This information is about a chemotherapy treatment for lung cancer called MIC. It describes the drugs used, how they are given and some of the possible side effects. If you have any questions you can ask your doctor or nurse at the hospital where you are having your treatment, or speak to one of our cancer support service nurses.

MIC is named after the initials of the chemotherapy drugs used, which are:

• mitomycin 
• ifosfamide 
• cisplatin.

Your chemotherapy treatment can be given to you as a day patient or during a short stay in hospital. Before you start treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. If the results of your blood test are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.

The nurse will then put a fine tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it should not take long. Some people have their chemotherapy given through a fine plastic tube which is inserted under the skin into a vein near the collarbone (central line), or passed through a vein in their arm (PICC line). Your doctor or nurse will explain more about this to you.

Once your chemotherapy drugs are ready, you will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip (infusion), although some anti-sickness medicines may also be given as tablets. The chemotherapy drugs are then given separately:

• an injection of mitomycin (a purple fluid), which is usually given along with an infusion of saline (salt water) into your cannula
• ifosfamide (a colourless fluid) is given as an infusion
• cisplatin (a colourless fluid), is also given as an infusion.

Before and after treatment with cisplatin you will be given plenty of fluid through the drip to keep your kidneys working normally. This is because cisplatin can sometimes damage the kidneys (see Possible side effects).

Although the mitomycin is often given first, the drugs may be given in a different order. This will not alter their effectiveness.

After treatment the cannula will be removed and you will be given a supply of anti-sickness drugs to take home with you. It is important to take these as directed even if you are not feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.

You may hear you doctor or nurse use the word 'regimen' (eg the MIC regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment that you are receiving.

When your treatment begins you will be given all three drugs: mitomycin, ifosfamide, and cisplatin for one day only (as described). After this you will have a rest period with no chemotherapy for the next three weeks. This completes what is called a cycle of your treatment.

After the rest period, the same drugs will be given to you again to begin the next cycle of your treatment. Usually 4–6 cycles of treatment will be given over a period of 3–5 months. This makes up a course of treatment.

Each person's reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described in this information will not affect everyone who is having MIC chemotherapy. We have outlined the most common side effects, but have not included those that are rare and therefore unlikely to affect you. If you notice any effects which you think may be due to the drug, but are not listed here, please let your nurse or doctor know.

Lowered resistance to infection MIC can reduce the production of white blood cells by the bone marrow, making you more prone to infection. This effect can begin seven days after treatment has been given, with your resistance to infection usually reaching its lowest point 10–14 days after chemotherapy. Your blood cells will then increase steadily and will usually have returned to normal levels before your next cycle of chemotherapy is due.

Contact your doctor or the hospital straightaway if:

• your temperature goes above 38ºC (100.5ºF)
• you suddenly feel unwell (even with a normal temperature).

You will have a blood test before having more chemotherapy to make sure that your number of white blood cells has returned to normal. Occasionally, it may be necessary to delay treatment if your number of blood cells (blood count) is still low.

Bruising or bleeding MIC can reduce the production of platelets (which help the blood to clot). Let your doctor know if you have any unexplained bruising or bleeding, such as nosebleeds, blood spots or rashes on the skin, and bleeding gums.

Anaemia (low number of red blood cells) While having treatment with MIC you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.

Loss of appetite A dietitian or specialist nurse at the hospital can give advice on boosting appetite, coping with eating difficulties and maintaining weight.

Feeling sick (nausea) and being sick (vomiting) If you feel sick, it may begin a few hours after the treatment is given and can last for a few days. Your doctor can now prescribe very effective anti-sickness (anti-emetic) drugs to prevent or reduce nausea and vomiting. If the sickness is not controlled or if it continues, tell your doctor, who can prescribe other drugs which may be more effective. Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.

Tiredness Many people feel extremely tired (fatigued) during chemotherapy, particularly towards the end of treatment. This is a very common side effect and it is important to try to get as much rest as possible.

Hair loss This usually starts 3–4 weeks after your first MIC treatment but may happen earlier. Hair may be lost completely or just thin. You may also lose eyelashes, eyebrows and other body hair. Hair loss is temporary and your hair will grow back once the treatment has finished.

Sore mouth and ulcers Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Drinking plenty of fluids and cleaning your teeth regularly and gently with a soft toothbrush can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can give you special mouthwashes and medicine to prevent or clear any mouth infection.

Taste changes You may notice that your food tastes different. Normal taste will come back after the treatment finishes.

Your kidneys may be affected Usually this does not cause any symptoms and the effect on the kidneys is mild. Rarely it may cause permanent damage to the kidneys unless treatment is stopped. Before each treatment your kidneys will be checked with a blood test.

You may be asked to drink more than normal during the day after the treatment and it is important to tell your doctor or chemotherapy nurse if you are not able to drink enough. Before and after the treatment you will be given plenty of fluid through a drip to keep your kidneys working normally. Let your doctor or nurse know if you are not passing normal amounts of urine at any time.

Irritation of the bladder Ifosfamide may cause irritation of the bladder lining. A drug called mesna is given with ifosfamide to protect your bladder. This is often given through the drip and may be followed by one or two doses of tablets. The tablets need to be taken at set times following the treatment – your nurse or pharmacist will tell you when to take them.

You will also be encouraged to drink lots of fluid. If you have any pain or discomfort, or you need to pass urine more often than is normal, let your doctor know.

Numbness or tingling in hands or feet This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. Tell your doctor if you notice these symptoms. This problem usually improves slowly a few months after the treatment ends.

Changes in hearing You may have ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. This is caused by cisplatin and usually improves when the treatment ends, although for some people it may be permanent. Tell your doctor if you notice any loss of hearing or tinnitus.

Changes to the lungs Mitomycin may cause some changes to your lung tissue. Tell your doctor if you notice any coughing or breathlessness, or if existing symptoms get worse.

Risk of blood clots Cancer can increase your risk of developing a blood clot (thrombosis), and having chemotherapy may increase this risk further. A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious, so it is important to tell your doctor straightaway if you have any of these symptoms. However, most clots can usually be successfully treated by using drugs which thin the blood. Your doctor or nurse can give you more information. 

Other medicines Some medicines can be harmful to take when you are having chemotherapy. Always tell your doctor about any medicines you are taking. This includes any medicines that you may have bought from a pharmacy or supermarket, as well as any herbal or complementary therapies.

Leakage into the tissue around the vein If this happens, the drugs can damage the tissue in that area. If you notice any stinging or burning around the vein while the drugs are being given, tell your doctor or nurse immediately.

Fertility Your ability to become pregnant or father a child may be affected by this treatment. It is important to discuss fertility with your doctor before starting treatment.

Contraception It is not advisable to become pregnant or to father a child while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking this drug, and for at least a few months afterwards. Again, discuss this with your nurse or doctor.

This section is based upon our MIC chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:

• Martindale: The Complete Drug Reference (35th edition). Eds. Sweetman et al. Pharmaceutical Press, 2007.
• British National Formulary (54th edition). British Medical Association and Royal Pharmaceutical Society of Great Britain, September 2007.
• The Chemotherapy Source Book (3rd edition). Ed. Perry. Lippincott, Williams and Wilkins, 2001.

For further references, please see general bibliography.