Mitomycin C in combination with vinorelbine in anthracycline- and/or taxane-pretreated patients with metastatic breast cancer

BACKGROUND

Patients with metastatic breast cancer (MBC) with disease progression after anthracycline-and/or taxane-containing therapy need an effective drug regimen with low toxicity. Mitomycin C (MMC) and vinorelbine (VNR) are suitable candidates for combination therapy in the second-/third-line treatment of MBC. This study evaluates the safety and efficacy of an MMC/VNR combination chemotherapy in pretreated patients with MBC.

PATIENTS AND METHODS

In a phase II trial, patients with anthracycline-and/or taxane-pretreated MBC were treated with MMC 8 mg/m(2) (day 1) and VNR 25 mg/m(2) (days 1 and 8) every 4 weeks for up to 6 cycles or until disease progression.

RESULTS

In 51 eligible patients, 13 (26%) partial remissions (PRs), 20 (39%) stable diseases (SDs) and 18 (35%) progressive diseases (PDs) were observed. The median progression-free survival (PFS) was 5.0 months. The main grade 3/4 toxicities were neutrocytopenia (41%), granulocytopenia (37%), and thrombocytopenia (4%). Other hematological and non-hematological toxicities were mostly mild.

CONCLUSION

The combination of MMC and VNR is an effective and relatively well-tolerated regimen for anthracycline- and/or taxane-pretreated patients with MBC and is suitable for outpatient therapy.

Histological changes due to intravesical instillation of mitomycin C

OBJECTIVE

Transurethral resection (TUR) is highly effective in the local control of superficial bladder cancer. However, the recurrence rate can reach 80% of the cases. Adjuvant intravesical chemotherapy may decrease significantly tumor recurrence. We describe a bladder adverse reaction to mitomycin C as adjuvant therapy for non-invasive bladder cancer

METHODS

Three patients with diagnosis of pTa G1 urothelial carcinoma were treated by TUR plus an instillation of 40 mg. of mitomicin C. A month later, the patients were attended for dysuria and hematuria. Cystoscopy and bladder biopsy were performed in all cases.

RESULTS

Multiple sessile lesions suspicious of tumor recurrence were found on cystoscopy. The histopathological diagnosis disclosed the existence of severe atypia of the urothelium and stromal changes similar to those observed after radiotherapy

CONCLUSIONS

Adjuvant intravesical chemotherapy with mitomycin C may cause local reactions with macroscopic patterns similar to tumoral recurrences.

Intravesical gemcitabine for non-muscle invasive bladder cancer

BACKGROUND

Intravesical immunotherapy or chemotherapy for non-muscle invasive bladder cancer is a well established treatment for preventing or delaying tumour recurrence following tumour resection. However, up to 70% of patients may fail and new intravesical agents with improved effectiveness are needed. Gemcitabine is a relatively new anticancer drug that has shown activity against bladder cancer.

OBJECTIVES

To evaluate the effectiveness and toxicity of intravesical gemcitabine in preventing tumour recurrence and progression in non-muscle invasive bladder cancer (NMIBC).

SEARCH METHODS

A search strategy was developed for MEDLINE to identify randomised trials of intravesical gemcitabine for the treatment of non-muscle invasive bladder cancer. The searches were from 1947 to May 2011. Other databases searched included EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials, LILACS, SCOPUS, BNI, Biomed Central, Web of Science and BIOSIS. Handsearching of meeting proceedings, international guidelines and trial registries was also carried out.

SELECTION CRITERIA

The titles and abstracts of the combined electronic and handsearching were manually screened by three authors independently to determine if they met the inclusion criteria for this review. Studies were selected if they were randomised, controlled trials or quasi-randomised clinical trials that included intravesical gemcitabine in at least one arm of a comparative study.

DATA COLLECTION AND ANALYSIS

Data extraction was carried out by three reviewers. The information retrieved included the author's details, the study design, the characteristics of the recruited patients, details of the interventions and data relating to the primary, and secondary outcome measures.

MAIN RESULTS

Six relevant randomised trials were identified with the number of patients randomised in each trial varying from 30 to 341 (total 704). All trials compared gemcitabine to active controls and varied in the reporting of outcomes. One study compared a single post-operative instillation of intravesical gemcitabine with a saline placebo in 341 patients and found no significant difference in the rates of tumour recurrence (28% versus 39%, respectively) or recurrence-free survival (HR (hazard ratio) 0.95, 95% CI 0.64 to1.39, P = 0.77). The rate of progression to invasive disease was greater with gemcitabine (2.4% versus 0.8%). A further trial compared gemcitabine with intravesical mitomycin C and demonstrated that the rates of recurrence (28% versus 39%) and progression (11% versus 18%) were lower with gemcitabine but did not reach statistical significance. The global incidence of adverse events was significantly less with gemcitabine (38.8% versus 72.2%, P = 0.02).Three trials compared gemcitabine with intravesical BCG but a meta-analysis was not possible due to clinical heterogeneity. In untreated patients at intermediate risk of recurrence (primary Ta-T1 no CIS) one trial showed that gemcitabine and BCG were similar with respective recurrence rates of 25% and 30% (P = 0.92) and overall progression equal (P = 1.0). Dysuria (12.5% versus 45%, P < 0.05) and frequency (10% versus 45%, P < 0.001) were significantly less with gemcitabine. In a second trial of high risk patients the recurrence rate was significantly greater with gemcitabine compared to BCG (53.1% and 28.1%, P = 0.04) and the time to recurrence significantly shorter with gemcitabine (25.5 versus 39.4 months, P = 0.042). Finally in a third trial of high risk patients who had failed previous intravesical BCG therapy, gemcitabine was associated with significantly fewer recurrences (52.5% versus 87.5%, P = 0.002) and a longer time to recurrence (3.9 versus 3.1 months, P = 0.9) compared to BCG. Progression rates were similar in both groups (33% versus 37.5%, P = 0.12) with no significant differences in grade 2 or 3 toxicities.The final trial was a marker lesion study which reported greater response rates when intravesical gemcitabine (2 g) was given as three bi-weekly doses (36%) or six weekly doses (40%) compared to a single dose (9%).

AUTHORS' CONCLUSIONS

A single dose immediately following surgery is ineffective based on one study. Gemcitabine may be more active than mitomycin C with a lower toxicity profile. Compared to intravesical BCG therapy, gemcitabine had similar effects in intermediate risk patients, less effective in high risk patient and superior in BCG refractory patients. However, each randomised trial identified represents a different clinical setting in NMIBC and therefore the evidence base is limited. Consequently these data should be interpreted with caution until further corroborative evidence becomes available. The aim of intravesical therapy in NMIBC is to prevent tumour recurrence and progression and to avoid the morbidity associated with cystectomy. Intravesical gemcitabine is a promising drug that may add to the urologist's options in achieving this goal.

Chemoradiotherapy for anal cancer in HIV patients causes prolonged CD4 cell count suppression

BACKGROUND

Despite the advent of highly active antiretroviral therapy, anal cancer remains a significant health problem in human immunodeficiency virus (HIV) patients. We present the clinical features and treatment outcomes of anal cancer in 60 HIV-positive patients over a 20-year period.

PATIENTS AND METHODS

A prospective database of all HIV-positive individuals managed in a specialist unit since 1986 includes 11 112 patients (71 687 person-years of follow-up). Sixty patients with anal cancer were identified. Their clinicopathological and treatment details were analysed.

RESULTS

At anal cancer diagnosis, the mean age was 44 years (range: 28-75 years) and the median CD4 cell count was 305 mm(-3) (range: 16-1252 mm(-3)). Fifty (83%) had chemoradiotherapy (CRT). Forty-six (92%) responded, of whom 10 (22%) subsequently relapsed with locoregional (70%), metastatic disease (10%) or both (20%). The overall 5-year survival is 65% (95% confidence interval 51% to 78%). The median CD4 count fell from 289 mm(-3) before CRT to 132 mm(-3) after 3 months and to 189 mm(-3) after 1 year (P<0.05). Six patients in remission of anal cancer died of acquired immunodeficiency syndrome defining illnesses.

CONCLUSIONS

The management of anal cancer with CRT achieves similar outcomes as the general population. CRT is associated with significant prolonged CD4 suppression that may contribute to late deaths of patients in remission.

[Repair of a leaking bleb filtration with conjunctival and amniotic membrane transplantation]

CLINICAL CASE

A 71-year-old woman presented with a leaking bleb after a combined phacotrabeculectomy performed 13 years ago. To construct a new filtering bleb, the necrotic area was fully excised. The amniotic membrane was inserted over the scleral flap underneath healthy conjunctiva edges. A conjunctiva-Tenon autograft from the contralateral eye was sutured and was sealed with fibrin adhesive.

DISCUSSION

We propose a new surgical technique to repair late leak failures after trabeculectomy with mitomycin C in blebs with a large avascular area. Transplantation of amniotic membrane and conjunctival autograft may be used to repair late leak failures with inadequate conjunctiva to advance.

Curcumin improves MMC-based chemotherapy by simultaneously sensitising cancer cells to MMC and reducing MMC-associated side-effects

Mitomycin C (MMC) potently suppresses tumour growth. However, its use is limited by its severe toxicity to the kidney and bone marrow. The purpose of this study is to investigate whether the chemoprevention agent curcumin can reduce MMC-associated side-effects and improve MMC efficacy in a breast cancer xenograft model. We first determined the effectiveness of combined MMC and curcumin to inhibit in vitro cell growth and to regress in vivo tumour outgrowth. We then investigated the mechanisms associated with MMC/curcumin-induced cell death by examining the effect of MMC/curcumin treatment on apoptosis, the activation of caspase-3, 8 and 9 and the expression of bcl-2 and bax. We also evaluated the ability of curcumin to alleviate MMC-associated side-effects by comparing the levels of creatinine/blood urea nitrogen (Cr/BUN) and glutamic oxalacetic transaminase/glutamic pyruvic transaminase (GPT/GOT) in serum between animals receiving MMC alone and MMC/curcumin. Curcumin significantly sensitised MCF-7 and MDA-MB-231 cells to MMC-induced cell death and improved MMC's ability to regress MCF-7 xenograft. MMC and curcumin together synergistically enhanced apoptosis in MCF-7 cells and the apoptosis most likely resulted from both the activation of caspases and modulation of bcl-2/bax expression. Most importantly, the inclusion of curcumin in MMC treatment decreased MMC-caused severe side-effects evidenced by significant improvement in the kidney function. Enhancing the tumoricidal effect of MMC, curcumin greatly reduces MMC-associated severe side-effects. Therefore, the combination treatment of MMC and curcumin may be of significant therapeutic benefit in treating breast cancer.

The rat gut micronucleus assay: a good choice for alternative in vivo genetic toxicology testing strategies

The in vivo bone marrow (BM) micronucleus assay is one of the three tests in the standard test battery to assess the genotoxic potential of a pharmaceutical candidate. In some cases, depending on results of in vitro studies, the route of administration or the degree of systemic exposure, in vivo assessment of genotoxicity in the BM alone may not be sufficient. Based on the potential for high gut exposures to orally administered compounds with low systemic exposures as well as the potential susceptibility of rapidly dividing cells of the intestinal tissues, we have developed a modified technique for evaluating micronuclei formation in both the duodenum and colon of rats based on earlier publications. Adult male Sprague Dawley rats were treated once daily for 2 days with either vehicle control or with the test articles acetyl salicylic acid (ASA), carbendazim (CAR), cyclophosphamide (CP), dimethylhydrazine (DMH), mitomycin C (MMC) or vinblastine sulfate (VIN). The duodenum, colon, and BM were harvested, processed, and analyzed for micronucleus induction. Results from these studies demonstrated differences in the susceptibility for different test compounds in the three tissues tested. When MMC and VIN were dosed by different routes at the same dose levels both compounds produced positive results in all three tissues by intraperitoneal injection but not oral administration. These studies suggest that overall the GI micronucleus assay might be a useful tool for clastogenic and aneugenic compounds that are expected to produce high sustained concentrations in the gastrointestinal tract with little systemic exposure.

Is the combination of mitomycin C, bleomycin and methotrexate effective as a neoadjuvant treatment for cervical cancer in women?

OBJECTIVE

To determine the effectiveness of the combination of mitomycin C, bleomycin and methotrexate as a neoadjuvant treatment in preparation for surgical treatment of cervical cancer.

METHODS AND MATERIALS

Twenty-seven patients with carcinoma of the uterine cervix (stages exophytic IB2 and IIB-IIIB) who had not previously undergone any treatment received mitomycin C, bleomycin and methotrexate in five sessions, once every four weeks.

RESULTS

The objective response rate was approximately 81%, including 16 complete responses and six partial responses. Significant toxic effects were not observed. Responsive patients underwent surgery and remained without evidence of disease for the next 20 years. Unresponsive patients did not fare well and passed away within five years after treatment.

CONCLUSION

Our data suggest that this strategy may be effective for advanced cases, enabling patients to receive surgical treatment.

[Chemotherapy in gallbladder carcinoma]

Gallbladder cancer is an aggressive tumor. Its incidence varies according to geography. Surgery is the standard treatment for localized stage but there is no standard treatment in metastatic or locally advanced disease. Because of the rarity of bile tract cancer (BTC) and gallblader carcinoma (GBC), most studies have grouped all BTC and GBC together, and there are very few GBC-specific studies. In addition, there is a paucity of randomized controlled studies in this disease with small numbers of patients and inclusion bias. One randomized trial ABC-02 was well conducted and showed a survival benefit in favor of gemcitabine (GEM)+cisplatin (CDDP), which can be regarded as the standard in locally advanced BTC. Adjuvant therapy after surgical resection is not validated. Understanding the molecular mechanisms of carcinogenesis of GBC has opened the way for the use of targeted therapies. This new treatment would improve survival and quality of life of our patients.

[Treatment of acute iatrogenic cystitis secondary to bladder chemo-immuno-instillation or pelvic radiotherapy]

The onset of cystitis during intravesical chemo-immunotherapy for the treatment of non-muscle invasive transitional cell bladder tumor, or after pelvic radiotherapy mainly for prostate cancer, is a frequent clinical situation, not easily manageable due to the lack of responsiveness to symptomatic drugs, often resulting in discontinuation of cancer treatment in many cases.?The similarity of symptoms with those of the painful bladder syndrome, otherwise called interstitial cystitis, has led us to use the same treatment with intravesical sodium hyaluronate in order to obtain an improvement of symptomatology. We therefore performed a prospective study on 55 consecutive male symptomatic patients, aged from 54 to 81 years: 11 after radiotherapy, 17 after BCG and 27 after Mitomicyn C bladder instillations ,12 of whom in combination with bladder hyperthermia.?All subjects underwent bladder instillations with sodium hyaluronate 40 mg in 50 mL weekly for 8 to 24 weeks depending on the time needed to the resolution of the symptoms.?During the first 4 weeks 32 mg of dexamethasone were also instilled intravesically, mixed with hyaluronate, in order to obtain a stronger anti-inflammatory activity due also to its higher capacity of penetration in the bladder mucosa. The symptoms intensity was evaluated through a Visual Analogue Score (VAS) of the discomfort and pain perceived from 0 to 10, and bladder capacity was recorded with micturition diary before and after the treatment.?After 16 weeks VAS improved in every case of chemical cystitis from an initial mean value of 8.6 to a final mean value of 1(with 3 as a maximum value recorded). The difference was highly significant (p <0.001). Bladder capacity increased in all cases of chemical cystitis from a mean value of 56 to 276 mL with a highly significant improvement (p <0.001) and in all cases of post-actinic cystitis from a mean bladder capacity of 89 to a final mean value of 239 mL, with a significant improvement (p= 0.05). We did not observe any side effect due to our treatment. Therefore, we can conclude that bladder instillation with sodium hyaluronate for at least 8 weeks and dexamethasone in the first 4 weeks can solve the symptoms of iatrogenic cystitis secondary to chemo-immunotherapy or pelvic radiotherapy, without incurring in side effects. To our knowledge this treatment has never been published before in scientific medical literature.

Mitomycin C for the treatment of bladder cancer

Bladder cancer is a heterogeneous disease: approximately 75% of its forms are non muscle invasive neoplasms. Standard treatment for non muscle invasive bladder cancer (NMIBC) consists of complete transurethral resection (TURB) of all visible lesions. Recurrence rates following TURB and intravesical chemoprophylaxis seem to decrease to 25-50% in 2 years of follow-up. The aim of the present paper is to review findings from the most relevant studies and evaluate the potentials of mitomycin C (MMC) in the treatment of non muscle invasive bladder cancer. Studies were identified by searching MEDLINE(R) and Pubmed(R) databases up to 2010 using both medical subject heading (Mesh) and a free text strategy with the name of known individual chemotherapeutic drug and the following key words: "non muscle-invasive bladder cancer", "intravesical therapy", "Mitomycin C", "Device Therapy". At the end of our research in literature we selected 66 articles. From literature is clear that in case of low or intermediate risk superficial bladder cancer, MMC is one of the most used agents with limited side effects. In fact MMC has a high molecular weight and is relatively hydrophobic, resulting in less sistemic absorption. Regimens are based on weekly instillations but despite many studies there is not universal consensus on timing and duration of therapy. MMC early istillation seems effective in preventing tumour recurrence in low risk non muscle invasive neoplasms. MMC maintenance chemotherapy continue to be considered effective in reducing tumour recurrence rate in low and intermediate risk tumours. It is known in literature that the lack of response to intravesical chemotherapy in patients with non muscle invasive bladder cancer is due to two factors: lack of sensitivity of the neoplasm to intravesical chemotherapy and inadequate drug delivery to the tumour. In order to resolve these limitations in the last years MMC, in many centers, is used with device assisted therapies or with new administration scheme.

Eosinophilic cystitis following immediate post-resection intravesical instillation of mitomycin-C

We present a patient who developed severe lower urinary tract symptoms following resection of a Ta low grade bladder urothelial carcinoma with immediate post-resection instillation of mitomycin-C. Urine cultures were negative. Radiographic imaging demonstrated a bladder mass. On biopsy she was found to have eosinophilic cystitis. We report the clinical scenario and discuss treatment options. A review of reported cases in the English literature is provided.

Management of anal cancer in 2010. Part 2: current treatment standards and future directions

The treatment of anal squamous cell cancer with definitive chemoradiation is the gold-standard therapy for localized anal cancer, primarily because of its sphincter-saving and colostomy-sparing potential. Studies have addressed different chemoradiation regimens in hopes of improving on the standard protocol of fluorouracil (5-FU), mitomycin, and radiation, but no alternative regimens have proven superior. Nevertheless, important conclusions have been derived regarding the continuity of radiation as well as the role of induction and maintenance chemotherapy in this setting. In the concluding part of this review, we consider the data on chemoradiation with 5-FU/mitomycin vs radiation alone, chemoradiation with 5-FU/mitomycin vs chemoradiation with 5-FU alone, neoadjuvant chemotherapy with cisplatin/5-FU followed by cisplatin/5-FU plus radiation vs mitomycin/5-FU plus radiation, the addition of induction or maintenance chemotherapy to chemoradiation, the effect of overall treatment time on tumor control, whether chemotherapy can be eliminated for early-stage anal cancer, and the impact of human immunodeficiency virus infection on treatment.

[Clinical observation of therapeutic efficacy and study of conjunctival impression cytology after pterygium surgery]

OBJECTIVE

To compare the pathologic changes, the recurrence rate and the ocular surface damage after 4 different types of pterygium surgical procedures.

METHODS

It is a prospective study. From Mar. 2006 to Mar. 2008, 84 patients (93 eyes) from Shi Jia-zhuang Center Hospital were selected and separated into 4 groups as follows, simple excision group, 24 patients (27 eyes); excision with conjunctival allograft group, 21 patients (22 eyes) excision with autologous limbus stem cell transplantation group, 18 patients (20 eyes) and excision with mitomycin (MMC) group, 21 patients (24 eyes). Slit lamp microscope examination and impression cytology were performed 1 day before the surgery and repeated 30 and 90 days after the surgery. Multivariate analysis of variance was used to analyze these data with statistical software SPSS 11.0. P value less than 0.05 was considered statistically significant.

RESULTS

Before the surgery, slight conjunctival epithelium keratinization, mild acantholysis and decrease in goblet cells density were identified in all patients (248.8 +/- 97.3, 256.2 +/- 75.1, 236.1 +/- 87.9, 245.1 +/- 81.0; F = 0.029, P = 0.993). All of these changes decreased 1 month after the surgery. MMC group showed more goblet cells than the other 3 groups, but the difference was not statistically significant (F = 0.747, P = 0.554). Three months after the surgery, all of these changes in MMC group (112.1 +/- 56.8) were significantly more severe than those in other 3 groups (309.6 +/- 77.0, 314.1 +/- 68.9, 317.4 +/- 73.2; F = 6.337, P = 0.017) and no difference could be detected between these 3 groups. There were 5 recurrences in simple excision group, 3 recurrences in MMC group, 1 recurrence in stem cell transplantation group and none in conjunctival allograft group.

CONCLUSIONS

There are fewer recurrent cases in conjunctival allograft group and stem cell transplantation group than the others. Severe ocular surface damage is present in MMC group.

[Drug eruption (erythema multiforme type) following chemoradiotherapy with mitomycin C and 5-fluorouracil administration for squamous cell carcinoma of the anal canal]

We report a case of drug eruption (erythema multiforme type) in a 54-year-old woman, following concurrent chemoradiotherapy for squamous cell carcinoma of the anal canal. Chemotherapy comprised one cycle of mitomycin C 10 mg/m2/day (intravenous bolus injection)on day 1 and 5-fluorouracil(5-FU)1, 000 mg/m 2/day (continuous intravenous infusion) on days 1-4 of radiotherapy. External irradiation of the pelvic space was performed, using daily fractions of 1. 5 Gy(total dose, 33 Gy). From day 4 after chemoradiotherapy, erythema appeared proximal to the forearm site used for drug administration. On day 6, erythema was noted on the trunk, hip and thigh. We suspected erythema multiforme based on the appearance of wheals and target lesions of the skin and a patient history of chemoradiotherapy. Steroids were administered orally, which resolved systemic eruption at week 2. The patient also experienced grade 3 leukocytopenia, neutropenia, thrombopenia, diarrhea, and anorexia. Although we could not provide sufficient chemotherapy and radiation therapy due to severe side effects, squamous cell carcinoma of the anal canal responded extremely well with a marked decrease in complete response. We surmise that the drug eruption was associated with 5-FU. Concurrent chemoradiotherapy is safe and effective for squamous cell carcinoma of the anal canal, but care is required to prevent drug eruption during treatment.

[Extra- and paravasation of cytotoxic drugs. Pathomechanisms and current preventive measures]

Defined anticancer drugs are able to induce severe local damages in cases of accidental extravasation. The underlying pathomechanisms differ from each other, e.g. vincristine and conventional doxorubicin, when the corresponding intervention needs hyaluronidase and dexrazoxane, respectively. Whether an intensified diagnostic measure may help to assume extent and severity of local drug extravasation more accurately, needs further clinical investigation.

Mitomycin-C-augmented deep sclerectomy in patients with primary open-angle glaucoma and exfoliation glaucoma: a 1-year prospective study

PURPOSE

To investigate the efficacy and safety of mitomycin C (MMC)-augmented deep sclerectomy with implant (DSCI) in patients with primary open-angle glaucoma (POAG) and exfoliation glaucoma (ExG).

METHODS

A total of 68 eyes of 68 patients with POAG and ExG were enrolled consecutively to undergo DSCI with MMC (0.4 mg/ml for 2 min). The intraocular pressure (IOP), number of antiglaucoma medications, neodymium:yttrium-aluminum-garnet (Nd:YAG) laser goniopunctures and complications were compared postoperatively. Surgery was considered as a complete success when IOP was < 18 mmHg without antiglaucoma medication.

RESULTS

Preoperatively, the mean IOPs were 23.1 +/- 5.8 and 25.4 +/- 8.3 mmHg, and 13.8 +/- 6.1 and 11.2 +/- 5.6 mmHg in the POAG and ExG groups, respectively, at 12 months. 77.4% and 75.7% of surgeries were a complete success in the POAG and ExG groups, respectively [not significant (NS)]. Five patients (16.1%) in the POAG group but none in the ExG group (0%) were receiving antiglaucoma medication at 12 months (NS). Nd:YAG laser goniopuncture was performed in 29.0% of eyes in the POAG group and in 55.6% of eyes in the ExG group (p = 0.047). Postoperatively, choroidal detachment occurred in 16.1% of eyes in the POAG group and in 10.8% of eyes in the ExG group (NS). We encountered no serious complications related to MMC use.

CONCLUSION

DS with MMC augmentation appears to be equally effective in ExG and POAG patients in lowering IOP to target levels, at least in the short term, with few immediate postoperative complications.

Corneal complications of intraoperative Mitomycin C in glaucoma surgery

PURPOSE

To report corneal toxicity of Mitomycin C application during filtering glaucoma surgery in two patients.

CASE REPORTS

An elderly woman, 81 years of age, developed diffuse corneal epitheliopathy with subepithelial stromal oedema seven weeks after a trabeculectomy with Mitomycin C application. Another patient, a 76-year-old man, first developed a central epithelium defect and stromal oedema in the second postoperative week after a similar procedure. Later the corneal stroma melted, what resulted in perforation in the second postoperative month.

RESULTS

Intraoperative Mitomycin C application during trabeculectomy induced serious corneal complications several weeks after the surgery.

CONCLUSIONS

Although infrequent, serious corneal complications may arise following the intraoperative use of Mitomycin C in filtering surgery for glaucoma. The possible contributing factors to the development of the corneal toxicity will be discussed.

Herpetic keratitis and keratouveitis after mitomycin-C use in glaucoma filtering surgery: a short case series

PURPOSE

We report 4 eyes of 3 patients with presumed herpetic keratitis/keratouveitis after glaucoma surgery wherein intraoperative mitomycin-C was used.

METHODS

Three patients, aged 18-75 years, were found to have unilateral or bilateral herpetic keratitis and/or keratouveitis, 15 days to 2 years after trabeculectomy with mitomycin-C.

RESULTS

All 3 cases healed without any sequelae after 4 to 6 weeks with topical and/or systemic acyclovir. Topical steroids were used in cases with stromal involvement.

CONCLUSIONS

Mitomycin-C may predispose/facilitate development of herpetic keratitis/keratouveitis up to 2 years after glaucoma surgery.

A phase I dose escalation study of a pharmacobiologically based scheduling of capecitabine and mitomycin C in patients with gastrointestinal malignancies

BACKGROUND

Mitomycin C (MMC) produces significant upregulation of thymidine phosphorylase, a principal determinant of the therapeutic index of capecitabine-based treatment, starting 4-6 days after treatment. On the basis of the time-dependency of this upregulation, we performed a phase I dose escalation study of capecitabine and MMC in patients with gastrointestinal malignancies.

METHODS

A total of 29 patients with advanced gastrointestinal malignancies received MMC at 6 mg/m2 on day 1 and capecitabine escalated in four successive patient cohorts of doses 500-1,000 mg/m2/day twice daily on days 8-21, every 28 days. MMC was capped at 36 mg/m2.

RESULTS

A total of 29 patients were enrolled and 90% had at least one prior treatment in the metastatic setting. There was one DLT, grade 3 hand and foot syndrome, at dose level four. The most common toxicity was fatigue (61%). No patients experienced grade 4 toxicities. Nine patients experienced prolonged stability of disease.

CONCLUSION

Capecitabine in combination with MMC in the proposed schedule is well-tolerated with evidence of preliminary activity. The recommended dose for phase II studies are MMC at 6 mg/m2 on day 1 of a 28-day cycle with the dose capped at 36 mg/m2, in combination with capecitabine at 1,000 mg/m2 twice daily on days 8-21.

Corneal and conjunctival findings after mitomycin C application in pterygium surgery: an in-vivo confocal microscopy study

PURPOSE

To perform a qualitative assessment of the topical side-effects of mitomycin C on cornea after pterygium surgery.

METHODS

In-vivo confocal microscopy (Heidelberg Retina Tomograph II in combination with the Rostock Cornea Module) was performed in 10 patients with unilateral primary pterygium. Mitomycin C 0.02% was applied topically to seven eyes for 5 min intraoperatively and twice daily for 5 days postoperatively. Three eyes underwent surgery without application of cytostatic agent. Patient follow-up was 1 month.

RESULTS

After application of mitomycin C, complete epithelialization of the operated zone was found 2 weeks after surgery. In-vivo confocal microscopy revealed signs of superficial punctate keratitis for 2 weeks in the central cornea only after application of mitomycin C. The presence of epithelial and stromal oedema in this group was noted for up to 2 weeks in the central cornea and for up to 4 weeks in the operated zone. In the control group, complete epithelialization was found after 1 week; there were no signs of oedema after 1 week in the central cornea or after 2 weeks in the operated zone. Leucocyte infiltration and increased Langerhans cell density were noted in both groups in the operated and central zones. Analysis of the conjunctiva revealed a decrease in goblet cell density following cytostatic application.

CONCLUSION

Local application of mitomycin C delays corneal epithelialization, and prolongs postoperative epithelial and stromal oedema in both the centre and periphery. Moreover, signs of punctate keratitis were noted 2 weeks after surgery in central intact cornea. Nevertheless, in-vivo confocal microscopy shows that these changes are reversible 4 weeks after application of mitomycin C 0.02%.

Vesicoenteric, vesicovaginal, vesicocutaneous fistula -an unusual complication with intravesical mitomycin

Intravesical instillation of mitomycin C is a routine practice for treatment of superficial transitional cell carcinoma of bladder. Despite usual precautions serious side effects like fistulation can occur with diverse presentation as illustrated by this report. The pathology demonstrates a dense necrotic and massive inflammatory reaction in the peri vesical tissue following the extravasation of an intravesically administered chemotherapeutic agent. The severe inflammatory tissue response and the necrotic effect associated with the extravasated chemotherapeutic agent could potentially lead to local sepsis with a subsequent fistula formation.

[Analysis of severe complications after transcatheter arterial chemoembolization for primary hepatocellular carcinoma]

OBJECTIVE

To investigate the cause and treatment as well as prevention measures of rarely occurring severe complications after transcatheter arterial chemoembolization (TACE) for primary hepatic carcinoma.

METHODS

573 consecutive patients with primary hepatic carcinoma underwent a total of 1252 TACE procedures from January 2005 to July 2007. All the patients who developed complications after TACE received imaging and biochemical examinations. The cause, treatment and preventive measures of the complications in the 573 cases were analyzed.

RESULTS

There were upper gastrointestinal hemorrhage in 3 cases, hepatic failure in 4, pulmonary embolism in 1, cholecystitis in 4, hepatic encephalopathy in 2, gastric perforation in 1, and intrahepatic biloma in 2 cases. Two patients died of the complications: 1 of hepatic failure and 1 of gastric perforation.

CONCLUSION

The rarely occurring severe complications after transcatheter arterial chemoembolization for primary hepatic carcinoma is correlated with poor hepatic function and portal hypertension before therapy, overdose and reflux of chemotherapeutic agents or allotopic chemoembolism, etc. It can be reduced or prevented through careful selection of proper cases before the treatment, close observation, and protection of hepatic function and gastric mucosa after treatment.

Phase I and pharmacokinetic study of mitomycin C and celecoxib as potential modulators of tumor resistance to irinotecan in patients with solid malignancies

PURPOSE

Based on the preclinical evidence of topoisomerase I (Topo-1) upregulation by mitomycin C(MMC) and decreased NF-kappaB activation by celecoxib, we evaluated combinations of irinotecan/MMC and irinotecan/MMC/celecoxib in patients with advanced solid malignancies.

PATIENTS-METHODS

Initially, patients received MMC on day 1 and irinotecan on days 2, 8, 15 and 22, every 6 weeks. MMC dose was fixed at 6 mg/m(2) and cumulative doses of >36 mg/m(2) were not permitted. Irinotecan was escalated in 25 mg/m(2) increments. Due to late-onset diarrhea, the schedule was subsequently shortened to 4 weeks, omitting irinotecan on days 15 and 22. In the second part of the study, celecoxib 400 mg orally twice daily was added to irinotecan/MMC regimen. Potential pharmacokinetic interactions and Topo-1 and DT-diaphorase (NQ01) gene expressions in peripheral-mononuclear cells were evaluated.

RESULTS

Forty-five patients were enrolled. Irinotecan 125 mg/m(2) on days 2 and 8 in combination with MMC 6 mg/m(2) on day 1 every 4 weeks is recommended for future studies; myelosuppression and diarrhea are dose-limiting. The addition of celecoxib resulted in unacceptable toxicities despite reductions on irinotecan's dose. No relevant pharmacokinetic interactions occurred between irinotecan and MMC, and mean increases in Topo-1, were observed. Sixteen of 36 patients evaluable for response-assessment had discernable anti-tumor activity, including 1 complete, 4 partial, 10 minor and 1 tumor marker response. Four patients had prolonged (>4 months) disease-stability (stable disease, not included in CR or PR). Patients experiencing complete and partial responses had higher increments in Topo-1 expression.

CONCLUSIONS

Modulation of irinotecan by MMC is feasible, devoid of pharmacological interactions and active in solid malignancies. The lack of improvement in therapeutic index does not support the addition of celecoxib.

[Severe cystitis and perivesical collection posterior to Mitomycin C immediate instillation in a patient with inadverted bladder perforation]

We present the clinical case of a 40 years male patient who, after a TURBt for non-muscle invasive recurrence with inadverted vesical perforation and Mitomycin C immediate instillation, come in his fourth postoperative day to the emergency room with severe irritative urinary symptomatology. An ultrasound was indicated, documenting a perivesical collection. The management was conservative with vesical drilling for 10 days and a puncture/drainage was necessary to solve it.

Histopathologic changes in guinea pig mastoid mucosa after topical mitomycin C application followed by mastoidectomy

PURPOSE

This study was performed to investigate the histopathologic changes observed in mastoid cavity of guinea pigs after the application of mitomycin C after mastoidectomy.

MATERIALS AND METHODS

The study was performed on 50 guinea pigs. Unilateral (right ear) mastoidectomy was performed on all guinea pigs. Twenty-five guinea pigs were separated as study group and the remaining were separated as control group. A mitomycin C-soaked sponge was placed in the mastoid cavities of the study group and a dry sponge was placed in those of the control group. Their mastoid cavities were examined histopathologically for absorbable sponge waste, abscess formation, fibrosis, vascularization, polymorphonuclear leukocyte infiltration, edema, lymphoplasmacytic inflammatory infiltration, and granulation tissue.

RESULTS

Absorbable sponge waste, abscess formation, fibrosis, vascularization, edema, and lymphoplasmacytic inflammatory infiltration were not significantly different between the groups. However, polymorphonuclear leukocyte infiltration and granulation tissue were statistically different between the groups.

CONCLUSION

Mitomycin C can be used after mastoidectomy to decrease the granulation tissue formation in ear discharges and to prevent the discharge.

Phase I study of irinotecan combined with mitomycin-C and 5-fluorouracil for gynecological malignancies: the JGOG study

BACKGROUND

A phase I study to evaluate combined therapy with irinotecan (CPT-11), mitomycin-C (MMC), and 5-fluorouracil (5-FU) was performed in patients with gynecological malignancy, especially non-squamous cell carcinoma of the uterine cervix.

MATERIALS AND METHODS

Eligibility for the study included patients with previously untreated, chemotherapy-naïve cervical and ovarian carcinoma. CPT-11 and MMC were administered on days 1 and 15 by intravenous infusion, while 5-FU was given on days 3 to 7. This regimen was repeated after 5 weeks. Four escalating dose levels were carried out (CPT-11/MMC: 120/5, 120/6, 150/6, and 150/7 mg/m2; 5-FU 600 mg/m2 fixed).

RESULTS

Fourteen patients were enrolled in the study. Although all the patients had no previous chemotherapy, three patients had undergone a simple hysterectomy and nine had a radical hysterectomy performed before this chemotherapy. The maximum tolerated dose was not reached by using CPT-11 150 mg/m2, MMC 7 mg/m2, and 5-FU 600 mg/m2 because none of the patients experienced any hematological or non-hematological toxicities of grade 4 during the first cycle.

CONCLUSION

The recommended doses of this new regimen are CPT-11 150 mg/m2, MMC 7 mg/m2, and 5-Fu 600 mg/m2 which can be well tolerated for gynecological malignancies.

Amifostine protection against mitomycin-induced chromosomal breakage in fanconi anaemia lymphocytes

Fanconi anaemia (FA) is a rare genetic chromosomal instability syndrome caused by impairment of DNA repair and reactive oxygen species (ROS) imbalance. This disease is also related to bone marrow failure and cancer. Treatment of these complications with radiation and alkylating agents may enhance chromosomal breakage. We have evaluated the effect of amifostine (AMF) on basal and mitomycin C (MMC)-induced chromosomal breakage in FA blood cells using the micronucleus assay. The basal micronuclei count was higher among FA patients than healthy subjects. Pre-treatment with AMF significantly inhibited micronucleation induced by MMC in healthy subjects (23.4 ± 4.0 – MMC vs 12.3 ± 2.9 – AMF → MMC) MN/1000CB, p < 0.01, one way ANOVA) as well as in FA patients (80.0 ± 5.8 – MMC vs 40.1 ± 5.8 – AMF → MMC) MN/1000CB, p < 0.01, ANOVA). Release of ROS by peripheral blood mononuclear cells treated with AMF → MMC and measured by chemoluminometry showed that AMF-protection was statistically higher among FA patients than in healthy individuals. Based on these results we suggest that AMF prevents chromosomal breakage induced by MMC, probably by its antioxidant effect.

E-PTFE (Gore-Tex) implant with or without low-dosage mitomycin-C as an adjuvant in penetrating glaucoma surgery: 2 year randomized clinical trial

PURPOSE

To test the expanded polytetrafluoroethylene (ePTFE) as a new adjuvant in trabeculectomy.

METHODS

Consecutive glaucoma surgical inpatients were observed at the Department of Ophthalmology of Palermo University. Sixty patients (60 eyes) were randomly assigned to undergo trabeculectomy (T), trabeculectomy with mitomycin-C (TMMC), with ePTFE (TG) or with mitomycin-C and ePTFE (TGMMC). Postoperative visits were scheduled at 24 hr, 7 days, 1, 3, 6, 12, 18 and 24 months. Complete success and qualified success were assessed at two target intraocular pressure (IOP) levels -< or =21 and < or =17 mmHg - by Kaplan-Meier curves.

RESULTS

The postoperative IOP reduction was significant (P < 0.01) at the endpoint in all groups, with a mean IOP of 16.9 (+/-2.9), 16.2 (+/-2.7), 15.3 (+/-3.4) and 15.2 (+/-4.3) mmHg in T, TMMC, TG and TGMMC eyes, respectively. No intergroup difference was found at either IOP targets. The Kaplan-Meier curves relating to either the < or =21 mmHg or the < or =17 mmHg target IOP did not show significant intergroup differences for complete and qualified success rate. When ePTFE was used, a trend favouring the medium-term survival rate was noted. No adverse reaction to the ePTFE was present, and no membrane extrusion or conjuctival erosion were noted in any cases. Hypotony was significantly more frequent (P = 0.035) in groups without ePTFE. Moreover, the late MMC-related complications were more frequent when MMC was applied.

CONCLUSION

Expanded polytetrafluoroethylene implant in trabeculectomy is well tolerated and could act as a filtration modulating device. Therefore, it is useful in reducing early hypotony-related complications and contributes to attaining medium-term IOP control that is comparable to the low-dosage MMC.

Protective effects of American ginseng (Panax quinquefolium) against mitomycin C induced micronuclei in mice

Mitomycin C (MMC) is a highly active anticancer drug commonly used alone and in combination with other chemotherapeutic agents for the treatment of different cancers. Its bioactivated form critically damages the DNA present in both rapidly dividing cancerous cells as well as in normal cells. Genotoxicity in the normal cells makes this drug highly toxic; thereby decreasing its therapeutic index for clinical use. The study investigated the chemoprotective potential of American ginseng root extract against MMC by using the micronuclei test in a mouse test system. Pre-treatment with ginseng at doses 50 mg/kg and 100 mg/kg, p.o. for 3 and 7 days significantly decreased the frequency of micronucleated polychromatic erythrocytes (PCEs). Similar protective effects were also observed during co-treatment with ginseng at similar doses for 3 and 7 days. The present results indicate that American ginseng extract is capable of suppressing the chromosomal aberration induced by MMC in mice. Thus, American ginseng may be a potent chemoprotective agent against the toxicity of the anticancer drug, mitomycin C.

Effect of topical mitomycin C on corneal endothelium

PURPOSE

To evaluate patients with ocular surface squamous neoplasia (OSSN) on treatment with topical mitomycin C (MMC) with regard to changes in corneal thickness and endothelial count.

DESIGN

Prospective, nonrandomized, interventional series.

METHODS

In this prospective evaluation, 25 patients with OSSN with different clock hours of involvement (range, one to eight), age varying from 19 to 76 years, were treated with topical MMC 0.04% in a cyclic manner. Preoperative corneal thickness measurement and endothelial cell density were obtained, and the tests were repeated after one, three, and six months of complete resolution. The fellow eyes of the same patients served as controls.

RESULTS

Mean +/- standard deviation (SD) pachymetry and endothelial cell counts before and after instillation were 504.48 +/- 5.45 microm and 2325.76 +/- 192.52 cells/mm2 and 503.52 +/- 5.75 microm and 2297.60 +/- 192.08 cells/mm2, respectively, suggesting no significant difference in the above two parameters. Similarly, in the fellow control eyes, mean +/- SD pachymetry and endothelial cell counts before and after instillation were 502.80 +/- 4.34 microm and 2326.72 +/- 191.93 cells/mm2 and 504.64 +/- 5.19 microm and 2313.60 +/- 192.03 cells/mm2, respectively.

CONCLUSIONS

Topical 0.04% MMC drops do not significantly affect the corneal endothelium. However, its judicious use and long-term follow-up are mandatory.

Radiotherapy and chemotherapy in the conservative treatment of anal canal carcinoma

AIM

To evaluate the feasibility of conformal radiotherapy and concurrent chemotherapy in patients with anal canal carcinoma.

PATIENTS AND METHODS

Between 1990 and 2006, 83 patients affected by anal canal carcinoma were treated at the Radiotherapy Department of "La Sapienza" University of Rome. In all patients, a daily dose of 1.8 Gy, five times per week, was given for a total dose of 45 Gy for the whole pelvis (CTV1) and of 55-60 Gy for the tumor bed (CTV2). In 63 patients, chemotherapy consisted of two cycles of 5-fluorouracil (5-FU) and mitomycinC (MMC) or cisplatin delivery during the first and last week of radiotherapy.

RESULTS

The median follow-up time for all patients was 56.2 months. Treatment response was considered complete in 53 patients (63.8%) and partial in 30 patients (36.1%). Local tumor relapse was observed in 13 patients (15.6%). The probability of overall survival for all patients at 5 years was 75%: 39% in patients who underwent radiotherapy alone and 85% in patients who underwent radiochemotherapy (p=0.0013). Concerning acute toxicity, 9 patients developed grade 1 skin toxicity (10.8%), 35 grade 2 (42.1%), 26 grade 3 (31.3%) and 3 grade 4 (3.6%); eleven patients had grade 2 diarrhea (14.5%) and 2 grade 3 diarrhea (2.4%).

CONCLUSION

This analysis suggests that the treatment scheme employed was effective for anal sphincter preservation and local control.

In vivo role of NAD(P)H:quinone oxidoreductase 1 in metabolic activation of mitomycin C and bone marrow cytotoxicity

NAD(P)H:quinone oxidoreductase 1(-/-) (NQO1(-/-)), NQO1(+/-) along with NRH:quinone oxidoreductase 2(-/-) (NQO2(-/-)), and wild-type (WT) mice were exposed to five once weekly doses of mitomycin C. The mice were euthanized 15 weeks after the first dose. Blood cell counts and histologic analyses were done. WT and NQO2(-/-) mice showed hypocellularity and a significant increase in adipocytes in bone marrow. They also showed anemia because of the loss of RBC and hemoglobin. The neutrophils and platelets were reduced, whereas other blood cell types and tissues were normal. Interestingly, NQO1(-/-) mice showed a complete resistance to mitomycin C-induced bone marrow cytotoxicity and reduction in RBC, hemoglobin, and neutrophils. NQO1(+/-) mice also showed limited resistance to mitomycin C-induced bone marrow cytotoxicity. These data show a major in vivo role of NQO1 in metabolic activation of mitomycin C with implications in mitomycin C chemotherapy.

Feasibility of Sequential Therapy with FOLFIRI Followed by Docetaxel/Cisplatin in Patients with Radically Resected Gastric Adenocarcinoma

OBJECTIVE

Combination therapies of fluorouracil (FU) with irinotecan (CPT-11) and docetaxel plus cisplatin have been proven to be active in metastatic gastric cancer. In this paper, we present the results of a phase III trial in which these two combinations given sequentially were compared to mitomycin C (MMC) monochemotherapy in an adjuvant setting.

METHODS

169 patients with radically resected gastric cancer were randomized to receive CPT-11 (180 mg/m2 day 1), leucovorin (100 mg/m2 days 1-2), FU (400-600 mg/m2 days 1-2, q 14; for four cycles; FOLFIRI regimen), followed by docetaxel (85 mg/m2 day 1), cisplatin (75 mg/m2 day 1, q 21; for three cycles; arm A), or MMC (8 mg/m2 days 1-2 as 2-hour infusion, q 42; for four cycles; arm B). All patients had histologically confirmed gastric carcinoma with nodal positivity or pT3/4. A total of 166 patients (85 in arm A and 81 in arm B) were treated. Adjuvant treatment was completed in 76% of the patients in arm A and in 70% of the patients in arm B. The main grade 3/4 side effects recorded were neutropenia in 35%, with only 1 febrile patient, and diarrhea in 11% in arm A, and thrombocytopenia in 10% and neutropenia in 7% in arm B. The FOLFIRI regimen and docetaxel/cisplatin given in sequence was well tolerated and feasible in adjuvant setting. This sequence treatment currently represents the experimental arm of an ongoing multicenter trial.

Intra-hepatic Mitomycin C bolus infusion in the treatment of extensive liver metastases of breast cancer

BACKGROUND

In the treatment of extensive liver metastasis of breast cancer (LMBC), locally administered Mitomycin C (MMC) to the liver might be an effective approach with limited toxicity.

PATIENTS AND METHODS

We retrospectively reviewed the records of 30 patients with LMBC treated with intra-hepatic MMC at our institution. MMC (12 mg) was administered by transcatheter bolus infusion into the hepatic arteries every 4 weeks. Tumour response according to RECIST criteria, progression free survival (PFS), overall survival (OS) and duration of response (DR) were used to evaluate efficacy.

RESULTS

There was a local response in the liver and a global response in respectively 33 and 26%. The median PFS, DR and OS were 3, 4 and 7 months, respectively. There was more benefit in patients without documented metastases outside the liver and without severe liver dysfunction. Thrombocytopenia, leucocytopenia and an allergic reaction were observed after MMC administration in 20 (67%), 12 (40%) and 4 patients (13%), respectively.

CONCLUSION

Intra-hepatic MMC bolus infusion as treatment of extensive LMBC is associated with limited toxicity and has a significant response rate in the liver. Prospective investigations are required to define the place of this modality for treating patients with breast cancer liver metastases.

Comparison of limbal-conjunctival autograft and intraoperative 0.02% mitomycin-C for treatment of primary pterygium

PURPOSE

To compare the outcomes of use of intraoperative 0.02% mitomycin-C (MMC) and limbal-conjunctival autograft (LCAG) for treatment of primary pterygia.

MATERIAL AND METHOD

One hundred and twelve eyes of eighty patients with primary pterygia were randomly treated either by intraoperative 0.02% MMC for 5 min or LCAG. Recurrence (defined as fibrovascular tissue invading the cornea >1.5 mm) and complications were evaluated.

RESULTS

Fifty-two eyes were included in the MMC group and sixty in the LCAG group. Recurrence occurred in three eyes (5.76%) in the MMC group and in two eyes (3.33%) in the LCAG group. This difference between recurrence in the two groups was not statistically significant (P > 0.05). Incidence of complications such as conjunctival cysts, symblephara, conjunctival hyperemia, and subconjunctival hemorrhage was similar in both groups (P > 0.05) whereas corneal epithelial defects (CED), irritation, lacrimation, and photophobia were more common in the MMC group (P < 0.05).

CONCLUSION

Simple excision then intraoperative use of 0.02% (MMC) for 5 min or LCAG are similarly successful in the treatment of primary pterygia. Some complications, for example irritation, lacrimation, photophobia, and CED are more common when simple excision is followed by MMC.

[Wound healing modulation in glaucoma surgery]

The wound healing response is one of the major determinants of filtering surgery success. Over the last two decades, antifibrotic agents, 5-fluorouracil (5-FU) and mitomycin C (MMC), have modified the prognosis of filtering surgery, particularly in patients at high risk for failure. Nevertheless, these agents are associated with severe complications. In order to maximize their benefits and minimize the rate of complications, the use of these powerful treatments has to be carefully evaluated in relation to patient risk factors for scarring. The choice of an antifibrotic agent, mode, dose and duration of application should be made with complete knowledge of the different effects of these treatments and adapted for each patient after an exhaustive preoperative evaluation.

[Hematogenous contact dermatitis after intravesicular instillation of mitomycin C]

Mitomycin C is an alkylating chemotherapeutic agent which is instilled intravesically to prevent recurrence of superficial bladder carcinomas. After several cycles of mitomycin C, our patient developed a pruritic genital dermatitis and palmar desquamation. Following exclusion of a fungal infection, we performed patch tests using the standard series, the major basic ointment ingredients, disinfectants, and mitomycin C in concentrations of 0.001 to 0.1%; the resulting diagnosis was allergic contact dermatitis due to delayed-type hypersensitivity to mitomycin C. The skin rash rapidly resolved with application of topical steroids, and the intravesical chemotherapy was changed to doxorubicin. Eczematous skin reactions are quite common side effects after intravesical instillation of mitomycin C. In the majority of cases, they are caused by delayed-type hypersensitivity reactions, presumably elicited by hematogenous spread of the allergen, and not by irritation. The sensitization most likely occurs via the bladder mucosa. In order to differentiate between allergic and toxic contact dermatitis, patch tests with the above-mentioned mitomycin C concentrations are useful. In cases of mild allergic contact dermatitis the intravesical chemotherapy might be continued with concomitant topical steroids.

Neoadjuvant chemotherapy with irinotecan and mitomycin-C for locally advanced squamous cell carcinoma of the uterine cervix

BACKGROUND

The efficacy and toxicity of combined therapy with irinotecan (CPT-11) and mitomycin-C (MMC) in a neoadjuvant setting were evaluated in patients with locally advanced squamous cell carcinoma (SCC) of the uterine cervix.

PATIENTS AND METHODS

Eligibility included patients with previously untreated cervical carcinoma. CPT-11 (100 mg/m2) was administered on days 1, 8 and 15 intravenously (i.v.), while MMC (10 mg/m2 i.v.) was given on day 1. Survival curves were generated using the Kaplan-Meier method.

RESULTS

Among 35 eligible patients, 3 showed a complete response and 27 a partial response, with an overall response rate of 85.7%. No patient showed progressive disease. Thirty-three patients were able to undergo radical surgery after neoadjuvant chemotherapy and only 2 patients (stage IIIb) received radiotherapy without the optimal surgery. The median disease-free survival (DFS) period was 42 months (range 5-73). The median overall survival (OAS) period was 44 months (range 17-74). Two-year DFS and OAS rates were 74.3% and 91.4%, respectively. Of the 58 treatment cycles administered, grade 3 or 4 neutropenia and thrombocytopenia were observed in 50% and 9% of the treatment cycles, respectively. Grade 3 or 4 diarrhea was observed in 6%.

CONCLUSION

Neoadjuvant chemotherapy with CPT-11 and MMC can be effective and well-tolerated against locally advanced SCC of the uterine cervix.

UFT/leucovorin and mitomycin C as salvage treatment in patients with advanced colorectal cancer – a retrospective analysis

Active anticancer drugs and/or combination regimens for the treatment of patients failing oxaliplatin, irinotecan and 5-fluorouracil are desperately needed. In this analysis we describe the safety and efficacy of the combination of mitomycin C, UFT and leucovorin in such an extensively pretreated patient population. Between January 2002 and June 2004, a total of 41 patients were treated with mitomycin C (8 mg/m on day 1) and UFT (350 mg/m)+ leucovorin (90 mg) both divided into three daily doses from day 1 to day 14 every 4 weeks. All patients had failed prior first-line and second-line treatment with oxaliplatin, irinotecan and 5-fluorouracil. The aim of this retrospective analysis was to evaluate the efficacy and safety data of this potential salvage therapy regimen. Thirty-nine patients were evaluable for the response. The overall response rate (intent-to-treat) was 7.3% (95% confidence interval, 2.5-19.4%) and disease stabilization was achieved in 29.3%. Median time to progression was 2.5 months (range, 1.5-13.5) and median overall survival was 6 months (range, 1.5-26). Myelosuppression was the most frequent side effect. Grade 3 hematotoxicity, however, was observed in only three patients. The most common nonhematological toxicities consisted of mild and reversible nausea, emesis and diarrhea; again, severe symptoms were only occasionally seen. These data show that the combination of mitomycin C/UFT/leucovorin is safe and active in about one-third of patients in terms of abrogation of progression in extensively pretreated metastatic colorectal cancer.

Mitomycin C plus capecitabine (mixe) in anthracycline- and taxane-pretreated metastatic breast cancer. A multicenter phase II study

BACKGROUND

Capecitabine is considered the treatment of choice for anthracycline- and taxane-pretreated metastatic breast cancer. Mitomycin C seems to improve the activity of capecitabine by up-regulation of thymidine phosphorylase.

PATIENTS AND METHODS

Fifty-five women with metastatic breast cancer previously treated with anthracyclinetaxane were treated with mitomycin C 10 mg/m2 on day 1 every six weeks and capecitabine 1000 mg/m2 on days 2-15 every three weeks.

RESULTS

An overall response rate of 38% was found, consisting of 3 (5%) complete responses (CR) and 18 (33%) partial responses (PR); 8 patients (14%) had a stable disease (SD) for more than 4 months. The combination was well-tolerated, with the main toxicities being neutropenia, diarrhea and fatigue; other toxicities were of mild to moderate intensity without impairment in the quality of life of the patients.

CONCLUSION

Capecitabine is confirmed as the drug of choice in the treatment of anthracycline- and taxane-pretreated metastatic breast cancer and its combination with mitomycin appears to improve its efficacy.

The role of antimetabolites in filtration surgery for neovascular glaucoma: intermediate-term follow-up

PURPOSE

To compare the intermediate-term efficacy of 5-fluorouracil (5-FU) and Mitomycin C (MMC) as adjunctive antimetabolites in neovascular glaucoma (NVG) filtration surgery.

METHODS

Forty consecutive eyes of 40 patients with NVG refractory to medical therapy were randomized to receive antimetabolite-augmented trabeculectomy. Eighteen eyes received postoperative 5-FU (5-FU group) and 22 eyes received intraoperative, low-dose (0.2 mg/ml) MMC for 2 mins (MMC group). The main outcome measure was intraocular pressure (IOP). Surgical success was defined as IOP < 21 mmHg with topical treatment (qualified success) or without topical treatment (complete success). Surgical failure was defined as IOP > or = 21 mmHg, despite postoperative topical treatment, and by postoperative blindness.

RESULTS

The mean follow-up period was 35.8 +/- 22.6 months in the 5-FU group and 18.6 +/- 17.2 months in the MMC group. This difference was not significant. Mean IOP decreased from 40.4 +/- 10.3 mmHg to 14.7 +/- 3.4 mmHg (p < 0.0001) in the 5-FU group and from 42 +/- 11.3 mmHg to 22.9 +/- 13.3 mmHg (p = 0.0006) in the MMC group; however, the difference between the 5-FU and MMC groups was not significant at any point. The success rate in the 5-FU group was 55.5% (44.4% complete, 11.1% qualified), compared with 54.5% (9.1% complete, 45.4% qualified) in the MMC group. This difference was not significant.

CONCLUSIONS

The percentage of patients who achieved postoperative IOP < 21 mmHg was similar in both groups, although a larger proportion of patients treated with MMC-augmented trabeculectomy required topical treatment in comparison with the 5-FU group.

Iris prolapse after non-penetrating trabeculectomy with sinusotomy and mitomycin C

Non-penetrating trabeculectomy (NPT) is effective in preventing numerous postoperative complications encountered with trabeculectomy. Recently, NPT has been modified to further reduce intraocular pressure (IOP) by combining other techniques. However, these modified NPT methods would make the globe even weaker than NPT alone. Here, we report a case of iris prolapse caused by blunt ocular trauma after NPT with sinusotomy and mitomycin C treatment. A 68-year-old man, who underwent NPT with sinusotomy and mitomycin C treatment, suffered from blunt ocular trauma to his left eye 28 days after surgery. The iris prolapsed from the sinusotomy site. Iridectomy, scleral suturing, and pars plana vitrectomy were performed. The bleb was absent post-re-operatively. Iris prolapse occurs uncommonly following simple NPT. However, additional sinusotomy and mitomycin C treatment render the globe weaker, and iris prolapse might occur. Iris prolapse increases risks in developing secondary infections and a loss of the filtration bleb. Thus, precautions are needed postoperatively.

Mitomycin C plus Infusional 5-Fluorouracil in Platinum-Refractory Gastric Adenocarcinoma: An Extended Multicenter Phase II Study

OBJECTIVE

To assess the toxicity and activity of bolus mitomycin C (MMC) in combination with a 24-hour continuous infusion of 5-fluorouracil (5-FU) in gastric cancer patients who had received at least one prior chemotherapy regimen.

PATIENTS AND METHODS

Patients were treated with MMC (10 mg/m(2)) on days 1 and 22, 5-FU (2.6 g/m(2)) as a 24-hour infusion, and folinic acid 500 mg/m(2) weekly for 6 weeks.

RESULTS

Thirty-four patients with gastric cancer, 16 after failure of first-line chemotherapy and 18 after failure of at least two prior chemotherapies, were included. In the intent-to-treat analysis, 9 (26.5%) of the 34 patients had a partial response and 10 (29.4%) a disease stabilization (disease control rate 56%). The median time to progression was 3.3 months (CI95: 2.8-3.7), and the median overall survival was 7.2 months (CI95: 5.9-8.4). Grade III/IV thrombocytopenia occurred in 14.7% of patients (n = 5), while the most frequent nonhematological grade III/IV toxicities were mucositis and diarrhea, each affecting 9% of patients.

CONCLUSIONS

As the tested regimen was generally safe and well tolerated by the patients, MMC plus infusional 5-FU/folinic acid may be a potential second-line regimen for patients with advanced gastric cancer.

Combined phacoemulsification and deep sclerectomy (PDS) with intraoperative mitomycin C (MMC) augmentation

AIM

To report the safety and efficacy of intraoperative mitomycin (MMC) augmentation of combined phacoemulsification and deep sclerectomy (PDS).

METHODS

Retrospective, non-randomized, comparative, interventional case series of 119 eyes (63 with and 56 without MMC augmentation) of 119 patients who had PDS between September 2001 and April 2004.

RESULTS

The mean follow-up was 23 months (range 12-41 months). There were no differences in the baseline characteristics of the two groups except that patients from the phacoemulsification and deep sclerectomy with mitomycin C (PDS-MMC) group were on average, younger by 3 years (P=0.01). Two years after surgery, the probability of maintaining an IOP below 19 and 15 mmHg without glaucoma medications or needle revision was 76 and 62% in the PDS-MMC group and 62 and 45% in the PDS-no MMC group (P=0.02 and 0.04, respectively). Nd:YAG laser goniopuncture was performed in 71.4% of eyes in the PDS-no MMC and 61.9% of the PD-MMC group (P=0.33). Needle revision was performed in 21.4% of the PDS-no MMC and 17.4% of the PDS-MMC group (P=0.65). Ten patients (8.4%) lost more than two lines of Snellen's visual acuity during follow-up, with no difference between the groups. There were few serious complications related to MMC use (hypotony in one eye after laser goniopuncture). The overall incidence of transconjunctival oozing in the PDS-MMC group was 9.5% compared with 5.4% in the PDS-no MMC group.

CONCLUSION

This study demonstrates that augmentation of PDS with MMC is safe. MMC augmentation appears to increase the probability of achieving lower target intraocular pressures after combined PDS.