Mitomycin

Aka: Mitomycin, Mitomycin C, Mutamycin

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II. Indications

  1. FDA Approved
    1. Gastric Cancer
    2. Pancreatic Cancer
  2. Off-Label
    1. Anal Cancer
    2. Bladder Cancer (superficial, intravesical instillation)
      1. Volpe (2010) Minerva Urol Nefrol 62(2):133-44 +PMID: 20562793 [PubMed]
    3. Cervical Cancer
    4. Esophageal Cancer
    5. Vulvar Cancer

III. Mechanism

  1. See Antibiotic Chemotherapy
  2. Mitomycin C is a methylazirinopyrroloindoledione Antineoplastic Antibiotic
    1. Isolated from the bacterium Streptomyces caespitosus
  3. Mitomycin C is more toxic to hypoxic cells
  4. Bioreduced Mitomycin C inhibits DNA synthesis (as well as RNA and Protein synthesis)
    1. Generates free radicals
    2. Alkylates DNA
    3. Induces DNA interstrand cross-links

IV. Medications

  1. Mitomycin Injection Solution: 5, 20 and 40 mg vials

V. Dosing

  1. See other references for disease specific dosing protocols

VI. Adverse Effects

  1. Adult Respiratory Distress Syndrome
  2. Alopecia
  3. Severe skin and soft tissue necrosis on extravasation
    1. Idarubicin is a strong Vesicant (causes Blistering)
  4. Hemolytic Uremic Syndrome
  5. Myelosuppression
  6. Nephrotoxicity

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Complete Blood Count
    2. Renal Function Tests

VIII. Resources

  1. Mitomycin Injection Powder for Solution (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=ff676355-313d-4575-8f2f-e4a1e9527477
  2. Mitomycin (StatPearls)
    1. https://www.ncbi.nlm.nih.gov/books/NBK562249/

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