Cancer Risk with Mitoxantrone

Buttmann M, Seuffert L, Mäder U, Toyka KV. Malignancies after mitoxantrone for multiple sclerosis: A retrospective cohort study. Neurology. 2016 Jun 7;86(23):2203-7.

OBJECTIVE:To assess the therapy-related risk of malignancies in mitoxantrone-treated patients with multiple sclerosis.
METHODS:This retrospective observational cohort study included all mitoxantrone-treated patients with multiple sclerosis seen at our department between 1994 and 2007. We collected follow-up information on medically confirmed malignancies, life status, and cause of death, as of 2010. Malignancy rates were compared to the German national cancer registry matched for sex, age, and year of occurrence.
RESULTS: Follow-up was completed in 676 of 677 identified patients. Median follow-up time was 8.7 years (interquartile range 6.8-11.2), corresponding to 6,220 person-years. Median cumulative mitoxantrone dose was 79.0 mg/m(2) (interquartile range 50.8-102.4). Thirty-seven patients (5.5%) were diagnosed with a malignancy after mitoxantrone initiation, revealing a standardized incidence ratio of 1.50 (95% confidence interval [CI] 1.05-2.08). Entities included breast cancer (n = 9), colorectal cancer (n = 7), acute myeloid leukemia (n = 4, 0.6%), and others (each entity n = 1 or 2). The standardized incidence ratio of colorectal cancer was 2.98 (95% CI 1.20-6.14) and of acute myeloid leukemia 10.44 (95% CI 3.39-24.36). It was not increased for other entities including breast cancer. Multivariate Cox regression identified higher age at treatment initiation but neither cumulative mitoxantrone dose (>75 vs ≤75 mg/m(2)) nor treatment with other immunosuppressive drugs or sex as a risk factor. Fifty-five patients had died, among them 12 of a malignancy and 43 reportedly of other causes.
CONCLUSIONS: While the overall incidence of malignancies was only mildly increased, the risk of leukemia and colorectal cancer was heightened. If confirmed, posttherapy colonoscopy could become advisable.

Mitoxantrone is an anti-cancer drug that is not licenced in the UK ut is sometimes used to treat MS. Its use is limited because it can cause damage to the heart muscles meaning that you can only take a limited number of doses. It is already known that there is a increased risk of cancer. In this German cohort followed for up to a number of years, they report that 5% of people got cancer so that is 1 in 20 people. Whilst life is assocaited with a cancer risk, this appears high and is one of the reasons that our use of ths agent has dwindled. It is strange that there is a resistance against cladribine and I wonder if such people will supply mitoxantrone when the risk of cancer is probably higher.

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  • Dear Angry
    You would not be right about the where abouts of ProfG, MD2 or myslef, although I was educating in Yorkshire for a day.

    As to Mojo…It was decided that we would not post as often as we had been to give use more time to do other things that we need to do and if you do not like the content of the posts you have to complain about what has been published or you need to send us links to things that we may have missed. It requires some action on your part. However others would disagree that the content is boring.

    Rearch Viagra to the content-You must appreciated that the big news is highlighted at ECTRIMS and the AAN and so you will have to wait until Septemeber
    and as we have discussed a number of out own publications recently

    As for your voting habits on Brexit…each to their own…yes lets celebrate British Victories in Sport.

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