The study did not, unfortunately, provide any additional information on these patients, including personal/family history of CRC, polyps, or whether the patients were up to date on CRC screening throughout mitoxantrone-treatment course. This has been 1 of the few studies to report this link between CRC and mitoxantrone use.

There are also prior studies showing some modest effect of mitoxantrone in actually treating patients with advanced CRC.3,4 Although it is not considered a first-line or standard of care treatment, it is unusual that there are conflicting reports about an agent such as mitoxantrone: it is associated with both the treatment and the development of the same cancer.


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These studies raise interesting questions: as mitoxantrone appears to increase the risk (albeit low) of post-treatment malignancy for certain cancers, should there be a screening protocol in place for these patients? Should these patients have different screening guidelines than the rest of the population?

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Based on the Neurology study, it may be warranted to alter the traditional CRC screening guidelines for patients receiving mitoxantrone. It is unclear, however, whether the increased risk of CRC is seen only among patients with MS or among all patients treated with mitoxantrone. There may be underdetermined pathophysiologic factors in patients with MS that predispose them to the carcinogenic side effects of mitoxantrone.

References

  1. Mitoxantrone Prescribing Information. FDA website. http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/019297s030s031lbl.pdf. Updated August 2008. Accessed October 2016.
  2. Buttmann M, Seuffert L, Mader U, Toyka KV. Malignancies after mitoxantrone for multiple sclerosis. Neurology. 2016;86:2203–7.
  3. Caponigro F, Avallone A, Rivellini F, et al. Phase I study of mitoxantrone, raltitrexed, levofolinic acid and 5-fluorouracil in advanced solid tumours. Cancer Chemother Pharmacol. 2001;47(2):113-6.
  4. Link KH, Sunelaitis E, Kornmann M, et al. Regional chemotherapy of nonresectable colorectal liver metastases with mitoxantrone, 5-fluorouracil, folinic acid, and mitomycin C may prolong survival. Cancer. 2001 Dec 1;92(11):2746-53.