Mitomycin-C pulmonary toxicity
- Edward D Chan, MD
Edward D Chan, MD
- Professor of Medicine
- National Jewish Health
- Talmadge E King, Jr, MD
Talmadge E King, Jr, MD
- Editor-in-Chief — Pulmonary and Critical Care Medicine
- Section Editor — Interstitial Lung Disease
- Dean, School of Medicine
- Vice Chancellor, Medical Affairs
- University of California San Francisco
- Section Editor
- Kevin R Flaherty, MD, MS
Kevin R Flaherty, MD, MS
- Section Editor — Interstitial Lung Disease
- Associate Professor of Medicine
- University of Michigan Health System
- Deputy Editors
- Helen Hollingsworth, MD
Helen Hollingsworth, MD
- Deputy Editor — Pulmonary, Critical Care, and Sleep Medicine
- Associate Professor of Medicine
- Boston University School of Medicine
- Diane MF Savarese, MD
Diane MF Savarese, MD
- Senior Deputy Editor — UpToDate
- Deputy Editor — Oncology and Palliative Care
- Clinical Instructor of Medicine
- Harvard Medical School
Mitomycin-C (MMC), an antineoplastic antibiotic derived from Streptomyces caespitosus, is a cell cycle-specific alkylating agent . Although it is active against a wide variety of tumors, newer agents have largely replaced MMC except in anal cancer; outside of the United States, MMC is infrequently used for treatment of advanced non-small cell lung cancer (NSCLC), and breast cancer. As with many other chemotherapeutic agents, most of the adverse effects of MMC are dose-related, including myelosuppression (which is typically delayed in onset), nausea, vomiting, diarrhea, stomatitis, dementia, and alopecia [1-3]. Pulmonary toxicity associated with MMC is unpredictable, but more likely to occur at higher doses.
The pulmonary complications associated with MMC therapy will be reviewed here. A general discussion of the clinical presentation, pathogenesis, diagnosis, differential diagnosis, and management of antineoplastic agent-induced pulmonary toxicity is presented separately. (See "Pulmonary toxicity associated with systemic antineoplastic therapy: Clinical presentation, diagnosis, and treatment".)
INCIDENCE AND SCOPE
Pulmonary toxicity associated with MMC is unpredictable, but more likely to occur at higher doses (in most literature reviews, >20 mg/m2) [4-7]. The frequency of clinically significant adverse pulmonary reactions from MMC is estimated to be between 2 and 12 percent [4,7-9].
The various pulmonary disorders that have been described with MMC include:
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- INCIDENCE AND SCOPE
- ACUTE LUNG INJURY
- Clinical manifestations
- INTERSTITIAL PNEUMONITIS
- Clinical manifestations
- THROMBOTIC MICROANGIOPATHY AND ACUTE RESPIRATORY FAILURE
- PULMONARY HYPERTENSION AND VENO-OCCLUSIVE DISEASE
- PLEURAL DISEASE
- LOCAL EFFECTS OF LARYNGOTRACHEAL MMC
- SUMMARY AND RECOMMENDATIONS