mitomycin

Mitomycin C (MMC)

This page tells you about a drug called mitomycin C.

Generic name: Mitomycin
Trade name: Mutamycin®
Other name: MTC

Mutamycin is the trade name for Mitomycin. Mitomycin-C and MTC are other names for Mitomycin. In some cases, health care professionals may use the trade name Mutamycin or other names Mitomycin-C and MTC when referring to the generic drug name Mitomycin.

Drug type: Mitomycin-C is an anti-cancer (“antineoplastic” or “cytotoxic”) chemotherapy drug. This medication is classified as an “antitumor antibiotic.” (For more detail, see “How this drug works” section below).

When used correctively in refractive surgery, this medication can be used to reduce corneal haze. Several studies have shown that the use of MMC can reduce such an instance of haze after procedures like PRK, LASIK, and ASA. For this reason, Dr. Khanna prefers using MMC as a preventive measure.

flaten cornea

To whom it may concern,

On May 30, 2003, Dr. Khanna performed Lasik Surgery on my left eye. Prior to the surgery my left eye was 20/200 correctable to 20/25. My eye now tests 20/30 without glasses, correctable to 20/20.

It was only recently that I learned of new technology, which addressed my extreme astigmatism thus making me a candidate for Lasik surgery. The operation took less than 5 minutes with no pain experienced by the eye. Both of my eyes are now very close to 20/20 which improves my distance vision as well and is helping my depth perception and giving me a better view of the golf ball on my back swing.

If I can obtain such a good result at the age of 74, I think just about anyone interested in improving their eyesight can benefit from the procedure. I am favorably impressed with Dr. Khanna’s skill and professionalism and would not hesitate to recommend him to my friends.

– D. Blanchard

General information
Mitomycin C is a purple liquid. It is an antitumor antibiotic that has been used in the medical field for a number of decades. It is used as an anti-cancer drug because it can stop the proliferation or growth of certain types of cells, such as those seen in tumors. It can also stop cells in the eye, which produce scarring or haze, however the use of MMC for the treatment and prevention of corneal haze is a newer use of this medication.

Mitomycin-C 0.02% has been shown to successfully prevent the recurrence of haze after radial keratotomy and PRK. Recent data show that prophylactic MMC effectively prevents haze formation in PRK and laser-assisted subepithelial keratectomy. Intraoperative application of MMC is probably 1 of the most consistently effective methods to prevent haze formation after corneal ablation. Prophylactic use of MMC with PRK can be beneficial to patients with risk factors for corneal haze, such as high myopia and deep ablation depth.24, 25

Mitomycin-C was first used by Schipper and coauthors16 and Talamo et al. in rabbit studies. Majmudar et al. applied MMC in patients who had corneal haze and decreased corrected visual acuity due to previous PRK or RK procedures. The authors removed the corneal scar mechanically and applied MMC, thus preventing the reformation of haze. Carones and coauthors25 also report similar cases with good results and few complications. At the Khanna Institute we have used it in patients undergoing PRK and Superlasik. Our current technique is to use 0.02% MMC for 20 seconds. The time of application as gradually come down from the original 2 minutes based on our and our colleagues experience.

Common side effects
MMC is very potent, and under certain circumstances, potentially toxic. Eye-related and vision threatening complications that have been reported when using MMC for other conditions include, but are not limited to:

  • Secondary Glaucoma
  • Corneal Edema
  • Corneal or scleral thinning or perforation requiring corneal transplants
  • Permanent stem cell deficiency
  • Sudden onset mature cataract
  • Corneal Decompensation
  • Corectopia ( displacement of the pupil form its normal position)
  • Iritis
  • Scleral Calcification
  • Scleral melt
  • Retinal vascular occlusion
  • Conjunctival irritation (redness of the eye)
  • Incapacitating photophobia and pain

Please note that Dr. Khanna uses a technique in which a low dosage of MMC is used and delivered by placing a small sponge on the central cornea for 20 seconds. This technique minimizes, but may not eliminate, the chance of developing MMC- related complications.

Remember
Not everyone will get these side effects. You may have none or several. A side effect may get worse through your course of treatment, or more side effects may develop as the course goes on. This depends on

  • How many times you’ve had the drug before
  • Your general health
  • How much of the drug you have (the dose)
  • The way you take the drug (tablets or drip)
  • Other drugs you are having

Some side effects are upsetting or inconvenient, but not damaging to your health.

Some side effects are serious medical conditions and need treating. Where we have urged you to contact your doctor, this is because.

  • Your side effect may need treating
  • Your drug dose may need reducing to try to prevent the side effect

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and other over the counter remedies – drugs can react together.

Talk to your doctor or nurse about all your side effects so they can help you manage them.

Mitomycin : when used systemically

Mitomycin (pronounced my-toe-my-sin) is a chemotherapy drug that is given as a treatment for several different types of cancer, including breast, stomach, gullet (oesophagus) and bladder cancers. This information describes mitomycin, how it is given and some of its possible side effects. It should ideally be read with our general information about chemotherapy and about your type of cancer, which give further information and advice.

How it is given
Mitomycin may be given:

  • as an injection into the vein (intravenously) through a fine tube inserted into the vein (cannula)
  • through a central line, which is inserted under the skin into a vein near the collarbone, or into a PICC line, which is inserted into a vein in the crook of the arm
  • into the bladder (intravesically)
  • by injection into an artery (intra-arterially).

Possible side effects
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is given mitomycin and may be different if you are having more than one chemotherapy drug.

We have outlined the most common and less common side effects, so that you can be aware of them if they occur. However, we have not included those that are very rare and therefore extremely unlikely to affect you. If you notice any effects which you think may be due to the drug, but which are not listed in this information, please discuss them with your doctor or chemotherapy nurse.

Lowered resistance to infection Mitomycin can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given and your resistance to infection usually reaches its lowest point about 28 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

  • Your temperature goes above 38ºC (100.5ºF)
  • You suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.

Bruising or bleeding Mitomycin can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding.

Anaemia (low number of red blood cells) While having treatment with mitomycin you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Loss of appetite A dietitian or specialist nurse at your hospital can give advice and tips on boosting appetite, coping with eating difficulties and maintaining weight.

Tiredness and a general feeling of weakness It is important to allow yourself plenty of time to rest.

Less common side effects

Nausea (feeling sick) and vomiting If you do feel sick it may begin a few hours after the treatment is given and can last for a few days. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs that can be given to prevent or greatly reduce nausea and vomiting. If the sickness is not controlled or continues tell your doctor, who can prescribe other anti-sickness drugs that may be more effective.

Changes to the lungs Mitomycin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.

Your kidneys may be affected Your kidneys will be checked by a blood test before each treatment.

Hair loss It is very unusual to lose your hair. Some people notice that their hair becomes a little thinner, but not usually enough to be noticeable to other people.

Skin changes Mitomycin can cause a rash which may be itchy. Your doctor can prescribe medicine to help with this.

Changes in nails Your nails may become darker. This change grows out over a few months once treatment has finished.

Sore mouth and taste change Your mouth may become sore, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as special mouthwashes and medicines to prevent or clear any mouth infection can be prescribed. You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Diarrhea This can usually be easily controlled with medicine but let your doctor know if it is severe or if it continues. It is important to drink plenty of fluids if you have diarrhea.

Additional information

If mitomycin leaks into the tissue around the vein it can damage the tissue in that area. If you notice any stinging or burning around the vein while the drug is being given, or any leakage of fluid from the cannula site, it is very important that you tell your doctor or nurse. If the area around the injection site becomes red or swollen at any time you should either tell the doctor or nurse on the ward, or if you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.

Fertility Your ability to become pregnant or father a child may be affected by taking this drug. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or father a child while taking mitomycin, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your doctor.