Mitomycin should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents. Appropriate management of therapy and complications is possible only when adequate diagnostic and treatment facilities are readily available.
Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of mitomycin.
Hemolytic uremic syndrome (HUS), a serious complication of chemotherapy, consisting primarily of microangiopathic hemolytic anemia, thrombocytopenia, and irreversible renal failure has been reported in patients receiving systemic mitomycin. The syndrome may occur at any time during systemic therapy with mitomycin as a single agent or in combination with other cytotoxic drugs; however, most cases occur at doses greater than or equal to 60 mg of mitomycin. Blood product transfusion may exacerbate the symptoms associated with this syndrome. The incidence of the syndrome has not been defined.
Note: Do NOT substitute mitomycin injection for mitomycin (ureteral gel) or mitomycin (ophthalmic) or vice versa; the products are different and are NOT interchangeable.
Anal carcinoma (off-label use): IV: 10 mg/m2 as an IV bolus on days 1 and 29 (maximum: 20 mg/dose) in combination with fluorouracil and radiation therapy (Ref) or 12 mg/m2 on day 1 only (maximum: 20 mg/dose) in combination with fluorouracil and radiation therapy (Ref) or 15 mg/m2 on day 1 only in combination with fluorouracil and radiation therapy (Ref) or 10 mg/m2 on day 1 (maximum dose: 15 mg) in combination with capecitabine and radiation therapy (Ref) or 12 mg/m2 on day 1 (maximum dose: 20 mg) in combination with capecitabine and radiation therapy (Ref).
Bladder cancer (off-label use):
Muscle invasive: IV (mitomycin injection solution): 12 mg/m2 on day 1 (in combination with fluorouracil and radiation) (Ref).
Nonmuscle invasive (off-label route): Intravesicular instillation of mitomycin injection solution:
Low risk of recurrence (uncomplicated): Intravesical ar instillation: 40 mg as a single dose postoperatively; retain in bladder for 1 to 2 hours (Ref).
Increased risk of recurrence: Intravesical ar instillation: 20 mg weekly for 6 weeks, followed by 20 mg monthly for 3 years; retain in bladder for 1 to 2 hours (Ref) or 40 mg weekly for 6 weeks (with urine alkalinization and decreased urine volume to increase drug concentration); retain in bladder for 2 hours (Ref).
Cervical cancer, recurrent or metastatic (off-label use; based on limited data): IV: 6 mg/m2 on day 1 once every 4 weeks (in combination with cisplatin) for a minimum of 2 cycles (preferably 9 cycles) (Ref).
Gastric cancer: Note: Although FDA approved for the treatment of disseminated adenocarcinoma of the stomach and as palliative treatment, mitomycin use has been replaced by other agents. Current guidelines for the management of gastric cancer do not include recommendations for the use of mitomycin in the treatment of this condition (Ref).
IV: 20 mg/m2 once every 6 to 8 weeks; discontinue if disease progression continues after 2 courses of therapy.
Off-label dosing: IV: 7 mg/m2 (maximum dose: 14 mg) once every 6 weeks for 4 cycles (in combination with cisplatin and fluorouracil) (Ref).
Hepatocellular cancer, chemoembolization (off-label use): Conventional transcatheter arterial chemoembolization (cTACE): Intra-arterial: 10 mg as a single dose via intra-arterial injection; based on clinical judgement, may repeat at 6 to 8 week intervals (Ref) or 8 mg/m2 as a single dose via intra-arterial injection every 4 weeks for at least 2 doses (Ref). Refer to protocol and institutional policies for additional dosing/administration details.
Pancreatic cancer: Note: Although FDA approved for the treatment of disseminated adenocarcinoma of the pancreas and as palliative treatment, mitomycin use has been replaced by other agents. Current guidelines for the management of metastatic pancreatic cancer do not include recommendations for the use of mitomycin in the treatment of this condition (Ref).
IV: 20 mg/m2 once every 6 to 8 weeks; discontinue if disease progression continues after 2 courses of therapy.
Vulvar cancer, advanced (off-label use; based on limited data): IV: 15 mg/m2 on day 1 every 14 days for 2 cycles (in combination with concomitant radiation and fluorouracil) (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The manufacturer’s labeling states to avoid use in patients with serum creatinine >1.7 mg/dL, although no other dosage modifications are provided. The following adjustments have been recommended:
Krens 2019:
GFR ≥30 mL/minute: No need for dose adjustment is expected.
GFR <30 mL/minute: Use is not recommended.
Hemodialysis: Use is not recommended.
There are no dosage adjustments provided in the manufacturer’s labeling. However, the following adjustments have been recommended:
Mild or moderate impairment: No need for dose adjustment is expected (Ref).
Severe impairment: Consider reducing dose to 50% of the original dose (Ref).
American Society of Clinical Oncology guidelines for appropriate systemic therapy dosing in adults with cancer with a BMI ≥30 kg/m2 : Utilize patient's actual body weight for calculation of BSA- or weight-based dosing; manage regimen-related toxicities in the same manner as for patients with a BMI <30 kg/m2; if a dose reduction is utilized due to toxicity, may consider resumption of full, weight-based dosing (or previously tolerated dose level) with subsequent cycles only if dose escalations are allowed in the prescribing information, if contributing underlying factors (eg, hepatic or kidney impairment) are sufficiently resolved, AND if performance status has markedly improved or is considered adequate (Ref). Note: Some protocols may have maximum recommended doses.
Hematologic toxicity (based on nadir at prior dose; according to the manufacturer’s labeling; also refer to individual protocols for dosage adjustment recommendations).
Leukocytes 3,000 to <4,000/mm3: Hold therapy until leukocyte count ≥4,000/mm3, then may resume 100% of prior dose in subsequent cycles.
Leukocytes 2,000 to <3,000/mm3: Hold therapy until leukocyte count ≥4,000/mm3; reduce mitomycin dose to 70% of prior dose in subsequent cycles.
Leukocytes <2,000/mm3: Hold therapy until leukocyte count ≥4,000/mm3; reduce mitomycin dose to 50% of prior dose in subsequent cycles.
Platelets 75,000 to <100,000/mm3: Hold therapy until platelets ≥100,000/mm3, then may resume 100% of prior dose in subsequent cycles.
Platelets 25,000 to <75,000/mm3: Hold therapy until platelets ≥100,000/mm3; reduce mitomycin dose to 70% of prior dose in subsequent cycles.
Platelets <25,000/mm3: Hold therapy until platelets ≥100,000 mm3; reduce mitomycin dose to 50% of prior dose in subsequent cycles.
Nonhematologic toxicity:
Pulmonary toxicity: Discontinue mitomycin if pulmonary toxicity occurs and other potential etiologies have been ruled out.
Refer to adult dosing.
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
>10%:
Gastrointestinal: Anorexia (14%), nausea (14%), vomiting (14%)
Hematologic & oncologic: Bone marrow depression (64%; onset: 4 weeks; recovery: 8 to 10 weeks), hemolytic-uremic syndrome (HUS; ≤15%), thrombotic thrombocytopenic purpura (TTP; ≤15%)
Miscellaneous: Fever (14%)
1% to 10%:
Dermatologic: Alopecia (4%)
Gastrointestinal: Mucous membrane disease (toxicity: 4%), stomatitis (4%)
Renal: Increased serum creatinine (2%)
<1%, postmarketing, and/or case reports: Adult respiratory distress syndrome (ARDS), bladder spasm (intravesical administration), cardiac failure, dyspnea, extravasation reactions, fibrosis (bladder; intravesical administration), hepatic sinusoidal obstruction syndrome (formerly known as hepatic veno-occlusive disease), interstitial fibrosis, malaise, nonproductive cough, pulmonary infiltrates, renal failure (irreversible), skin rash, weakness
Hypersensitivity to mitomycin or any component of the formulation; thrombocytopenia; coagulation disorders, or other increased bleeding tendency.
Concerns related to adverse effects:
• Bladder fibrosis/contraction: Bladder fibrosis/contraction has been reported with intravesical administration (unlabeled administration route).
• Bone marrow suppression: Bone marrow suppression (thrombocytopenia and leukopenia) is common and may be severe and/or contribute to infections. WBC and platelet nadir usually occurs at 4 weeks, although may occur at up to 8 weeks; recovery occurs within 10 weeks. Fatalities due to sepsis have been reported. Myelosuppression is dose-limiting, delayed in onset, and cumulative.
• Extravasation: Mitomycin is a potent vesicant; ensure proper needle or catheter placement prior to and during infusion. Avoid extravasation. May cause necrosis and tissue sloughing; delayed erythema and/or ulceration have been reported.
• Heart failure: In a scientific statement from the American Heart Association, mitomycin has been determined to be an agent that may either cause reversible direct myocardial toxicity or exacerbate underlying myocardial dysfunction (magnitude: moderate) (AHA [Page 2016]).
• Hemolytic-uremic syndrome: Hemolytic-uremic syndrome (HUS) has been reported (incidence not defined); condition usually involves microangiopathic hemolytic anemia (hematocrit ≤25%), thrombocytopenia (≤100,000/mm3), and irreversible renal failure (serum creatinine ≥1.6 mg/dL). HUS may occur at any time (either with single agent or combination therapy), is generally associated with single doses ≥60 mg, and HUS symptoms may be exacerbated by blood transfusion. Other less common effects may include pulmonary edema, neurologic abnormalities, and hypertension. A high mortality from HUS has been reported.
• Pulmonary toxicity: Cases of acute respiratory distress syndrome (ARDS) have been reported in patients receiving mitomycin in combination with other chemotherapy who were maintained at FIO2 concentrations >50% perioperatively; use caution to provide only enough oxygen to maintain adequate arterial saturation and avoid overhydration. Pulmonary toxicity has also been reported as dyspnea with nonproductive cough and appearance of pulmonary infiltrates on radiograph.
Concurrent drug therapy issues:
• Vinca alkaloids: Shortness of breath and bronchospasm have been reported in patients receiving vinca alkaloids in combination with mitomycin or who received mitomycin previously; this acute respiratory distress has occurred within minutes to hours following the vinca alkaloid; may be managed with bronchodilators, steroids and/or oxygen.
Other warnings/precautions:
• Product selection: Mitomycin is available as mitomycin for injection, mitomycin (ophthalmic), and mitomycin (ureteral gel); the products are different and are NOT interchangeable. Verify product label prior to reconstitution and administration to prevent medication errors.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Reconstituted, Intravenous:
Mutamycin: 5 mg (1 ea); 20 mg (1 ea); 40 mg (1 ea)
Generic: 5 mg (1 ea); 20 mg (1 ea); 40 mg (1 ea)
Solution Reconstituted, Intravenous [preservative free]:
Generic: 5 mg (1 ea); 20 mg (1 ea); 40 mg (1 ea)
Yes
Solution (reconstituted) (mitoMYcin Intravenous)
5 mg (per each): $180.00 - $291.92
20 mg (per each): $132.00 - $758.40
40 mg (per each): $264.00 - $1,516.80
Solution (reconstituted) (Mutamycin Intravenous)
5 mg (per each): $423.87
20 mg (per each): $1,101.18
40 mg (per each): $2,202.35
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Solution Reconstituted, Injection:
Generic: 20 mg (1 ea)
Solution Reconstituted, Intravenous:
Generic: 5 mg ([DSC]); 20 mg (1 ea)
IV: Administer by slow IV push/bolus via a freely-running saline infusion. Consider using a central venous catheter.
Vesicant; ensure proper needle or catheter placement prior to and during infusion; avoid extravasation.
Extravasation management: If extravasation occurs, stop infusion immediately and disconnect (leave cannula/needle in place); gently aspirate extravasated solution (do NOT flush the line); remove needle/cannula; elevate extremity. Initiate dimethyl sulfate (DMSO) antidote. Apply dry cold compress for 20 minutes 4 times/day for 1 to 2 days (Ref).
DMSO: Apply topically to a region covering twice the affected area every 8 hours for 7 days; begin within 10 minutes of extravasation; do not cover with a dressing (Ref).
Intravesicular administration of mitomycin injection solution (off-label use/route): Instill into bladder and retain for 1 to 2 hours (Ref); rotate patient every 15 to 30 minutes.
Intra-arterial: Transcatheter arterial chemoembolization (TACE; off-label use): For conventional TACE, mitomycin was administered with lipiodol and contrast media followed by particle embolization with an embolic agent (Ref) or followed by starch microspheres for vessel occlusion (Ref). IV antibiotics were administered prior to the procedure and embolic material was injected through the catheter until hemostasis was achieved (Ref). Refer to protocol and institutional policies for additional administration details.
Hazardous agent (NIOSH 2016 [group 1]).
Use appropriate precautions for receiving, handling, storage, preparation, dispensing, transporting, administration, and disposal. Follow NIOSH and USP 800 recommendations and institution-specific policies/procedures for appropriate containment strategy (NIOSH 2016; USP-NF 2020).
Gastric cancer: Treatment of disseminated adenocarcinoma of the stomach (in combination with other chemotherapy agents) and as palliative treatment when other modalities have failed.
Note: Although FDA approved for the treatment of disseminated adenocarcinoma of the stomach and as palliative treatment, mitomycin use in the management of gastric cancer has been replaced by other agents. Current guidelines for the management of gastric cancer do not include recommendations for the use of mitomycin in the treatment of this condition (ESMO [Lordick 2022]).
Pancreatic cancer: Treatment of disseminated adenocarcinoma of the pancreas (in combination with other chemotherapy agents) and as palliative treatment when other modalities have failed.
Note: Although FDA approved for the treatment of disseminated adenocarcinoma of the pancreas and as palliative treatment, mitomycin use in the management of pancreatic cancer has been replaced by other agents. Current guidelines for the management of metastatic pancreatic cancer do not include recommendations for the use of mitomycin in the treatment of this condition (ASCO [Sohal 2020]).
Limitations of use: Not recommended for single-agent primary therapy or to replace appropriate surgery and/or radiotherapy in the treatment of these conditions.
Anal cancer; Bladder cancer; Cervical cancer, recurrent or metastatic; Hepatocellular carcinoma (chemoembolization); Vulvar cancer, advanced
MitoMYcin (Systemic) may be confused with MitoMYcin (Ophthalmic), MitoMYcin (ureteral gel), mitotane, mitoXANTRONE
This medication is in a class the Institute for Safe Medication Practices (ISMP) includes among its list of drug classes which have a heightened risk of causing significant patient harm when used in error.
MitoMYcin is available as mitoMYcin for injection, mitoMycin (ophthalmic), and mitoMYcin (ureteral gel); the products are different and are NOT interchangeable. Verify product label prior to reconstitution and administration to prevent medication errors.
Substrate of P-glycoprotein/ABCB1 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
5-Aminosalicylic Acid Derivatives: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Abrocitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Antineoplastic Agents (Vinca Alkaloids): May enhance the adverse/toxic effect of MitoMYcin (Systemic). Specifically, the risk of pulmonary toxicity may be increased. Risk C: Monitor therapy
Antithymocyte Globulin (Equine): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Antithymocyte Globulin (Equine). Specifically, these effects may be unmasked if the dose of cytotoxic chemotherapy is reduced. Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Antithymocyte Globulin (Equine). Specifically, infections may occur with greater severity and/or atypical presentations. Risk C: Monitor therapy
Baricitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Baricitinib. Risk X: Avoid combination
BCG (Intravesical): Myelosuppressive Agents may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Products: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of BCG Products. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of BCG Products. Risk X: Avoid combination
Brincidofovir: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Brincidofovir. Risk C: Monitor therapy
Brivudine: May enhance the adverse/toxic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Chikungunya Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Chikungunya Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Chikungunya Vaccine (Live). Risk X: Avoid combination
Chloramphenicol (Ophthalmic): May enhance the adverse/toxic effect of Myelosuppressive Agents. Risk C: Monitor therapy
Chloramphenicol (Systemic): Myelosuppressive Agents may enhance the myelosuppressive effect of Chloramphenicol (Systemic). Risk X: Avoid combination
Cladribine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk X: Avoid combination
Cladribine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Cladribine. Risk X: Avoid combination
CloZAPine: Myelosuppressive Agents may enhance the adverse/toxic effect of CloZAPine. Specifically, the risk for neutropenia may be increased. Risk C: Monitor therapy
Coccidioides immitis Skin Test: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the diagnostic effect of Coccidioides immitis Skin Test. Management: Consider discontinuing cytotoxic chemotherapy several weeks prior to coccidioides immitis skin antigen testing to increase the likelihood of accurate diagnostic results. Risk D: Consider therapy modification
COVID-19 Vaccine (Adenovirus Vector): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Adenovirus Vector). Management: Administer a 2nd dose using an mRNA COVID-19 vaccine (at least 4 weeks after the primary vaccine dose) and a bivalent booster dose (at least 2 months after the additional mRNA dose or any other boosters). Risk D: Consider therapy modification
COVID-19 Vaccine (Inactivated Virus): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Inactivated Virus). Risk C: Monitor therapy
COVID-19 Vaccine (mRNA): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (mRNA). Management: Give a 3-dose primary series for all patients aged 6 months and older taking immunosuppressive medications or therapies. Booster doses are recommended for certain age groups. See CDC guidance for details. Risk D: Consider therapy modification
COVID-19 Vaccine (Subunit): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Subunit). Risk C: Monitor therapy
COVID-19 Vaccine (Virus-like Particles): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of COVID-19 Vaccine (Virus-like Particles). Risk C: Monitor therapy
Deferiprone: Myelosuppressive Agents may enhance the neutropenic effect of Deferiprone. Management: Avoid the concomitant use of deferiprone and myelosuppressive agents whenever possible. If this combination cannot be avoided, monitor the absolute neutrophil count more closely. Risk D: Consider therapy modification
Dengue Tetravalent Vaccine (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Dengue Tetravalent Vaccine (Live). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Dengue Tetravalent Vaccine (Live). Risk X: Avoid combination
Denosumab: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Management: Consider the risk of serious infections versus the potential benefits of coadministration of denosumab and cytotoxic chemotherapy. If combined, monitor patients for signs/symptoms of serious infections. Risk D: Consider therapy modification
Deucravacitinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Dipyrone: May enhance the adverse/toxic effect of Myelosuppressive Agents. Specifically, the risk for agranulocytosis and pancytopenia may be increased Risk X: Avoid combination
Etrasimod: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Fexinidazole: Myelosuppressive Agents may enhance the myelosuppressive effect of Fexinidazole. Risk X: Avoid combination
Filgotinib: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Inebilizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Inebilizumab. Risk C: Monitor therapy
Influenza Virus Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Influenza Virus Vaccines. Management: Administer influenza vaccines at least 2 weeks prior to initiating chemotherapy if possible. If vaccination occurs less than 2 weeks prior to or during chemotherapy, revaccinate at least 3 months after therapy discontinued if immune competence restored. Risk D: Consider therapy modification
Leflunomide: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Leflunomide. Management: Increase the frequency of chronic monitoring of platelet, white blood cell count, and hemoglobin or hematocrit to monthly, instead of every 6 to 8 weeks, if leflunomide is coadministered with immunosuppressive agents, such as cytotoxic chemotherapy. Risk D: Consider therapy modification
Lenograstim: Antineoplastic Agents may diminish the therapeutic effect of Lenograstim. Management: Avoid the use of lenograstim 24 hours before until 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Lipegfilgrastim: Antineoplastic Agents may diminish the therapeutic effect of Lipegfilgrastim. Management: Avoid concomitant use of lipegfilgrastim and myelosuppressive cytotoxic chemotherapy. Lipegfilgrastim should be administered at least 24 hours after the completion of myelosuppressive cytotoxic chemotherapy. Risk D: Consider therapy modification
Mumps- Rubella- or Varicella-Containing Live Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Mumps- Rubella- or Varicella-Containing Live Vaccines. Risk X: Avoid combination
Nadofaragene Firadenovec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Nadofaragene Firadenovec. Specifically, the risk of disseminated adenovirus infection may be increased. Risk X: Avoid combination
Natalizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Natalizumab. Risk X: Avoid combination
Ocrelizumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ocrelizumab. Risk C: Monitor therapy
Ofatumumab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ofatumumab. Risk C: Monitor therapy
Olaparib: Myelosuppressive Agents may enhance the myelosuppressive effect of Olaparib. Risk C: Monitor therapy
Palifermin: May enhance the adverse/toxic effect of Antineoplastic Agents. Specifically, the duration and severity of oral mucositis may be increased. Management: Do not administer palifermin within 24 hours before, during infusion of, or within 24 hours after administration of myelotoxic chemotherapy. Risk D: Consider therapy modification
Pidotimod: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pidotimod. Risk C: Monitor therapy
Pimecrolimus: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Pneumococcal Vaccines: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Pneumococcal Vaccines. Risk C: Monitor therapy
Poliovirus Vaccine (Live/Trivalent/Oral): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Poliovirus Vaccine (Live/Trivalent/Oral). Risk X: Avoid combination
Polymethylmethacrylate: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the potential for allergic or hypersensitivity reactions to Polymethylmethacrylate. Management: Use caution when considering use of bovine collagen-containing implants such as the polymethylmethacrylate-based Bellafill brand implant in patients who are receiving immunosuppressants. Consider use of additional skin tests prior to administration. Risk D: Consider therapy modification
Promazine: May enhance the myelosuppressive effect of Myelosuppressive Agents. Risk C: Monitor therapy
Rabies Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Rabies Vaccine. Management: Complete rabies vaccination at least 2 weeks before initiation of immunosuppressant therapy if possible. If combined, check for rabies antibody titers, and if vaccination is for post exposure prophylaxis, administer a 5th dose of the vaccine. Risk D: Consider therapy modification
Ritlecitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ritlecitinib. Risk X: Avoid combination
Ropeginterferon Alfa-2b: Myelosuppressive Agents may enhance the myelosuppressive effect of Ropeginterferon Alfa-2b. Management: Avoid coadministration of ropeginterferon alfa-2b and other myelosuppressive agents. If this combination cannot be avoided, monitor patients for excessive myelosuppressive effects. Risk D: Consider therapy modification
Ruxolitinib (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ruxolitinib (Topical). Risk X: Avoid combination
Sipuleucel-T: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Sipuleucel-T. Management: Consider reducing the dose or discontinuing the use of immunosuppressants, such as cytotoxic chemotherapy, prior to initiating sipuleucel-T therapy. Risk D: Consider therapy modification
Sphingosine 1-Phosphate (S1P) Receptor Modulator: May enhance the immunosuppressive effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk C: Monitor therapy
Tacrolimus (Topical): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tacrolimus (Topical). Risk X: Avoid combination
Talimogene Laherparepvec: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Talimogene Laherparepvec. Specifically, the risk of infection from the live, attenuated herpes simplex virus contained in talimogene laherparepvec may be increased. Risk X: Avoid combination
Tertomotide: Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Tertomotide. Risk X: Avoid combination
Tofacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Tofacitinib. Risk X: Avoid combination
Typhoid Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Typhoid Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Typhoid Vaccine. Risk X: Avoid combination
Ublituximab: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Ublituximab. Risk C: Monitor therapy
Upadacitinib: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the immunosuppressive effect of Upadacitinib. Risk X: Avoid combination
Vaccines (Inactivated/Non-Replicating): Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Vaccines (Inactivated/Non-Replicating). Management: Give inactivated vaccines at least 2 weeks prior to initiation of chemotherapy when possible. Patients vaccinated less than 14 days before initiating or during chemotherapy should be revaccinated at least 3 months after therapy is complete. Risk D: Consider therapy modification
Vaccines (Live): Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Vaccines (Live). Specifically, the risk of vaccine-associated infection may be increased. Vaccines (Live) may diminish the therapeutic effect of Immunosuppressants (Cytotoxic Chemotherapy). Risk X: Avoid combination
Yellow Fever Vaccine: Immunosuppressants (Cytotoxic Chemotherapy) may enhance the adverse/toxic effect of Yellow Fever Vaccine. Specifically, the risk of vaccine-associated infection may be increased. Immunosuppressants (Cytotoxic Chemotherapy) may diminish the therapeutic effect of Yellow Fever Vaccine. Risk X: Avoid combination
Mitomycin is expected to have a low risk of treatment-related azoospermia and male infertility (ESMO [Lambertini 2020]).
Adverse events have been observed in animal reproduction studies.
It is not known if mitomycin is present in breast milk.
Due to the potential for serious adverse reactions in the breastfed infant, breastfeeding is not recommended by the manufacturer.
Monitor CBC with differential (repeatedly during therapy and for ≥8 weeks following therapy); serum creatinine; pulmonary function tests. Monitor for signs/symptoms of HUS, pulmonary toxicity, and infection. Monitor infusion site.
The American Society of Clinical Oncology hepatitis B virus (HBV) screening and management provisional clinical opinion (ASCO [Hwang 2020]) recommends HBV screening with hepatitis B surface antigen, hepatitis B core antibody, total Ig or IgG, and antibody to hepatitis B surface antigen prior to beginning (or at the beginning of) systemic anticancer therapy; do not delay treatment for screening/results. Detection of chronic or past HBV infection requires a risk assessment to determine antiviral prophylaxis requirements, monitoring, and follow-up.
Mitomycin alkylates DNA to produce DNA cross-linking (primarily with guanine and cytosine pairs) and inhibits DNA and RNA synthesis. Mitomycin is not cell cycle specific but has its maximum effect against cells in late G and early S phases (Perry 2012).
Metabolism: Primarily hepatic
Half-life elimination: 17 minutes (30 mg dose)
Excretion: Feces (primarily [Perry 2012]); Urine
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