Mitomycin (Jelmyto®-given through nephrostomy tube)

Mitomycin is an antitumor antibiotic that is made from a soil fungus called Streptomyces caespitosus. Mitomycin inhibits DNA synthesis by producing DNA cross-links which halt cell replication and eventually cause cell death. Since cancer cells, in general, divide faster and with less error-correcting than healthy cells, they are more sensitive to this damage. This cell damage slows or stops the growth of cancer cells in your body.

How Mitomycin is Given Through Nephrostomy Tube

This medication is given directly into a nephrostomy tube or catheter by a provider. You may be given oral sodium bicarbonate the night before, the morning of, and 30 minutes before the medication is given. You may also be given other medications to help you relax or to prevent allergic reactions.

This medication may turn your urine a blue/violet color after is it given. This is expected and can last one or two days after each dose.

Precautions After Treatment

• Sit to urinate for 6 hours after the treatment to prevent splashing urine on the skin or exposing others to the medication.
• Do not use public toilets or urinate outside.
• For the first six hours after treatment, flush the toilet twice with the toilet seat down.
• Wash your hands and genital area with soap and water after urinating to remove any traces of the medication from your skin and prevent skin irritation.
• If urine gets on your clothes, wash them separately from other clothes. Keep others from being exposed to the medication by washing your clothes separately from the rest of the laundry and wearing rubber gloves when cleaning the toilet or any urine spills.

Possible Side Effects of Mitomycin Given Through Nephrostomy Tube

There are a number of things you can do to manage the side effects of mitomycin gel formula. Talk to your care team about these recommendations. They can help you decide what will work best for you. These are some of the most common or important side effects:

Kidney & Urinary Changes

You may have trouble urinating, have blood in your urine, may feel like you need to urinate more during the day, urinate more than usual, or develop a urinary tract infection.

This medication can cause kidney problems, including an increased creatinine level and decreased albumin, which your oncology care team may monitor for using blood tests. Notify your healthcare provider if you notice decreased urine output, blood in the urine, swelling in the ankles, or loss of appetite.

Anemia

Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing, or pain in your chest. If the count gets too low, you may receive a blood transfusion.

Thrombocytopenia

Platelets help your blood clot, so when the count is low you are at a higher risk of bleeding. Let your oncology care team know if you have any excess bruising or bleeding, including nose bleeds, bleeding gums, or blood in your urine or stool. If the platelet count becomes too low, you may receive a transfusion of platelets.

• Do not use a razor (an electric razor is fine).
• Avoid contact sports and activities that can result in injury or bleeding.
• Do not take aspirin (salicylic acid), non-steroidal, anti-inflammatory medications (NSAIDs) such as Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), etc. as these can all increase the risk of bleeding. Please consult with your healthcare team regarding the use of these agents and all over-the-counter medications/supplements while on therapy.
• Do not floss or use toothpicks and use a soft-bristle toothbrush to brush your teeth.

Fatigue

Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.

Other important but less common side effects:

• Ureteric obstruction - The ureter is a tube that connects the kidney to the bladder. This medication can cause this tube to become blocked. Call your provider right away if you have a fever (temperature greater than 100.4°F or 38°C or side (flank) pain.

Reproductive Concerns

Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment and for at least 6 months after treatment for women and 3 months after treatment for men. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should not breastfeed while taking this medication or for 1 week after treatment.