Mitomycin is a chemotherapy drug that is given as a treatment for several different types of cancer, including anal, breast, stomach, bowel, lung, bladder and oesophagus cancers. This information describes mitomycin, how it is given and some of its possible side effects.

What mitomycin looks like

Mitomycin is a purple fluid.

How it is given

Mitomycin may be given:

• as an injection into the vein (intravenously) through a fine tube inserted into the vein (cannula)
• through a central line (Hickman / Portacath), which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm
• into the bladder (intravesically)

Chemotherapy is usually given as a course of several sessions (or cycles) of treatment over a few months. The length of your treatment and the number of cycles you have will depend on the type of cancer for which you are being treated. Your nurse or doctor will discuss your treatment plan with you.

Possible side effects

Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given mitomycin and may be different if you are having more than one chemotherapy drug.

We have outlined the most common side effects as well as rarer ones, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection

Mitomycin can reduce the production of white blood cells by the bone marrow, making you more prone to infection.

This side effect is particularly common with mitomycin and also delayed by several weeks. This effect can begin after seven days after treatment has been given and your resistance to infection usually reaches its lowest point about 28 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).
• You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding

Mitomycin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, or bleeding gums.

Anaemia (low number of red blood cells)

While having treatment with mitomycin you may become anaemic. This may make you feel pale, tired and short of breath on exertion. Let your doctor or nurse know if these symptoms are a problem.

Loss of appetite

A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, and maintaining weight.

Tiredness and feeling weak

You may feel very tired. It is important to allow yourself plenty of time to rest.

 

Less common side effects

Feeling sick (nausea) and being sick (vomiting)

If you do feel sick this may begin a few hours after the treatment is given and last for a few days. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent, or greatly reduce nausea. If the sickness is not controlled, or continues, tell your doctor; they can prescribe other anti-sickness drugs which may be more effective.

Changes to the lungs

Mitomycin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness. This is fairly unusual and rare but the drug may need to be stopped if this occurs and you may need a course of steroids.

Your kidneys may be affected (rarely)

Your kidneys will be checked by a blood test before each treatment. Mitomycin can cause a rare syndrome called HUS (Haemolytic Uraemic Syndrome) which can be life threatening if not treated. Before each treatment you will have a blood test to measure kidneys and blood cells to check for this.

Hair loss

It is very unusual to lose your hair with mitomycin. Some people notice that their hair becomes a little thinner, but not usually enough to be noticeable to other people.

Skin changes

Mitomycin can cause a rash which may be itchy. Your doctor can prescribe medicine to help with this.

Changes in nails

Your nails may become darker. This change grows out over a few months once treatment has finished.

Sore mouth and ulcers

Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed.

Taste changes

You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Diarrhoea

This can usually be easily controlled with medicine such as imodium (loperamide) or codeine, but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhoea.

 

Additional information

Leakage into the tissue

If mitomycin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell your doctor or nurse. If the area around the injection site becomes red or swollen at any time you should either tell the doctor or nurse on the ward, or if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

When mitomycin is given into the bladder the side effects may be different to those mentioned here. Usually the side effects listed above would be milder or may not occur at all. When mitomycin is given in this way, it can occasionally cause damage to the bladder, including ulcers and a need to pass urine more often.

Risk of blood clots

Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information.

Other medicines

Some medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.

Fertility

Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception

It is not advisable to become pregnant or father a child while taking mitomycin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.

 

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ADDITIONAL INFORMATION FOR HEALTHCARE PROFESSIONALS

ADVERSE REACTIONS SIGNIFICANT

>10%:

• Cardiovascular: CHF (3% to 15%) (doses >30 mg/m2)
• Central nervous system: Fever (14%)
• Dermatologic: Alopecia, nail banding/discoloration
• Gastrointestinal: Nausea, vomiting and anorexia (14%)
• Hematologic: Anemia (19% to 24%); myelosuppression, common, dose limiting, delayed
  • Onset: 3 weeks
  • Nadir: 4-6 weeks
  • Recovery: 6-8 weeks

1% to 10%:

• Dermatologic: Rash
• Gastrointestinal: Stomatitis
• Neuromuscular: Paresthesia
• Renal: Creatinine increase (2%)
• Respiratory: Interstitial pneumonitis, infiltrates, dyspnea, cough (7%)

<1% (Limited to important or life-threatening):

Extravasation reactions, hemolytic uremic syndrome, malaise, pruritus, renal failure, bladder fibrosis/contraction (intravesical administration)

MECHANISM OF ACTION

Acts like an alkylating agent and produces DNA cross-linking (primarily with guanine and cytosine pairs); cell-cycle nonspecific; inhibits DNA and RNA synthesis; degrades preformed DNA, causes nuclear lysis and formation of giant cells. While not phase-specific per se, mitomycin has its maximum effect against cells in late G and early S phases.

PHARMACODYNAMICS / KINETICS

Distribution: Vd: 22 L/m2; high drug concentrations found in kidney, tongue, muscle, heart, and lung tissue; probably not distributed into the CNS

• Metabolism: Hepatic
• Half-life elimination: 23-78 minutes; Terminal: 50 minutes
• Excretion: Urine (<10% as unchanged drug), with elevated serum concentrations