Mitomycin – Targeted Therapy

Mitomycin, also known as Mitomycin-C, is an antineoplastic antibiotic isolated from the culture of Streptomyces caespitosus. The drug acts as a bifunctional alkylating agent that causes cross-linking in the DNA molecule. It possesses phase-nonspecific activity, inhibiting DNA synthesis and, to a lesser extent, RNA and protein synthesis in rapidly dividing cells.

The mechanism of action of mitomycin involves its intracellular activation through enzymatic reduction. The activated form of the drug creates strong covalent bonds between complementary DNA strands, making their separation and replication impossible. This leads to chromosomal fragmentation and tumor cell death. Due to its ability to selectively suppress the growth of tissues with high metabolic rates, mitomycin is effective against various forms of adenocarcinomas.

The drug is administered intravenously or topically (intravesically for bladder cancer). It is rapidly distributed in tissues and metabolized primarily in the liver. A key feature of mitomycin is its cumulative myelotoxicity, which requires careful planning of intervals between treatment cycles.

Wikipedia page
Mitomycin

Indications

Mitomycin is used in oncological practice both as monotherapy and as part of comprehensive treatment regimens:

  • Gastrointestinal Cancers: adenocarcinoma of the stomach and pancreas (in combination with fluorouracil and doxorubicin).
  • Bladder Cancer: intravesical therapy for treating superficial tumors and preventing recurrence after resection.
  • Head and Neck Tumors: comprehensive treatment of squamous cell carcinoma in combination with radiation therapy.
  • Lung Cancer: as part of combined chemotherapy regimens for non-small cell lung cancer.
  • Cervical and Anal Canal Cancer: systemic treatment of advanced forms of the disease.

Dosage and administration

Mitomycin dosing schedules depend on the route of administration and the treatment protocol.

  • Intravenous Administration: the standard dose is 10–20 mg/m² of body surface area every 6–8 weeks. Long intervals are necessary due to delayed toxicity to the bone marrow.
  • Intravesical Administration: typically 20–40 mg of the drug dissolved in saline, administered directly into the bladder once a week for 6–8 weeks.
  • Solution Preparation: the drug should be dissolved immediately before administration, avoiding skin contact (it is a potent irritant).
  • Precautions: extravasation (leakage under the skin) must be strictly avoided, as mitomycin causes severe soft tissue necrosis.
  • Blood Monitoring: monitoring of hematological parameters should be conducted weekly throughout the entire period between cycles.

The use of mitomycin is contraindicated or restricted in the following clinical conditions:

  • Severe Myelosuppression: baseline leukocyte count < 3000/µL or platelet count < 75000/µL.
  • Renal Impairment: significant kidney failure (creatinine level > 1.7 mg/dL).
  • Coagulopathies: presence of hemorrhagic syndrome or an increased tendency for bleeding.
  • Pregnancy and Lactation: the drug has mutagenic and teratogenic effects; breastfeeding is prohibited.
  • Hypersensitivity: known allergy to mitomycin or other components of the lyophilizate.

The toxicity profile of mitomycin is characterized by its delayed and cumulative nature:

  • Hematologic Toxicity: leukopenia and thrombocytopenia, reaching a peak 4–6 weeks after administration.
  • Renal System: risk of developing Hemolytic Uremic Syndrome (HUS), which can lead to irreversible kidney failure.
  • Pulmonary Toxicity: development of interstitial pneumonitis or pulmonary fibrosis with long-term use.
  • Gastrointestinal Tract: nausea, vomiting, stomatitis, and diarrhea (usually moderate).
  • Local Reactions: when administered into the bladder — cystitis, frequent urination, and hematuria.

Frequently Asked Questions

Mitomycin is an antitumor antibiotic derived from Streptomyces caespitosus. It acts as an alkylating agent by binding to the cancer cell's DNA and creating strong "cross-links" between its strands. This inhibits DNA synthesis and cell division, ultimately leading to cell death.
Mitomycin has a broad spectrum of clinical use. Intravenously, it is used to treat stomach, pancreatic, breast, and non-small cell lung cancers. It is also highly effective when administered locally (intravesically) for the treatment of superficial bladder cancer and to prevent recurrence after surgery.
In the treatment of bladder cancer, a mitomycin solution is instilled directly into the bladder via a catheter. The patient must retain the solution for 1–2 hours, periodically changing positions to ensure the medication covers all walls of the organ. This method targets the tumor directly while minimizing systemic side effects.
Mitomycin is a potent vesicant. If the solution leaks into the surrounding tissue during injection (extravasation), it can cause severe tissue damage and necrosis. Additionally, the substance exhibits "delayed" bone marrow toxicity: the nadir for white blood cells and platelets may not occur until 4–6 weeks after administration.
Since mitomycin is excreted in the urine, strict hygiene must be maintained for 48 hours following administration (especially intravesical). It is recommended to flush the toilet twice and wash hands thoroughly after urinating to prevent skin irritation and accidental exposure of household members to the active substance residues.

List of medicines by active substance Mitomycin

-14%
Mitomycin 40 40 mg Zydus Celexa
View
Zydus Celexa

Mitomycin 40

Mitomycin
40 mg 1 vial
3252₴ 3780₴
-18%
Mitomycin 10 10 mg Zydus Celexa
View
Zydus Celexa

Mitomycin 10

Mitomycin
10 mg 1 vial
1187₴ 1450₴
✅ All products loaded (2)

Contact us

Choose a convenient way to contact

We work daily from 9:00 to 20:00