Other Names for this Medication (Brand Names): Mitox, Novantron, Novantrone

Appearance

Injection: A dark blue clear liquid for injection into the bloodstream.

Why this Medication is Used

This medication may be used alone, or in combination with other drugs, for the treatment of breast cancer, prostate cancer, acute myelogenous leukemia, liver cancer and Non-Hodgkin’s lymphoma.

How do you take this Medication

Injection: Mitoxantrone is injected into your vein by your chemotherapy nurse over a few minutes.

Precautions

• Your urine may be coloured blue-green for 1 or 2 days after your treatment. Your body eliminates the drug through both your urine and bowel movements. Wash your hands thoroughly after using the bathroom. In addition, the whites of your eyes may have a slight blue colour during treatment.

• Your doctor may ask you to drink plenty of clear fluids so that you will pass more urine.

• This medication may affect your heart after several treatments. Your doctor may order special heart tests, from time to time, to see how your heart is working.

• Tell your chemotherapy nurse immediately if you feel pain at injection site.

• This chemotherapy should not be used if you are pregnant or breast-feeding. It is important to discuss birth control with your doctor (Note: birth control pills alone are not recommended as the only birth control method). Birth control should also be used by female partners, if you are a male taking this medication

• It is important to tell your doctor if you have chickenpox (or have recently been exposed to someone who has had chickenpox), shingles, kidney disease or liver disease. Any of these conditions could affect therapy with this medication.

• Due to increased risk of infection check with your doctor before having any vaccinations. Check with your doctor, before any surgery or dental work.

• Do not take ASA without your doctor’s knowledge and consent.

> If a doctor has advised you to take ASA to prevent heart disease or stroke, please discuss this with your oncologist (cancer doctor) before starting treatment.

> Do not use ASA (aspirin, acetylsalicylic acid) for headache, fever, or occasional aches and pains; use acetaminophen (Tylenol) instead. Many non-prescription medications contain ASA; always ask your pharmacist’s advice when choosing a product.

For more information on this medication, please call your doctor, pharmacist or nurse.

Nilutamide

Nilutamide (Nilandron) is indicated for add-on therapy following surgical or chemical castration. The drug promotes disease regression, prolongs survival, and decreases bone pain. In one double-blind, randomized multicenter study comparing 225 castrated patients who received nilutamide and 232 castrated patients who received placebo, patients in the nilutamide group showed a longer progression-free survival (21.2 months in the nilutamide group versus 14.7 months in the placebo group), a longer median overall survival (27.3 months versus 23.6 months), and significant improvements in bone pain (54% versus 37%). Side effects, experienced by 86% of nilutamide patients, included hot flashes (28% incidence in treated patients and 22% in placebo patients) and transient night blindness (13% in treated patients and 1% in placebo patients). Less frequent side effects seen in clinical studies were nausea, constipation, and dizziness. Two serious side effects were pulmonary toxicity (2% incidence of interstitial pneumonitis) and hepatotoxicity (1% incidence of hepatitis or marked increases in liver enzymes).

The recommended dosage of nilutamide is six 50-mg tablets once daily for 30 days, followed by three 50 mg tablets once daily, with therapy beginning the same day or the day after surgical castration.

Mitoxantrone

Mitoxantrone (Novantrone) is indicated for hormone-resistant prostate cancer when given in combination with corticosteroids. Available for about 10 years for the treatment of acute non-lymphocytic leukemia, mitoxantrone is also under investigation for metastatic breast cancer and non-Hodgkin’s lymphoma. The drug was approved for prostate cancer on the strength of one open-label Canadian study showing that mitoxantrone plus prednisone significantly reduced bone pain in patients who had failed hormone therapy. The unblinded Canadian study involved 161 patients whose cancer had progressed despite castration and antiandrogen therapy (estrogen, luteinizing-hormone-releasing hormone agonists, cyproterone acetate, or flutamide). Patients were randomized to mitoxantrone 12 mg/m2 IV every three weeks plus 5 mg oral prednisone twice daily, or to prednisone alone. Patients who did not respond to prednisone alone were crossed over to mitoxantrone plus prednisone.

Overall, 38% of patients in the mitoxantrone plus prednisone group reported pain relief (or reduction in analgesic use) compared with 12% of patients on prednisone alone. The duration of pain relief was 33 weeks for the combination and eight weeks for prednisone alone. Also, mitoxantrone delayed progression of the disease (time to progression was 24 weeks compared to 10 weeks for prednisone alone) and reduced prostate specific antigen levels (PSA dropped 75% or more in 27% of patients receiving mitoxantrone compared with 5% of patients on prednisone alone). The most common side effects were nausea, hair loss, fatigue, weight loss and infection, and the most serious side effects were left ventricular dysfunction and myelosuppression. Despite the side effects, mitoxantrone therapy was associated with improvements in the quality of life, both physical and functional.