Etoposide/mitozantrone induction – pro
Some references are older because this regimen is now well established and not being investigated much.
Arlin Z, Case DC Jr, Moore J, et al. Randomized multicenter trial of cytosine arabinoside with mitoxantrone or daunorubicin in previously untreated adult patients with acute nonlymphocytic leukemia (ANLL). Lederle Cooperative Group. Leukemia. 1990;4:177-183.
The 2-drug regimen of daunorubicin given in conjunction with cytarabine will result in a complete response rate of approximately 65%. Some physicians opt to add a third drug, thioguanine, to this regimen, though little evidence is available to conclude that this 3-drug regimen is better therapy. One study suggested that the addition of etoposide during induction therapy may improve response duration. Idarubicin appeared to be more effective than daunorubicin, though the doses of idarubicin and daunorubicin may not have been equivalent. No significant difference between daunorubicin and mitoxantrone has been reported.
When the induction does nto work, common practice is to reinduce with the same or a different regimen. If successful, the prognosis is as good as if the initial induction succeeded. Etoposide and mitozantrone is a reasonable regimen for a reinduction attempt.
Rowe JM, Neuberg D, Friedenberg W, et al. A phase 3 study of three induction regimens and of priming with GM-CSF in older adults with acute myeloid leukemia: a trial by the Eastern Cooperative Oncology Group. Blood. 2004;103:479-485.
Anderson JE, Kopecky KJ, Willman CL, et al. Outcome after induction chemotherapy for older patients with acute myeloid leukemia is not improved with mitoxantrone and etoposide compared to cytarabine and daunorubicin: a Southwest Oncology Group study. Blood. 2002;100:3869-3876.
Bow EJ, Sutherland JA, Kilpatrick MG, et al.: Therapy of untreated acute myeloid leukemia in the elderly: remission-induction using a non-cytarabine-containing regimen of mitoxantrone plus etoposide. J Clin Oncol 14 (4): 1345-52, 1996