Mitomycin in the treatment of mesothelioma

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Mytomycin in the treatment of mesothelioma may be helpful in some patients. Several studies show that some people with mesothelioma can be helped by this antibiotic, leading to disease stability and symptom relief by combining it with other drugs.

What is Mitomycin?

Mitomycin is an antibiotic used in the treatment of cancer, as part of chemotherapy. It is approved to treat metastatic pancreatic and stomach cancer, but is sometimes used for other cancers, including cervical cancer, non-small cell lung cancer, and mesothelioma.

Although it is an antibiotic, a type of drug commonly used to treat bacterial infections, mitomycin is only used to treat cancer. It comes from a substance isolated from the Streptomyces caespitosus bacteria, and it works by slowing or stopping the growth of cancer cells. Other chemotherapy drugs kill or destroy cancer cells.

Mitomycin kills cancer cells by generating radicals, compounds that interact with and alter DNA. In the cancer cells, these radicals cross DNA molecules. This prevents the cells from multiplying, which serves to slow or possibly stop tumor growth.

How is mitomycin used?

Oncologists may use mitomycin as part of chemotherapy treatment for patients with specific types of cancer who have not responded well to other chemotherapy drugs, radiation therapy, or surgery. It is given intravenously, approximately every six to eight weeks.

Mitomycin is often given with other chemotherapy drugs. The dosage and exact combination of drugs varies depending on the individual patient, the type and extent of the cancer, and previous treatments.

Side Effects of Mitomycin

Like other chemotherapy drugs, mitomycin targets fast-growing cells, cells in the body that quickly divide into new cells. This helps them target and kill tumor cells, but it also makes other healthy cells vulnerable and causes uncomfortable side effects.

The side effects that are more common and less severe are nausea, vomiting, loss of appetite, hair loss, and an increased risk of infections. You may also experience skin rashes, fatigue and numbness in fingers and toes. Side effects that can be more serious include coughing, passing urine less, shortness of breath, swelling in the feet and legs, and mouth sores.

If you have been given mitomycin and experience blood in the stool or black tarry stools, fever, difficulty urinating, red spots on the skin, unusual bleeding and bruising, or pain in the side or lower back, contact your doctor immediately.

Treating Mesothelioma With Mitomycin

The chemotherapy drugs most commonly used to treat mesothelioma are pemetrexed, cisplatin, carboplatin, gemcitabine, and vinorelbine. Patients often receive a combination of more than one drug for better results, and for mesothelioma, pemetrexed and cisplatin are the most commonly used combination.

The earliest studies of the usefulness of mitomycin for the treatment of mesothelioma used laboratory mice. In an early study, mice were implanted with human mesothelioma cells. The combination treatment of mitomycin with cisplatin was found to be most effective. Based on this finding, the researchers then used this linkage in 12 human patients, and four responded, with three partial responses and one complete response.

Since that study, several others have explored the use of mitomycin with cisplatin and several other drugs. In one study, patients were given the two drugs along with alpha-2b interferon, an antiviral drug thought to boost the immune system to help fight cancer. Some participants had good results, while others experienced cancer progression despite the new treatment regimen. The researchers concluded that the interferon was not helpful, although it tended to show potential improvement if more patients were included in the study.

In another study, researchers combined mitomycin and cisplatin with irinotecan, a chemotherapy drug most commonly used for colon and rectal cancer. They enrolled forty-nine pleural mesothelioma patients to receive this combination treatment. Most saw a good response to treatment with no disease progression. Only four patients still had disease progression and a few patients went unreported. The researchers concluded that this combination could be an effective first-line treatment to slow the spread of mesothelioma.

Mitomycin in combination with cisplatin and vinblastine can help mesothelioma patients relieve symptoms with palliative treatment. Palliative care is the treatment of symptoms for patients with advanced cancer. Researchers found that most of the thirty-nine mesothelioma patients in palliative care tolerated the combination well, and twenty-four saw a significant reduction in cancer symptoms, especially pain.

Not everyone responds the same way to chemotherapy drugs and combinations. While mitomycin in combination with other medications may provide good results for some patients, it does not work for others. There is a possibility of combining this antibiotic with other chemotherapy drugs for patients with mesothelioma, but research is still limited. Talk to your doctor about the use of mitomycin or any clinical trials where the drug is currently used.

Kyle J. Becker

Kyle J. Becker, PharmD is certified by the Board of Pharmacy Specialties in Oncology Pharmacy. dr. Becker received his pharmacy degree from Shenandoah University and currently works as an oncology pharmacist at Parkview Cancer Institute.

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