-15(29)3-4-16(30)20(19)22(18)32/h1-4,23-30H,5-12H2 ; Key:KKZJGLLVHKMTCM-UHFFFAOYSA-N ;
	(verify)

Mitoxantrone (INN, BAN, USAN; also known as Mitozantrone in Australia; trade name Novantrone) is an anthracenedione antineoplastic agent.

Uses

Mitoxantrone is used to treat certain types of cancer, mostly acute myeloid leukemia. It improves the survival rate of children suffering from acute lymphoblastic leukemia relapse.^[2]

The combination of mitoxantrone and prednisone is approved as a second-line treatment for metastatic hormone-refractory prostate cancer. This combination was once the first line of treatment; however, a combination of docetaxel and prednisone improves survival rates and lengthens the disease-free period.^[3]

Mitoxantrone is also used to treat multiple sclerosis (MS), most notably the subset of the disease known as secondary-progressive MS. In the absence of a cure, mitoxantrone is effective in slowing the progression of secondary-progressive MS and extending the time between relapses in both relapsing-remitting MS and progressive-relapsing MS.^[4]

Side effects

Mitoxantrone, as with other drugs in its class, may cause adverse reactions of varying severity, including nausea, vomiting, hair loss, heart damage and immunosuppression, possibly with delayed onset. Cardiomyopathy is a particularly concerning effect as it is irreversible; thus regular monitoring with echocardiograms or MUGA scans is recommended for patients.

Because of the risk of cardiomyopathy, mitoxantrone carries a limit on the cumulative lifetime dose (based on body surface area) in MS patients.^[5]

Mechanism of action

Mitoxantrone is a type II topoisomerase inhibitor; it disrupts DNA synthesis and DNA repair in both healthy cells and cancer cells by intercalation^[6]^[7] between DNA bases. It is also classified as an antibiotic.^[8]

Human topoisomerase II beta in complex with DNA and mitoxantrone. PDB entry 4g0v.^[9] Detail showing mitoxantrone (spheres) intercalated with DNA.

References

^ "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
^ Parker C, Waters R, Leighton C, Hancock J, Sutton R, Moorman AV, et al. (December 2010). "Effect of mitoxantrone on outcome of children with first relapse of acute lymphoblastic leukaemia (ALL R3): an open-label randomised trial". Lancet. 376 (9757): 2009–2017. doi:10.1016/S0140-6736(10)62002-8. PMC 3010035. PMID 21131038.
^ Katzung BG (2006). "Cancer Chemotherapy". Basic and clinical pharmacology (10th ed.). New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6. OCLC 157011367.
^ Fox EJ (April 2006). "Management of worsening multiple sclerosis with mitoxantrone: a review". Clinical Therapeutics. 28 (4): 461–474. doi:10.1016/j.clinthera.2006.04.013. PMID 16750460.
^ "Mitoxantrone Hydrochloride (marketed as Novantrone and generics) – Healthcare Professional Sheet text version". U.S. Food and Drug Administration. Retrieved 19 September 2014.
^ Mazerski J, Martelli S, Borowski E (1998). "The geometry of intercalation complex of antitumor mitoxantrone and ametantrone with DNA: molecular dynamics simulations". Acta Biochimica Polonica. 45 (1): 1–11. doi:10.18388/abp.1998_4280. PMID 9701490.
^ Kapuscinski J, Darzynkiewicz Z (December 1985). "Interactions of antitumor agents Ametantrone and Mitoxantrone (Novatrone) with double-stranded DNA". Biochemical Pharmacology. 34 (24): 4203–4213. doi:10.1016/0006-2952(85)90275-8. PMID 4074383.
^ "Mitoxantrone".
^ Wu CC, Li YC, Wang YR, Li TK, Chan NL (December 2013). "On the structural basis and design guidelines for type II topoisomerase-targeting anticancer drugs". Nucleic Acids Research. 41 (22): 10630–10640. doi:10.1093/nar/gkt828. PMC 3905874. PMID 24038465.

External links

"Mitoxantrone". Drug Information Portal. U.S. National Library of Medicine.

[FDA-AllBoxedWarnings-1] "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.

[Parker-2] Parker C, Waters R, Leighton C, Hancock J, Sutton R, Moorman AV, et al. (December 2010). "Effect of mitoxantrone on outcome of children with first relapse of acute lymphoblastic leukaemia (ALL R3): an open-label randomised trial". Lancet. 376 (9757): 2009–2017. doi:10.1016/S0140-6736(10)62002-8. PMC 3010035. PMID 21131038.

[3] Katzung BG (2006). "Cancer Chemotherapy". Basic and clinical pharmacology (10th ed.). New York: McGraw-Hill Medical Publishing Division. ISBN 0-07-145153-6. OCLC 157011367.

[Fox-4] Fox EJ (April 2006). "Management of worsening multiple sclerosis with mitoxantrone: a review". Clinical Therapeutics. 28 (4): 461–474. doi:10.1016/j.clinthera.2006.04.013. PMID 16750460.

[FDA_Postmarket_Drug_Safety-5] "Mitoxantrone Hydrochloride (marketed as Novantrone and generics) – Healthcare Professional Sheet text version". U.S. Food and Drug Administration. Retrieved 19 September 2014.

[pmid-6] Mazerski J, Martelli S, Borowski E (1998). "The geometry of intercalation complex of antitumor mitoxantrone and ametantrone with DNA: molecular dynamics simulations". Acta Biochimica Polonica. 45 (1): 1–11. doi:10.18388/abp.1998_4280. PMID 9701490.

[7] Kapuscinski J, Darzynkiewicz Z (December 1985). "Interactions of antitumor agents Ametantrone and Mitoxantrone (Novatrone) with double-stranded DNA". Biochemical Pharmacology. 34 (24): 4203–4213. doi:10.1016/0006-2952(85)90275-8. PMID 4074383.

[8] "Mitoxantrone".

[9] Wu CC, Li YC, Wang YR, Li TK, Chan NL (December 2013). "On the structural basis and design guidelines for type II topoisomerase-targeting anticancer drugs". Nucleic Acids Research. 41 (22): 10630–10640. doi:10.1093/nar/gkt828. PMC 3905874. PMID 24038465.

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