Mitoxantrone adverse effects

Adverse Effects Adverse effects are seen regularly in patients given mitoxantrone (see Table 26-3). Patients often experience bluish discoloration of the sclera and the urine for 24 hours after infusion.46 Transient leukopenia and neutropenia are common with a nadir 10 to 14 days after the infusion. Patients should avoid exposure to infectious individuals during this time.46 Patients taking mitoxantrone should not receive live virus vaccines other vaccines should be held for 4 to 6 weeks after a mitoxantrone dose.46 Amenorrhea, caused by a direct toxic effect on the ovary, may be permanent, an important consideration because the MS population includes women of childbearing potential.27... 

Cardiotoxicity is a serious, rare adverse effect of mitox-antrone. The incidence of congestive heart failure was 0.15% in patients with normal left ventricular ejection fraction and 2.18% in those who had asymptomatic left ventricular ejection fraction of less than 50% at baseline.46 Therefore, mitoxantrone should not be used in patients with baseline cardiomyopathy, even if asymptomatic. The risk of cardiotoxicity is dose-related. The maximum lifetime dose of mitoxantrone is 140 mg/m2, or about 3 years of MS therapy. The use of cyclooxygenase-2 inhibitors should be avoided in patients receiving mitoxantrone because of a potential for worsening cardiac toxicity.46... 

Palliative responses were noted in 29% of patients in the mitoxantrone plus prednisone group and 12% of patients in the prednisone-alone group. The duration of palliative response was greater and quality-of-life scores for pain, physical activity, constipation, and mood were better in patients who received mitoxantrone plus prednisone. Overall survival was the same in both groups. Patients treated with mitoxantrone plus prednisone experienced tolerable adverse effects, although five patients did develop some cardiac-related adverse effects. Mitoxantrone plus corticosteroids is approved by the FDA for hormone-refractory prostate cancer. 

On May 19, 2004, docetaxel was approved for the treatment of metastatic prostate cancer. The approval was based on the TAX327 study, a randomized, multicenter global clinical trial enrolling over 1000 men with metastatic, hormone-refractory prostate cancer. The study compared docetaxel 75 mg/m every 3 weeks and prednisone 5 mg twice a day with docetaxel 35 mg/m weekly five out of six weeks and prednisone 5 mg twice a day and mitoxantrone 75 ng/m every 3 weeks and prednisone 5 mg twice a day. Docetaxel, in combination with prednisone, given every 3 weeks showed a survival advantage of approximately 2.5 months over the control group in the trial p =. 009). The most common adverse events reported were nausea, alopecia, and bone marrow suppression. In addition, fluid retention and peripheral neuropathy, known effects of docetaxel, were... 

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