Pixantrone (Specialist drug)

How it works

It intercalates DNA and inhibits topoisomerase II, forming stable DNA adducts that disrupt replication in dividing tumour cells.

Prescribing in practice

• Myelosuppression, particularly neutropenia, is the main dose-limiting toxicity and predisposes to serious infection, so blood counts must be monitored and treatment adjusted accordingly.
• Although designed to reduce cardiac toxicity relative to anthracyclines, cardiac function should still be assessed, especially with prior anthracycline exposure.
• It can colour the urine bluish and may cause tissue damage on extravasation.

Monitoring

Monitor full blood count before each cycle and cardiac function periodically during treatment.

Counselling the patient

• Report fever or signs of infection promptly during treatment.
• Your urine may temporarily turn a blue-green colour, which is harmless.
• Effective contraception is required during and after treatment.

Evidence & guidelines

NICE and the EU marketing authorisation support pixantrone monotherapy in multiply relapsed or refractory aggressive B-cell non-Hodgkin lymphoma.