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Mitoxantrone

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Drug Management of Prostate Cancer

Abstract

Mitoxantrone (dihydroxyanthracenedione, DHAD) is an anthracenedione derivative developed in the 1970s in an effort to find a less cardiotoxic doxorubicin derivative. Although the exact mechanism of action remains unclear, mitoxantrone intercalates between base pairs of the DNA double helix, resulting in cross links, strand breaks, and inhibition of nucleic acid synthesis. Early studies with mitoxantrone demonstrated a low potential for drug–drug interactions, other than a significantly increased risk of infection when administered concomitantly with live vaccines. Currently, there are five black box warnings described in the US package insert. Initially approved in 1987 for treatment of acute non-lymphocytic leukemia (ANLL – now AML) in adults, mitoxantrone was approved in 1996 for use in combination with corticosteroids as initial chemotherapy for the treatment of patients with pain related to advanced castration-resistant prostate cancer (CRPC). For this indication, the recommended dosage is 12–14 mg/m2 every 3 weeks, as a 30-min intravenous infusion. In multiple large randomized studies, mitoxantrone plus prednisone was shown to reduce pain and increase quality of life for patients with CRPC, though it does not extend survival. Subsequent to the approval of docetaxel as a treatment for CRPC, mitoxantrone has primarily been used as a second-line therapy.

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Author information

Authors and Affiliations

  1. Clinical Pharmacy, Nevada Cancer Institute, Las Vegas, NV, USA

    Patricia Halterman

Authors
  1. Patricia Halterman
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  2. Nicholas J. Vogelzang
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  3. Alireza Farabishahadel
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  4. Oscar B. Goodman Jr.
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Corresponding author

Correspondence to Patricia Halterman .

Editor information

Editors and Affiliations

  1. Medical Oncology Branch, NIH National Cancer Institute, Rockville Pike 9000, Bethesda, 20892, Maryland, USA

    William D. Figg

  2. Medical Oncology Branch, NIH National Cancer Institute, Rockville Pike 9000, Bethesda, 20892, Maryland, USA

    Cindy H. Chau

  3. School of Medicine, Dept. Urology, University of California, San Francisco, Divisadero Street 1600, San Francisco, 94115, California, USA

    Eric J. Small

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Halterman, P., Vogelzang, N.J., Farabishahadel, A., Goodman, O.B. (2010). Mitoxantrone. In: Figg, W., Chau, C., Small, E. (eds) Drug Management of Prostate Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-60327-829-4_11

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  • DOI: https://doi.org/10.1007/978-1-60327-829-4_11

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  • Publisher Name: Springer, New York, NY

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  • Online ISBN: 978-1-60327-829-4

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