"Mitoxantrone (Novantrone)" TUMOR TIDBITS, A BIWEEKLY VETERINARY ONCOLOGY E-LETTER Volume 3; Number 24; July 5, 2002. Editor: Kevin A. Hahn, DVM, PhD, Dipl - ACVIM (Oncology) & Overall Nice Guy! ANNOUNCEMENTS 1 - We're proud of our residents! Of the 8 active and approved programs nationwide, we're the only clinical practice training oncology residents? Check our web site for more information about Drs. Freeman and Turner. They see more cancer patients that all other programs COMBINED! 2 - We're beginning a Phase 2 clinical trial to prevent weakness and anemia in cancer patients and 'geriatric' patients in July - check the web for details. 3 - We're still enrolling dogs with lymphoma into a clinical trial using a novel antiangiogenic agent. It is for dogs with relapsed lymphoma and the criteria for entry are strict. Call or email us for additional details. THIS WEEK'S TUMOR TIDBIT: Mitoxantrone (Novantrone) Do you have a pet with heart disease and Adriamycin (Doxorubicin) is indicated for the cancer treatment. Knowing that Adriamycin is cardiotoxic limits your ability to manage the cancer right? Wrong. Think about Mitoxantrone. Here's a brief tidbit on "Blue Thunder": CHEMICAL NATURE 1,4-dihydroxy-5,8-bis[[2-[(2-hydroxyethyl) amino]ethyl]amino]-9,10- anthracenedione dihydrochloride; structurally related to the anthracyclines doxorubicin and daunorubicin; available in 10, 12.5 or 15 ml vials (2 mg/ml); solution must be diluted prior to use; incompatible with heparin. PHARMACOLOGY Anticancer antibiotic. Similar to doxorubicin in action. Rapidly distributed to tissues; does not enter CNS nor eye in appreciable quantities following parenteral administration; halflife is days; excreted primarily by liver. INDICATIONS Used for leukemia, lymphoma, and soft tissue sarcomas and carcinomas (especially head and neck squamous cell carcinoma and transitional cell carcinoma of the urinary bladder). DOSING INFORMATION Dogs: 5 to 6 mg/m2 IV (30 minute infusion) every 14 to 21 days. Cats: 6.5 mg/m2 IV (30 minute infusion) every 21 days. COST The typical 20 mg vial costs about $800, or $40 per mg. Therefore a medium sized dog would get 5 mg of Mitoxantrone at "cost" for $200 in drug. Mitoxantrone can be refrigerated and multidosed from a single vial. Caution should always be used in preparing, storing, and administering cytotoxic agents. CONTRAINDICATIONS As with all anticancer agents, certain adverse effects are predictable and unavoidable and related to drug's action. Mitoxantrone produces myelosuppression, vomiting, anorexia, and gastrointestinal upset, but may be less cardiotoxic than doxorubicin. Contraindicated in patients with severe myelosuppression. No apparent cumulative dose-limiting cardiotoxicity in dogs or cats. ADVERSE REACTIONS/DRUG INTERACTIONS Severe but not life-threatening myelosuppression. Congestive heart failure rare (less cardiotoxic than doxorubicin and does not appear to potentiate doxorubicin-induced cardiac abnormalities). Mutagenic in vitro; fetal toxicity observed. Nausea, vomiting, diarrhea, lethargy, sepsis secondary to myelosuppresion, and seizures have been reported in the dog and cat. Signs are more likely to occur in older animals and likely to occur in subsequent treatments if noticed following the first treatment. Synergistic toxicity (nausea, vomiting, etc.) with cytarabine. WHAT DO WE DO AT GULF COAST? We use Mitoxantrone commonly in our practice and here's a brief list of our indications: -Bladder tumors, especially when combined with palliative radiation -Nasal tumors, especially when combined with palliative radiation -Lymphomas, especially Adriamycin sensitive lymphomas that have reached a cumulative dose limit -Squamous cell carcinomas, especially when combined with palliative radiation I hope this info helps. Don't hesitate to call or email us at Gulf Coast Veterinary Oncology! Kevin Kevin A. Hahn, DVM, PhD Diplomate American College of Veterinary Internal Medicine (Oncology) & Overall Nice Guy Gulf Coast Veterinary Diagnostic Imaging & Oncology 1111 West Loop South, Suite 150, Houston, TX 77027 P: 713.693.1166 F: 713.693.1167 W: http://www.gcvs.com Email: mailto:drhahn@gcvs.com