Antineoplastic antibiotic isolated from the culture of the fungus Streptomyces caespitosus. Inhibits DNA synthesis at high concentrations, inhibits protein synthesis and RNA. Most active and Gi S- phases of mitosis. After enzymatic activation in the tissues it acts as a bi- or trifunctional alkylating drug. It has a relatively weak immunosuppressive activity. Like other cytotoxic agents has myelosuppressive effects. It is metabolized mainly in the liver; to some extent in other tissues, including the kidney. Mitomycin displayed mainly kidneys (about 10% unchanged). It does not cross the blood-brain barrier. When administered into the bladder is practically not absorbed.
Indications for use of
gastric cancer, pancreatic cancer, liver cancer, bile duct cancer, cancer of the colon and rectum, esophagus cancer, breast cancer, cervical cancer, endometrial cancer, vulval cancer, non-small cell lung cancer, mesothelioma, a cancer of the renal pelvis and ureter cancer, bladder cancer, prostate cancer, cancers of the head and neck.
- Increased sensitivity to mitomycin
- Severe depression testosterone propionate cream of bone marrow function
- Severe renal impairment
- Violation of blood clotting, increased bleeding
- Pregnancy and lactation
With care – acute infectious diseases of viral, fungal or bacterial etiology, children.
Dosage and administration
Dosage is determined individually depending on the evidence, the state of the patient and the applied scheme anticancer therapy.
The drug is administered intravenously slowly or intravesically (for tumors of the bladder). If necessary, the drug may be administered intraarterially, intraperitoneally or intrapleurally.
Typically mitomycin applied in the following doses:
- 20 mg / m 2 intravenously once every 1 6/4 weeks;
- 2 mg / m 2 intravenously in the 1-5 and 8-12 days every 4-6 weeks;
- 10 mg / m 2 intravenously day 1 every 6-8 weeks, in combination with other cytostatic agents;
- 30-40 mg 30-60 ml (concentration of not more than 1 mg / mL) of a sterile aqueous solution intravesically weekly for 6-8 weeks and then monthly for 6 months. If testosterone propionate cream before the next planned course of treatment blood counts recovered (leukocytes 4,000 / mm3 and platelets 100,000 / mm3 of blood), the mitomycin can be administered in doses adjusted according to the table. When using mitomycin in combination with other myelosuppressive drugs dose should be adjusted accordingly. Preparation of solution for intravenous administration. Mitomycin typically dissolved with water for injection to a concentration of 0.4 mg / ml.
Side effect From hemopoiesis system: a leukopenia, thrombocytopenia, anemia. Inhibition of bone marrow function may occur at any time during the 8 weeks. The greatest reduction in the number of leukocytes and platelets is observed after an average of four weeks, blood recovery rates average 10 weeks after injection. Mitomycin causes cumulative myelosuppression. Respiratory system: shortness of breath, dry cough, pulmonary infiltrates. In the event of pulmonary toxicity of mitomycin application should stop and treat glucocorticosteroids. From the urinary system: increased creatinine concentration in blood serum, hemolytic uremic syndrome, accompanied mostly thrombocytopenia microangiopathic hemolytic anemia with fragmented erythrocytes and anuricheskoy form of acute renal failure. Less common manifestations of the syndrome may be pulmonary edema, neuropathy, high blood pressure syncope. The development of hemolytic uremic syndrome was observed in patients receiving mitomycin intravenously as a single agent or in combination with other cytotoxic drugs in doses exceeding 60 mg. From the digestive system: stomatitis or esophagitis, nausea, vomiting, anorexia, diarrhea, abnormal liver function. On the part of the skin and skin appendages: reversible alopecia, sometimes a skin rash or ulceration, purple stripes on the nails. on the part of the cardiovascular system: reduction in myocardial contractility, development or exacerbation of a heart failure (in patients previously treated with doxorubicin). Local reactions: thrombophlebitis, when hit the drug under the skin – redness, pain, inflammation of the subcutaneous fat necrosis. When intravesical use – urinary tract irritation, dizuricheskie disorder, nocturnal enuresis, increased frequency of urination, cystitis, hematuria, and other symptoms of local irritation, atrophy of the bladder. Rash and itching on the hands and in the genital area. Other: fever, numbness or tingling in fingers and toes; purple stripes on the nails, fatigue or weakness.
A specific antidote to an overdose of the drug is unknown. Symptomatic treatment should be performed in cases of overdose.
Interaction with other drugs and other forms of interaction
At simultaneous application of mitomycin with drugs that provide myelotoxic and nephrotoxicity, as well as in combination with radiation therapy may increase the toxicity.
In a preliminary or simultaneous administration to patients with vinca alkaloids with the drug mitomycin may develop acute respiratory distress syndrome . Also, the development of this syndrome has been observed in patients treated with mitomycin and oxygen therapy (inhalation of a mixture containing more than 50% oxygen).
In patients previously treated with doxorubicin in the treatment of mitomycin may develop congestive heart failure.
Mitomycin should be used under the supervision of a physician who has experience with anticancer drugs.
Intravenous injection is carried out only slowly and with great caution (carefully avoiding contact with extravasal space solution).
During the course testosterone propionate cream of treatment and for 8 weeks after the end of necessary control peripheral blood (white blood cell count, neutrophils, platelets, hemoglobin) and the concentration of creatinine and urea in serum.
When the concentration of creatinine in the blood serum of