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A trial of prophylactic thiotepa or mitomycin C intravesical therapy in patients with recurrent or multiple superficial bladder cancers.

There were 40 consecutive patients with recurrent or multiple superficial stage Ta or T1 transitional cell cancer assigned randomly to receive prophylactic thiotepa or mitomycin C intravesical chemotherapy. Patients received 8 weekly instillations followed by 22 monthly treatments of either 60 mg. thiotepa or 40 mg. mitomycin C. Of 25 patients randomized to receive mitomycin C 4 had recurrence in a total of 337 patient-months (1.19 per 100 patient-months), while disease recurred in 1 of 15 patients randomized to receive thiotepa who were followed for a total of 220 patient-months (0.45 per 100 patient-months). No significant difference in recurrence rate was noted for either drug group (p equals 0.18). Toxicity requiring cessation of therapy was observed in 7 patients (28 per cent) on mitomycin C and none on thiotepa.

Carcinoma, Transitional Cell↗

Mitomycin C plasma levels after intravesical instillation with and without hyaluronidase.

In 20 patients undergoing transurethral resection for bladder tumor or multiple transurethral biopsies for monitoring after transurethral resection, mitomycin C, 20 mg., was instilled into the bladder immediately after the procedure. Mitomycin C was associated with hyaluronidase, 200.000 U, in 10 patients. Serum levels of mitomycin were determined by column chromatography 30 and 60 minutes after instillation. Hyaluronidase was not found to make any difference in mitomycin absorption. Potential expansions of the therapeutic modalities for preventing recurrent bladder tumor by hyaluronidase are discussed.

Combined Modality Therapy↗

Intravesical thiotepa and mitomycin C treatment immediately after transurethral resection and later for superficial (stages Ta and Tis) bladder cancer: a prospective, randomized, stratified study with crossover design.

In a prospective, randomized, stratified study with crossover design the effect of thiotepa was compared to that of mitomycin C when each was instilled intravesically immediately at the end of complete removal of superficial bladder cancer (stages Ta and Tis) and later on tumor recurrence. The 3-month and 1-year rates free of recurrence were 93 and 78 per cent, respectively, for thiotepa (41 patients), and 97.6 and 67.1 per cent, respectively, for mitomycin C (42 patients) (p equals 0.6). On crossover (5 patients to thiotepa and 9 to mitomycin C) at 1 year 60 per cent of the patients receiving thiotepa secondarily and 51.9 per cent of those receiving mitomycin C secondarily were free of recurrence (p equals 0.52). Therefore, both drugs are equally effective in reducing bladder tumor recurrence. Future comparative studies should continue to include thiotepa as a standard by which the efficacies of other agents are judged.

Adult↗

Liquid chromatographic determination of mitomycin C in human plasma and urine.

A method is given for the determination of the antineoplastic drug mitomycin C in plasma and urine samples. Mitomycin is isolated from the biological matrix with the aid of a Sep-Pak C18 extraction column and eluted with methanol. The methanol is evaporated and the residue is redissolved in the chromatographic mobile phase (methanolic phosphate buffer). Mitomycin C is separated from coextracted compounds by reversed-phase liquid chromatography on a LiChrosorb RP-8 column. A high detection sensitivity and selectivity was obtained by photometric measurements at 365 nm. The precision of the determinations was better than 6% relative standard deviation for plasma samples within the range 2-1000 ng/ml, and for urine samples within the range 0.5-4.4 micrograms/ml. The pH-dependent stability of mitomycin in buffer solutions has been studied.

Buffers↗

Effect of site-specifically located mitomycin C-DNA monoadducts on in vitro DNA synthesis by DNA polymerases.

A series of site-specifically modified oligodeoxynucleotides were synthesized that contained either of the two known mitomycin C-DNA monoadducts. In vitro DNA synthesis was carried out on some of these templates using a modified bacteriophage T7 DNA polymerase (Sequenase), AMV reverse transcriptase, and two different varieties of Escherichia coli DNA polymerase I (Klenow fragment)--one that carries the normal 3'-->5' exonuclease activity and a mutant protein that lacks this enzymatic function. Regardless of the type of DNA polymerase being used, DNA synthesis was terminated nearly quantitatively at the nucleotide 3' to each of these two monoadduct sites, although primer extension to full length of the template was noted with the unmodified control template. Substitution of Mn2+ for Mg2+ at a high concentration of the deoxynucleotide triphosphates resulted in incorporation of nucleotides opposite the adduct in the incubations with Sequenase or the 3'-->5' exonuclease-free Klenow fragment; however, primer extension beyond the adduct site did not take place. These studies demonstrated that the mitomycin monoadducts are strong blocks of replication and are likely to be toxic lesions in vivo. Since previous molecular modeling studies and molecular mechanical calculations indicated that the mitomycin adduction does not induce severe distortions at the site of adduction, a lack of base-pairing ability of the modified base in the extended product is unlikely to be the reason for the inhibitory effect. Instead, energy-minimized structural models indicated that additional hydrogen-bonding interactions have been introduced by the mitomycin moiety, and perhaps this increased thermodynamic stabilization of a distorted structure of the replication fork, in turn, may block the replication bypass. Experimental evidence of increased thermodynamic stability was provided by thermal melting of a template/primer complex that presumably a polymerase encounters in a typical replication fork. Consistently higher Tm of the adducted "replication fork" was noted when compared to its unmodified counterpart.

Base Sequence↗

A comparison of mechanisms proposed for the conversion of mitomycins into mitosenes.

Two mechanisms proposed for the acid-catalyzed conversions of mitomycins into mitosenes were investigated by deuterium incorporation methods. Four different mitomycins, an aziridinomitosene, and an N-acetylmitomycin all underwent the conversion in acetic acid-d with no incorporation of deuterium at C-1. This evidence suggests that the mechanism based on initial elimination of the elements of methanol to give an aziridinomitosene is more likely the correct one. The products of these reactions had considerable variation in the ratios of cis to trans isomers: 7-aminomitosanes gave a predominance of trans and 7-methoxymitosanes gave a predominance of cis. Treatment of mitomycin C with DCl in D2O gave predominantly cis product with about 45% deuterium exchange at C-1. The isomeric 2,7-diamino-1-methoxymitosenes previously obtained by treating mitomycin C in methanol containing acetic acid were found to have stereochemistry opposite to that originally assigned by us.

Acetates↗

Metal complexes of mitomycins.

The preparation of stable complexes between the N7-[2-(2-pyridyl)ethyl] and N7-(2-piperazinylethyl) derivatives of mitomycin C and metal ions such as Cu(II), Zn(II), and Pt(II) was accomplished. Mitomycin C did not form stable complexes, but it rearranged to a mitosene capable of complex formation. Some of these complexes had antitumor activity in mice. However, they were less active than mitomycin C. Weak associations between mitomycin C and metal ions were demonstrated by 13C and 15N NMR spectrometry.

Animals↗

Trabeculectomy with simultaneous topical application of mitomycin-C in refractory glaucoma.

From May 1981 to Feb. 1989 trabeculectomy with per-operative topical application of mitomycin C was performed on eyes with refractory glaucoma. All eyes had undergone prior one, two or more than two antiglaucoma surgeries without success for IOP control. Other risk factors in the present series of eyes included young age, aphakia, rubeosis and glaucoma secondary to trauma or associated with anterior uveitis. 59 eyes underwent trabeculectomy with mitomycin application. 14 eyes were lost. 45 eyes of 42 cases, 33 eyes of 31 males and 12 eyes of 11 females were followed for a period of 1 to 8 years, an average 3.0 +/- 1.9 years. The success for IOP control less than 21 mmHg was 77.8%, 35/45 eyes. The success rates were 92%, 11/12 eyes in females and 73%, 24/33 eyes in males. Complications reported in 5-fluorouracil studies such as corneal epithelial toxicity and delayed healing of conjunctival wound were not encountered. The histo-pathological changes of wound healing after trabeculectomy with topical mitomycin application was discussed. In the healing process success to achieve filtration is more likely by pharmacolocally interferring with earlier steps in the process. We recommend the use of per-operative topical application of mitomycin C during trabeculectomy in eyes with uncontrolled glaucoma and poor prognosis, specifically after previous cataract extraction or unsuccessful antiglaucoma surgery.

Adolescent↗

Renal toxicity of mitomycin-C.

The clinical spectrum and the pathological findings of renal toxicity in four patients treated with mitomycin-C are described. Our experience and evidence in the literature indicates that the renal impairment appears to be total-dose-related, with most patients developing renal symptoms after receiving at least 60 mg of mitomycin-C. The renal morphologic changes reveal a glomerular and vascular process similar to that seen in a number of clinical situations associated with the hematologic findings of microangiopathic hemolytic anemia. In patients with malignant disease, it may be that the use of mitomycin-C either alone or in combination with other drugs causes endothelial vascular damage with resultant activation of the coagulation system. There is evidence that early detection of the renal impairment and withdrawal of mitomycin-C might halt further progression of renal failure.

Adult↗

Obligatory coupling of colicin release and lysis in mitomycin-treated Col+ Escherichia coli.

Previous work has shown that Escherichia coli K12 strains carrying the small, high copy number ColE2-P9 plasmid produce large amounts of colicin and then lyse and release colicin when grown in broth culture containing mitomycin C. Strains carrying the larger, low copy number ColIa-CA53 plasmid produced much less colicin and did not lyse or discharge more than 15% of their colicin when grown under the same conditions. Naturally-occurring Col+ strains and E. coli K12 derivatives carrying different Col plasmids could be classified either as ColE2+-like or ColIa+-like according to whether or not they produced large amounts of colicin and lysed and discharged colicin when grown in the presence of mitomycin, and also by the size and presumed copy number of the Col plasmid they carried. Strains carrying multiple copies of the cloned colicin Ia structural gene produced large amounts of colicin but did not lyse or release colicin when grown in the presence of mitomycin. This result rules out the possibility that high level accumulation of colicin is sufficient to cause lysis. Conditions were sought under which colicin Ia could be released from the producing cells. It was found that mitomycin-treated cultures of strains carrying both ColE2 and ColIa plasmids released both colicins when they lysed, although colicin Ia release occurred later than colicin E2 release. It was also noted that colicin Ia-laden cells released their colicin when diluted into fresh culture medium.

Bacterial Proteins↗

Isolation and physiological characterization of mitomycin C-sensitive/UV-sensitive mutants in Bacteroides fragilis.

Mutants of Bacteroides fragilis sensitive to mitomycin C were isolated after mutagenesis with ethyl methane sulphonate. One mutant (MTC25) was markedly sensitive to mitomycin C but was unaffected as regards UV sensitivity; another mutant (UVS9) was sensitive to UV radiation but was only moderately sensitive to mitomycin C. Caffeine decreased the survival after UV-irradiation of the wild-type, MTC25 and UVS9 strains by the same relative amount. Aerobic liquid holding recovery occurred in each of the three strains. The MTC25 and UVS9 mutants showed reduced host cell phage reactivation. The wild-type, MTC25 and UVS9 strains all showed UV- and H2O2-induced phage reactivation. The physiological characterization of the MTC25 and UVS9 mutants indicates that it is possible to differentiate between mechanisms for the repair of mitomycin C- and UV-induced DNA damage in B. fragilis.

Bacteriophages↗

Mitomycin therapy in gastric cancer.

Adenocarcinoma of the stomach remains a significant cause of mortality worldwide. The majority of patients present with stage III or IV disease, negating surgery as a curative option. Numerous drugs have been tested over the past 2 decades in single-agent and combination chemotherapy trials. Given by intravenous bolus, mitomycin has induced responses as high as 63% and as low as 24% in patients with various gastrointestinal malignancies. Mitomycin has also demonstrated efficacy when given in combination with doxorubicin and in the three-drug regimen FAM (5-fluorouracil/doxorubicin/mitomycin). FAM has been explored in multiple phase II and III trials and has become the standard with which many new combinations are compared. Compared with other doxorubicin-containing regimens, it has demonstrated the longest median survival (29.5 weeks) and the lowest incidence of severe toxicity. The addition of semustine or leucovorin to FAM has yielded responses comparable with those attained by FAM alone. In Japan, where treatment of gastric cancer has been more successful, possibly due to earlier diagnosis and more aggressive surgical approaches, mitomycin has been given intraperitoneally during surgery and postoperatively in combination with fluorinated pyrimidines or other agents. Mitomycin will undoubtedly play a role in the development of new approaches to the treatment of gastric cancer.

Adenocarcinoma↗

Relationship between enhancement of cytotoxic effect of mitomycin C and increase of intracellular cyclic adenosine 3':5'-monophosphate by isoproterenol in rat ascites hepatoma cells.

Cyclic adenosine 3':5'-monophosphate (cyclic AMP) levels in six lines of rat ascites hepatoma cells were determined after the treatment with isoproterenol. The maximum increase of cyclic AMP levels was induced by the treatment with 10(-7) M of isoproterenol in each cell line, though the difference was observed at the time to reach the maximum levels. Following the treatment with 10(-7) M of isoproterenol, cyclic AMP levels increased by 55 to 80% of control in AH-44, AH-130 and AH-7974 cells, by 25 to 45% in AH-41C and AH-109A cells, and slightly in AH-13 cells. The combined cytotoxic effect of isoproterenol and mitomycin C was studied using AH-13, AH-44 and AH-130 cells. The cytotoxicity of mitomycin C on AH-44 and AH-130 cells was potentiated by the pretreatment with 10(-7) M of isoproterenol that was not cytotoxic by itself, but such a potentiation was not observed in AH-13 cells. The cyclic AMP levels were examined in the cells after the combined treatment. Mitomycin C by itself hardly affected the levels in three cell lines. In AH-44 and AH-130 cells, however, the period of the high levels of cyclic AMP was longer in the combined treatment than in the treatment with isoproterenol alone. On the other hand, the cyclic AMP level in AH-13 cells was hardly affected by each agent or the combined treatment. These results suggest that the combination effect of isoproterenol and mitomycin C is closely related to the increase of cyclic AMP in the cells treated with isoproterenol.

Animals↗

In vitro fertilization and development of ova obtained from female mice treated with aminopterin and mitomycin C.

We examined the effects of mitomycin C and aminopterin on ovulation in vivo and, fertilization, subsequent cleavage and implantation in slc-ICR female mice using methods of fertilization and culture in vitro. Chemicals were injected into mice at the MI (meiosis I) stage or 3 hours before the MI stage in order to examine their toxicity. Mitomycin C did not affect ovulation, but decreased the rate of fertilization. A high dose of mitomycin C (4 mg/kg) inhibited fertilization and the development of ova to the 2-cell stage. Aminopterin affected neither ovulation nor fertilization. At either the MII (meiosis II) stage or 3 hours before the MII stage, high doses (4 and 2 mg/kg) of mitomycin C arrested cleavage and implantation. The cleavage was blocked frequently between the 3-4 cell stage and the 5-8 cell stage. Aminopterin affected neither cleavage nor implantation.

Aminopterin↗

Intravesical mitomycin C for carcinoma in situ of the urinary bladder.

Mitomycin C was given intravesically over periods of 2-32 months to 34 patients with carcinoma in situ of the urinary bladder. Initial complete response was obtained in 17 patients, 14 of whom remained without evidence of disease during follow-up averaging 28 months from cessation of mitomycin therapy. In three responding patients malignant cells reappeared in the urine during follow-up, although no recurrence of carcinoma could be proven in bladder biopsy specimens. In eight of the 17 non-responders, muscle invasion and/or metastatic disease developed during or after mitomycin treatment. The prostatic urethra was involved in five cases. Chemotherapy had to be discontinued because of chemical cystitis in three cases. Mitomycin C appears to be effective for intravesical treatment of carcinoma in situ of the urinary bladder. Close surveillance of these patients is mandatory, however, and must include monitoring not only of the bladder, but also of the prostatic urethra and the upper urinary tract.

Administration, Intravesical↗

Role of free radicals produced during the metabolism of mitomycin C in Escherichia coli inactivation.

1. The primary objective of this study was to assess whether reactive oxygen species produced during the metabolism of mitomycin C are responsible for, or contribute to, the induction of the cytotoxic response. 2. Escherichia coli wild-type and superoxide dismutase mutants were grown either anoxically or euoxically, in K medium or minimal glucose medium, and treated with mitomycin C in K medium or M9 salts. The cytotoxic response did not vary significantly between the wild-type and the SOD mutants. 3. The toxicity of mitomycin C was not affected by the hydroxyl radical scavengers, dimethyl sulphoxide or ethanol, whereas protection was afforded by thiourea. 4. It is concluded that oxygen radical species do not play a significant role in mediating mitomycin C inactivation of normally growing bacteria.

Dimethyl Sulfoxide↗

The derivation of 1a-demethylmitomycin G from mitomycin C.

Mitomycin G (2) was derived from porfiromycin (10b) in 3 steps via the methanesulfonate (14b) in an overall yield of 39%. On the basis of the established method for the introduction of an exomethylene group in mitomycins with a 9a-methoxy group, the preparation of biologically more important 1a-demethylmitomycin G (5) from mitomycin C (1) was accomplished by the use of a protective acetyl group on the aziridine in an overall yield of 57%. 1a-Demethylmitomycin K (6) was obtained from 5 in a yield of 42%. In a preliminary evaluation of their antitumor activity, compound 5 showed superior activity against sarcoma 180 (sc-ip) to its 1a-methyl congener, i.e., mitomycin G (2).

Animals↗

Augmentation of activity of cis-diamminedichloroplatinum(II) and mitomycin C by interferon in human malignant mesothelioma xenografts in nude mice.

Two human mesothelioma xenograft lines, BG and ES, serially passaged in athymic mice, were studied to determine the efficacy of alpha-interferon in this type of tumor. Treatment began after progressive tumor growth was established. Recombinant human alpha-interferon-2a (Roferon- A) was given by s.c. injection, at a site distant from the tumor, at a dose of 2 x 10(5) IU 5 days per wk for 5 wk. Mild inhibitory activity was noted in both lines with interferon alone. cis-Diamminedichloroplatinum(II) (CDDP) (4 mg/kg) weekly x 5 was effective in line BG, while mitomycin C (1.5 mg/kg) weekly x 3 was effective in line ES. CDDP was not as effective in line ES. The moderate activity of CDDP in line BG and of mitomycin C in line ES was markedly increased by the addition of alpha-interferon. The combination of mitomycin C and alpha-interferon was as effective as mitomycin C and CDDP. No additional toxicity was noted by the addition of alpha-interferon. The combination of recombinant human alpha-interferon-2a and active chemotherapeutic agents is effective in mesothelioma xenografts.

Animals↗