미톡산트론

항종양제 - 안트라센디온계

미톡산트론은 개와 고양이의 다양한 악성 종양 치료에 사용되는 합성 안트라센디온계 항종양제입니다. **주요 임상 적용:** * **림프종:** 1차 치료 프로토콜(예: CHOP)이 실패했을 때 구제 약물로 자주 사용됩니다. * **암종(Carcinomas):** 이행세포암(TCC), 편평세포암, 신장 선암, 갑상선암에 효과적입니다. * **육종(Sarcomas):** 섬유육종, 혈관주위세포종, 유선 선암에 사용됩니다. **임상 핵심 정보:** * 구조적으로 안트라사이클린계(독소루비신 등)와 유사하지만 아미노당 부분이 없어 활성산소 생성을 크게 줄입니다. 이로 인해 독소루비신보다 **심장 독성이 훨씬 낮습니다**. * 신장 청소율이 매우 낮기 때문에(~10%), 신부전이 있는 고양이에게 독소루비신보다 훨씬 안전한 대안입니다. * 짙은 파란색과 강력한 효능 때문에 수의 종양학에서는 종종 "블루 썬더(blue thunder)"라고 불립니다.

작용 기전: Mitoxantrone exerts its cytotoxic effects through multiple mechanisms: * **DNA Intercalation:** It inserts itself between DNA base pairs, causing structural distortion. * **Electrostatic Interaction:** Nonintercalative binding to DNA further stabilizes the drug-DNA complex. * **Topoisomerase II Inhibition:** **(Pharmacological addition)** It inhibits the enzyme Topoisomerase II, preventing the religation of DNA strands and leading to double-strand DNA breaks. * **Synthesis Inhibition:** Ultimately inhibits both DNA and RNA synthesis. While it is not strictly cell-cycle phase specific, it demonstrates the highest activity during the **S phase** (DNA synthesis phase) of the cell cycle.

동물 종별 용량

Cats

Soft-tissue sarcomas · 6-6.5 mg/m2 IV given every 3-4 weeks for 4-6 treatments · IV · every 3-4 weeks · 4-6 treatments
Effective dose (general) · 6.5 mg/m2 IV every 2-3 weeks · IV · every 2-3 weeks
Single rescue agent for lymphoma · 6-6.5 mg/m2 IV every 3 weeks · IV · every 3 weeks

Dogs

Transitional cell carcinoma · 5 mg/m2 IV every 21 days with piroxicam (0.3 mg/kg PO once daily) · IV · every 21 days
Lymphoma, squamous cell carcinoma, transitional cell carcinoma, mammary gland tumors, etc. · 6 mg/m2 IV every 2-3 weeks · IV · every 2-3 weeks
Single rescue agent for lymphoma · 5.5-6 mg/m2 IV every 3 weeks · IV · every 3 weeks
Rescue agent for canine lymphoma · 6 mg/m2 IV every 2-3 weeks · IV · every 2-3 weeks · Check CBC on day 7 after treatment and the protocol can be repeated on day 14 or 21 if the dog attains complete or partial response. Combining with DTIC (dacarbazine) may improve response rate.
Transitional cell carcinoma after laser ablation of the primary tumor · 5 mg/m2 IV every 3 weeks for 4 treatments · IV · every 3 weeks · 4 treatments · Piroxicam was given at a dosage of 0.3 mg/kg PO once daily for the remaining life of the dog.

용량은 면허 수의 전문가를 위한 임상 참고 자료입니다. 항상 최신 라벨과 개별 환자에 대해 확인하십시오.

투여 경로

금기

Severe pre-existing myelosuppression
Concurrent active infection
Significantly impaired cardiac function
Patients with prior extensive cytotoxic drug or radiation exposure (relative)
Pregnancy (FDA Category D) and nursing mothers
Pre-existing myelosuppression
Concurrent infection
Hepatic disease
Impaired cardiac function

이상반응

Dose-dependent GI distress (vomiting, anorexia, diarrhea)
Bone marrow depression (neutropenia, sepsis; nadir typically around day 10)
Non-regenerative anemia
Lethargy
Seizures (specifically noted in cats)
Blue-green discoloration of urine and sclera (benign)
Tissue necrosis or phlebitis (if extravasated, though less severe than doxorubicin)
Rarely: conjunctivitis, jaundice, renal failure, allergic reactions, thrombocytopenia
Gastrointestinal signs (vomiting, anorexia, diarrhoea)
Bone marrow depression (WBC nadir generally at 10 days)
Seizure activity (reported in cats)
Blue discoloration of urine and sclera (very rare)
Acute renal failure (anecdotal in cats)

약물 상호작용

Doxorubicin, Daunorubicin, or Radiation Therapy · Cardiotoxicity risks may be enhanced in patients that have previously received these therapies to the mediastinum.
Immunosuppressant Drugs (e.g., azathioprine, cyclophosphamide, corticosteroids) · Concurrent use may significantly increase the risk of severe infection.
Myelosuppressive Drugs (e.g., chloramphenicol, flucytosine, amphotericin B, colchicine) · Additive bone marrow depression; use with extreme caution.
Live Vaccines · Increased risk of vaccine-induced infection; should be used with extreme caution or avoided during therapy.
Myelosuppressive agents · Increased risk of severe bone marrow depression · major
Immunosuppressive agents · Increased risk of severe immunosuppression and infection · major
Heparin · Chemically incompatible · major

모니터링

CBC with differential and platelets (especially around day 7-10 to check for nadir)
Tumor measurements/efficacy
Chest radiographs, ECG, or other cardiac function tests (if cardiac symptomatology is present)
Liver function tests (if jaundice or clinical signs of hepatotoxicity occur)
Serum uric acid levels (for susceptible patients)
Complete Blood Count (CBC), especially WBC count around day 10 post-administration
Gastrointestinal signs (vomiting, diarrhoea, appetite)
Renal parameters (especially in cats)
Hepatic function
Cardiac function (echocardiogram) if pre-existing disease exists

과용량

Due to the narrow therapeutic index and potential for serious toxicity (profound myelosuppression, severe GI mucosal damage, sepsis), dosage determinations must be made with extreme care. Overdose management is primarily supportive, focusing on aggressive fluid therapy, broad-spectrum antibiotics to manage sepsis secondary to neutropenia, and potentially the use of recombinant granulocyte-colony stimulating factors (G-CSF) to accelerate bone marrow recovery.

VetSheet 약물 레퍼런스는 면허 수의 전문가를 위한 임상 의사결정 보조 도구이며, 전문적 판단이나 제조사의 최신 라벨을 대신하지 않습니다.