Mitomycin extravasation

Patients may be asymptomatic at the time of extravasation but may return within days to weeks with signs of tissue damage (particularly with mitomycin C). 

Dimethylsulfoxide (DMSO) is the antidote of choice for anthracycline and mitomycin C extravasations. It readily penetrates tissues and increases diffusion in the tissue area. In addition, DMSO is a free-radical scavenger that functions to block this principal mechanism of anthracycline- and mitomycin C-mediated tissue injury. DMSO generally is well tolerated but may cause some mild burning and redness. Dexrazoxane is a free-radical scavenger typically used for cardio-protection from anthracyclines. Promising results have been seen with large-volume extravasations and in a mouse model.38... 

Mitomycin C -antitumor antibiotic inhibits RNAand DNA synthesis -bone marrow suppression -nausea and vomiting—mild to moderate -mucocutaneous effects (mucositis, stomatitis, diarrhea) -vesicant if extravasated -nephrotoxicity -veno-occlusive disease (VOD) of the liver -hemolytic-uremic syndrome... 

Local extravasation of mitomycin causes inflammation and ulceration, starting within 7-10 days and lasting several weeks. In four cases the onset of tissue necrosis was delayed several weeks or months after exposure (21,22). In one case, ulceration seemed to have been precipitated by drinking ethanol, and in another by exposure to the sun. 

Early withdrawal of the drug and administration of corticosteroids appear to significantly improve the outcome. Topical application of dimethyl sulfoxide may be effective for management of mitomycin C extravasation. 

Mitomycin is administered IV in the treatment of disseminated adenocarcinoma of the stomach or pancreas, and it has been used intravesically in superficial bladder cancer. Biotransformation pathways are saturable, and approximately 10% of an administered dose is eliminated unchanged via the kidneys. Myelosuppression is the major use-limiting side effect of this drug, which is slow to manifest but quite prolonged in duration. Severe skin necrosis can occur on extravasation, and potentially fatal pulmonary toxicities have been noted as well. Mitomycin can induce hemolytic uremia accompanied by irreversible renal dysfunction and thrombocytopenia, and the drug should not be administered to patients with serum creatinine levels greater than 1.7 mg/dL. Severe bronchospasm also has been noted in patients treated with vinca alkaloids who also are receiving (or who have previously received) mitomycin. 

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