Generic Name: Mitomycin

(mye-toe-MYE-sin)

Trade name:  Mutamycin^®
Other names:  Mitomycin-C, MTC

Drug type: Mitomycin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  This medication is classified as an "antitumor antibiotic."  (For more detail, see "How this drug works" section below).

What This Drug Is Used For:

• Treatment of adenocarcinoma of the stomach or pancreas.
• Also used in treatment of anal, bladder, breast, cervical, colorectal, head and neck, and non-small cell lung cancer.

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How This Drug Is Given:

• As an injection or infusion into the vein (intravenous, IV).
• Mitomycin is a vesicant.  A vesicant is a chemical that causes extensive tissue damage and blistering if it escapes from the vein.  The nurse or doctor who gives this drug must be carefully trained.  If you notice redness or swelling at the IV site while you are receiving mitomycin, alert your health care professional immediately.
• As an intravesicle infusion to treat superficial bladder cancer (cancer on the surface of the bladder wall).  This means it is given directly into the bladder through a urinary catheter.  The urinary catheter is inserted through the urethra (the tube which carries urine from the bladder to the outside the body).  The mitomycin solution is injected into the catheter, which is then removed.  Normal walking around helps to disperse the medication throughout the bladder.  The medication is left in for about 2 hours, after which the patient then empties the bladder (urinates).
• There is no pill form of mitomycin.
• The amount of mitomycin that you will receive depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose, schedule, and the method it will be given.

Side Effects:

Important things to remember about the side effects of mitomycin:

• Most people do not experience all of the side effects listed.
• Side effects are often predictable in terms of their onset and duration. 
• Side effects are almost always reversible and will go away after treatment is complete.
• There are many options to help minimize or prevent side effects.
• There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
• The side effects of mitomycin and their severity depend on how much of the drug is given, and how it is given. In other words, high doses may produce more severe side effects, or if it is given directly into the bladder the side effects will be localized to the bladder.

The following side effects are common (occurring in greater than 30%) for patients taking mitomycin:

• Low blood counts.  Your white and red blood cells and platelets may temporarily decrease.  This can put you at increased risk for infection, anemia and/or bleeding.  The nadir counts are delayed with this drug.

Nadir: Meaning low point, nadir is the point in time between chemotherapy cycles in which you experience low blood counts.

Onset: 3 weeks
Nadir: 4-6 weeks
Recovery: 6-8 weeks

• Mouth sores
• Poor appetite
• Fatigue

These side effects are less common side effects (occurring in about 10-29%) of patients receiving mitomycin:

• Nausea and vomiting, usually mild
• Diarrhea
• Hair loss
• Bladder inflammation (urinary frequency, burning, cramping, pain) - seen with intravesical (into the bladder) therapy.

These are rare but serious complications of mitomycin therapy:

• Lung problems: pneumonitis, rarely pulmonary fibrosis.  The incidence of lung problems increases with age and pre-existing lung conditions.  There is a maximum lifetime dose of mitomycin.  Your health care professional will monitor the amount of mitomycin you receive as well as your lung function during treatment.
• Hemolytic-uremic syndrome. This syndrome is characterized by destruction of red blood cells, damage to the lining of blood vessel walls, and, in severe cases, kidney failure.  This is a rare event seen in less than 2 % of patients treated with mitomycin, it can occur at any time but usually seen after several cycles of therapy.  Your health care provider will monitor your blood tests for early signs of this condition.

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When to contact your doctor or health care provider:

Contact your health care provider immediately, day or night, if you should experience any of the following symptoms:

• Fever of 100.4° F (38° C) or higher, chills (possible signs of infection)

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

• Nausea (interferes with ability to eat and unrelieved with prescribed medication)
• Vomiting (vomiting more than 4-5 times in a 24 hour period)
• Mouth sores (painful redness, swelling or ulcers)
• Diarrhea (4-6 episodes in a 24-hour period)
• Unusual bleeding or bruising
• Black or tarry stools, or blood in your stools
• Extreme fatigue (unable to carry on self-care activities)
• Blood in the urine
• Pain or burning with urination
• Swelling of the feet or ankles.  Sudden weight gain. Shortness of breath.
• Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

• Before starting mitomycin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   Do not take aspirin, or products containing aspirin unless your doctor specifically permits this.
• Do not receive any kind of immunization or vaccination without your doctor's approval while taking mitomycin.
• Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment.  Pregnancy category D (mitomycin may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
• For both men and women: Do not conceive a child (get pregnant) while taking mitomycin. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
• Do not breast feed while taking this medication.

Self-Care Tips:

• Apply ice if you have any pain, redness or swelling at the IV site, and notify your doctor. 
• Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
• You may be at risk of infection so try to avoid crowds or people with colds and those not feeling well, and report fever or any other signs of infection immediately to your health care provider.
• Wash your hands often.
• To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times a day with 1/2 to 1 teaspoon of baking soda and/or 1/2 to 1 teaspoon of salt mixed with 8 ounces of water.
• Use an electric razor and a soft toothbrush to minimize bleeding.
• Avoid contact sports or activities that could cause injury.
• To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals. 
• Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
• In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
• Get plenty of rest. 
• Maintain good nutrition.
• If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing:

You will be checked regularly by your health care professional while you are taking mitomycin, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.   

How This Drug Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue.   "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability.  Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division.  If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink.  They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Mitomycin is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.  There are several types of antitumor antibiotics:

• Anthracyclines:  Doxorubicin, Daunorubicin, Mitoxantrone, and Idarubicin.
• Chromomycins:  Dactinomycin and Plicamycin.
• Miscellaneous:  Mitomycin and Bleomycin.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.

Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org