Mitomycin C (MMC)

Mitomycin C (MMC) is a chemotherapy drug and alkylating agent used in cancer treatment, including intravesical therapy for non-muscle-invasive bladder cancer (NMIBC). It works by damaging the DNA of rapidly dividing cancer cells, leading to cell death.

Adjuvant therapy after transurethral resection of bladder tumor (TURBT) to reduce recurrence.
Alternative to BCG in low- or intermediate-risk NMIBC when BCG is unavailable or contraindicated.
Sometimes used as a single-dose instillation immediately after TURBT to prevent tumor implantation.

Given via a catheter into the bladder.
Retained for 1–2 hours before voiding.
Typical schedule:
- Single postoperative dose (within 24 hrs of TURBT).
- Induction course: Weekly for 6–8 weeks.
- Maintenance: Monthly for up to 1 year in some cases.

Forms DNA cross-links, preventing replication and transcription.
Acts as a bioreductive alkylator, becoming activated in hypoxic (low-oxygen) tumor environments.

Local:
- Bladder irritation (dysuria, frequency, hematuria).
- Chemical cystitis (less common than with BCG).
Systemic (rare, if absorbed):
- Myelosuppression (low blood counts).
- Allergic reactions (rash, fever).
- Bladder contracture (long-term use).

Reduces recurrence by ~15–20% in low-risk NMIBC (less effective than BCG for high-risk tumors).
Often used when BCG is unavailable or for patients who cannot tolerate immunotherapy.

Feature	Mitomycin C (MMC)	BCG
Type	Chemotherapy	Immunotherapy
Best For	Low/intermediate-risk NMIBC	High-risk NMIBC, CIS
Side Effects	Less systemic, more local irritation	More immune-related (flu-like symptoms, rare infections)
Efficacy	Moderate reduction in recurrence	Superior for high-risk tumors