Mitomycine Accord (Mitomycin)

Mitomycin is used as an alkylating agent in the management of solid tumours that are responsive to DNA cross‑linking therapy.

• Non‑muscle invasive bladder cancer: intravesical administration aims to reduce tumour recurrence and progression.
• Gastric carcinoma: intravenous infusion is used as part of combination regimens to improve response rates.
• Pancreatic carcinoma: intravenous dosing contributes to tumour control when combined with other chemotherapeutics.
• Other solid tumours (e.g., breast, colorectal): intravenous use is incorporated into multi‑drug protocols to enhance cytotoxic effect.

• Mitomycin exerts its antineoplastic activity by undergoing enzymatic reduction within hypoxic tumour cells, forming a reactive intermediate that covalently cross‑links DNA strands. This cross‑linking blocks DNA replication and transcription, leading to inhibition of cell division and ultimately triggering apoptotic cell death in rapidly proliferating cancer cells.

Mitomycin may cause a range of adverse reactions that vary in frequency and severity.

Common Side Effects

• Nausea and vomiting: gastrointestinal upset occurring during or after infusion.
• Myelosuppression: reduced white blood cells, platelets, and red cells.
• Hematuria: blood in urine, especially after intravesical administration.
• Fatigue: generalized tiredness during treatment cycles.
• Skin discoloration: localized hyperpigmentation at infusion sites.

Serious or Rare Side Effects

• Pulmonary fibrosis: progressive scarring of lung tissue.
• Severe renal toxicity: acute kidney injury requiring monitoring.
• Hemorrhagic cystitis: bladder inflammation with bleeding.
• Anaphylactic reactions: rare hypersensitivity requiring immediate intervention.

Mitomycin requires careful monitoring and specific safety measures before, during, and after administration.

• Renal function assessment: evaluate creatinine clearance prior to dosing.
• Pulmonary evaluation: baseline lung function tests for patients with pre‑existing respiratory disease.
• Hematologic monitoring: regular complete blood counts to detect myelosuppression.
• Pregnancy and lactation: avoid use unless benefits outweigh potential fetal or neonatal risks.
• Drug handling: healthcare personnel should use protective equipment and follow aseptic techniques.
• Store at 2-8°C: keep refrigerated, protect from light, do not freeze or shake the product.

Mitomycin may interact with other medicines, altering efficacy or toxicity.

Major Interactions (Avoid)

• High‑dose cyclophosphamide: combined use markedly increases risk of severe bone‑marrow suppression.
• Nephrotoxic agents (e.g., cisplatin, aminoglycosides): concurrent therapy can exacerbate renal injury.
• Anticoagulants (e.g., warfarin): may enhance bleeding tendency due to thrombocytopenia.

Moderate Interactions (Monitor Closely)

• Other alkylating agents: cumulative myelosuppression requires dose adjustments.
• Radiotherapy: concurrent treatment may increase tissue toxicity.
• CYP450 inducers or inhibitors: may affect metabolic clearance of mitomycin, warranting therapeutic monitoring.