Author Topic: Mitoxantrone may raise colorectal cancer risk  (Read 111 times)

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Offline agate

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Mitoxantrone may raise colorectal cancer risk
« on: May 13, 2016, 03:05:28 pm »
Novantrone (mitoxantrone) isn't used very often in MS, mainly because of possible cardiac complications and acute myeloid leukemia (AML). Now it seems that it may put patients at a greater risk for colorectal cancer.

From Medical News Today, May 12, 2016:

Quote
MS drug may raise colorectal cancer risk


Written by Honor Whiteman

For the first time, a new study suggests patients with multiple sclerosis who use the drug mitoxantrone may be at greater risk for colorectal cancer.

The study suggests MS patients who use mitoxantrone are 10 times more likely to develop colorectal cancer.
Furthermore, the study - published in the journal Neurology - supports previous research that suggests the drug raises the risk of acute myeloid leukemia (AML).

Mitoxantrone - brand name Novantrone - is a drug approved for the reduction of disease relapses among patients with aggressive multiple sclerosis (MS) who do not respond to other therapies.

The drug works by suppressing the immune system, reducing the activity of T cells, B cells, and macrophages that are believed to promote the attack on myelin - the protective coating that surrounds nerves.

However, Dr. Mathias Buttmann, of the University of Würzburg, Germany, and colleagues note that the use of mitoxantrone for MS is limited, primarily because previous research has suggested the drug raises the risk of heart problems and AML.

For this latest study, the team further investigated the association between mitoxantrone and cancer.


Using medical records of patients treated at a German hospital-based MS center between 1994-2007, the researchers identified 676 individuals with MS who were treated with mitoxantrone.

Over a median follow-up period of 8.7 years, 37 - 5.5 percent - of the patients developed cancer after using mitoxantrone, including breast cancer, colorectal cancer, and AML.

On comparing cancer incidence among these patients with the general population of Germany, the researchers found that patients with MS treated with mitoxantrone were at 10 times greater risk of AML.

The rate of colorectal cancer was found to be three times higher among mitoxantrone-treated patients than the general population - an association that had not been identified previously.

The rate of breast cancer and other cancer types was no higher for patients treated with mitoxantrone than the general population, the researchers report.

Cancer risk 'acceptably low to justify mitoxantrone use' in severe cases

Of four patients treated with mitoxantrone who developed AML, three were treated successfully and were alive at the end of follow-up.

Of the seven mitoxantrone-treated patients who developed colorectal cancer, three died during follow-up. The researchers say this indicates that colorectal cancer is more life-threatening for MS patients treated with mitoxantrone than AML.

Older age at first use of mitoxantrone was found to be a risk factor for cancer development. However, cumulative mitoxantrone dose and use of other drugs that suppress the immune system did not appear to affect cancer risk.

While the findings clearly indicate an increased risk of AML and colorectal cancer with mitoxantrone use, the team says the overall cancer incidence in this cohort "appears acceptably low to justify mitoxantrone treatment in severely affected patients with MS if no better therapeutic alternative is available."

"Mitoxantrone is the only approved treatment for people with secondary progressive MS without relapses and should be considered in people where the disease is evolving quickly.

"Also, many of the new and highly effective MS drugs are not available to people in a number of countries for economic reasons, so mitoxantrone is being used for people with very active relapsing forms of the disease."

Dr. Buttmann notes that their findings need to be confirmed in a larger study. If they are confirmed, he suggests that MS patients undergo colonoscopies following mitoxantrone use to screen for colorectal cancer.




The article can be seen here.
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

Offline agate

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Re: Mitoxantrone may raise colorectal cancer risk
« Reply #1 on: May 17, 2016, 05:25:03 pm »
This doesn't seem to add much information but there is another article about this in DocGuide Weekly, May 11, 2016:

Quote
MS Drug Mitoxantrone Linked to Increased Risk of Colorectal Cancer

The multiple sclerosis (MS) drug mitoxantrone may be associated with an increased risk of colorectal cancer, according to a study published in the May 11, 2016, online issue of the journal Neurology.

Mitoxantrone is used for aggressive types of relapsing-remitting or progressive MS that do not respond to other MS drugs. But its use is limited because previous studies have shown an increased risk of leukaemia and heart damage.

The current study examined whether the drug increases the risk of other types of cancer.

Mathias Buttmann, MD, University of Würzburg, Würzburg, Germany, and colleagues looked at all people with MS who were treated with mitoxantrone from 1994 to 2007 and followed them until 2010.

Of the 676 people, 37 people (5.5%) were diagnosed with cancer after taking the drug, including 9 people with breast cancer, 7 with colorectal cancer, and 4 with acute myeloid leukaemia, which has been associated with mitoxantrone.

The rate of leukaemia was 10 times higher in the people treated with mitoxantrone than in the general population in Germany. The rate of colorectal cancer was 3 times higher than that of the general population.

For breast cancer and all other types of cancer, people who had taken mitoxantrone were no more likely to develop the diseases than those in the general population.

Of the 7 people with colorectal cancer, 3 died from the cancer during the study. The 4 people with leukaemia all went into remission after treatment and were alive at the end of the study.

The researchers also looked at whether factors such as how much of the drug people had received cumulatively and whether they also received other immunosuppressant drugs affected their risk of developing cancer. The only factor related to a higher risk of cancer was being older when starting to take the drug.

“Despite an increased risk of acute myeloid leukaemia and colorectal cancer, the overall rate of cancer was low enough to justify still using this drug for people severely affected by MS if no better treatment is available,” said Dr. Buttmann. “Mitoxantrone is the only approved treatment for people with secondary progressive MS without relapses and should be considered in people where the disease is evolving quickly. Also, many of the new and highly effective MS drugs are not available to people in a number of countries for economic reasons, so mitoxantrone is being used for people with very active relapsing forms of the disease.”

He noted that the study was relatively small and needs to be confirmed. If the results are confirmed, he said that colonoscopies should be given after treatment with the drug to screen for colorectal cancer, which can be treated more effectively when diagnosed earlier.

SOURCE: American Academy of Neurology
MS Speaks--online for 13 years

SPMS, diagnosed 1980. Avonex 2001-2004. Copaxone 2007-2010.

 

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