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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › ANTINEOPLASTIC AGENTS › CYTOTOXIC ANTIBIOTICS AND RELATED SUBSTANCES › Other cytotoxic antibiotics
mitomycin
L01DC03
Forms & Strengths
- Intravenous powder for reconstitution: 5 mg, 20 mg, 40 mg
- Intravesical solution/powder: 20 mg, 40 mg
Adult Dosing
- Intravenous (Disseminated carcinoma): 10 to 20 mg/m² as a single dose via IV injection, repeated every 6 to 8 weeks
- Intravenous (Combination therapy): 8 to 10 mg/m² every 6 to 8 weeks
- Intravesical (Superficial bladder cancer): 20 to 40 mg instilled intravesically weekly for 6 to 8 weeks
Pediatric Dosing
- Safety and efficacy in pediatric patients have not been established
- Rarely used off-label in pediatrics following adult protocols with extreme caution
Indications
- Palliative treatment of disseminated adenocarcinoma of the stomach or pancreas
- Intravesical instillation for prophylaxis and treatment of recurrent superficial bladder carcinoma
- Used off-label in various other solid tumors and ophthalmic surgeries (as an antifibrotic agent)
Mechanism of Action
- Antineoplastic antibiotic derived from Streptomyces caespitosus
- Acts as an alkylating agent after enzymatic reduction inside the cell
- Forms covalent cross-links with DNA, preferentially at guanine-cytosine rich sites, inhibiting DNA synthesis and cellular replication
Contraindications
- Hypersensitivity to mitomycin or any component of the formulation
- Coagulation defects or bleeding tendencies
- Baseline thrombocytopenia, coagulation disorders, or severe bone marrow suppression
- Serum creatinine greater than 1.7 mg/dL
- Intravesical use in patients with perforation of the bladder wall or acute urinary tract infection
Adverse Reactions
- Delayed bone marrow suppression (leukopenia and thrombocytopenia nadir at 4-6 weeks)
- Hemolytic Uremic Syndrome (HUS) and thrombotic thrombocytopenic purpura (TTP)
- Interstitial pneumonitis and pulmonary fibrosis (dose-dependent and potentially fatal)
- Nephrotoxicity and elevated serum creatinine
- Extravasation leading to severe local tissue necrosis and ulceration
- Nausea, vomiting, anorexia, and stomatitis
- Alopecia, fatigue, and local bladder irritation (with intravesical administration)
Drug Interactions
- Other myelosuppressive agents: Increased risk of severe bone marrow suppression and immunosuppression
- Vinca alkaloids: May cause acute shortness of breath and severe bronchospasm
- Radiation therapy: Potential for enhanced toxicity and radiosensitization
- Live virus vaccines: Decreased vaccine efficacy and increased risk of generalized infection due to immunosuppression
Curated Content: Needs Vetting Before Put to Clinical Use