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This information is about a chemotherapy treatment for breast cancer called MMM. 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.
MMM is named after the initials of the chemotherapy drugs used, which are mitomycin (pronounced my-toe-my-sin), methotrexate (me-tho-trex-ate) and mitozantrone (my-toe-zan-trone).
MMM treatment can usually be given to you as a day patient. Before you start treatment you will need to have a blood test 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 thin plastic tube that 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.
You will be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, central or PICC line, which is connected to a drip (infusion), although some anti-sickness medicines may be given as tablets. The chemotherapy drugs are then given separately:
Altogether, your treatment will usually take up to an hour. Although the mitomycin is often given first, the order in which the drugs are given will not alter their effectiveness.
If you are having your treatment as a day patient you can then go home. The cannula will be removed and you will be given a supply of anti-sickness drugs to take with you. It is important to take these regularly as directed, even if you are not feeling sick. This is because some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
Your doctor may use the word 'regimen' (eg the MMM regimen) when talking about your chemotherapy. This means the whole plan or schedule of the particular treatment that you are receiving.
On the first day of your treatment you will be given all three drugs (mitomycin, methotrexate and mitoxantrone), as described.
You will then have a three week rest period with no chemotherapy, before the next part of your treatment. In the next part, you are given only two of the drugs, methotrexate and mitoxantrone. After this, you will have another three-week rest period with no chemotherapy. This completes the first cycle of your treatment, which takes six weeks (42 days).
After this, you will start the next cycle of your treatment. Usually 3–4 cycles are given over a period of 3–6 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 below will not affect everyone who is having MMM chemotherapy. We have outlined the most common side effects, so that you can be aware of them if they occur. However we have not included those that are rare and therefore unlikely to affect you. If you notice any effects that you think may be due to the drugs, but which are not listed here, please let your nurse or doctor know.
Lowered resistance to infection MMM 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:
You will have a blood test before having more chemotherapy to make sure that your cells have recovered. Occasionally, it may be necessary to delay your treatment if the number of blood cells (the blood count) is still low.
Bruising or bleeding MMM 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 MMM you may become anaemic. This may make you feel tired and breathless. Let your doctor or nurse know if these are a problem.
Feeling sick (nausea) and vomiting 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 anti-sickness drugs that may be more effective. Some anti-sickness drugs may 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 you need.
Gritty and sensitive eyes If this happens let your doctor know. They can prescribe soothing eye drops.
Hair loss Hair may thin or, rarely, be lost completely. If you do have any hair loss it is temporary. Your hair will start to grow again once 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 do 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 usually come back after the treatment finishes.
Diarrhoea If you have diarrhoea it can usually be controlled easily with medicine. Let your doctor know if it is severe or if it continues. Try to drink as many as 2–3 litres of fluid a day to replace the fluid you are losing.
Discoloured urine Your urine may become a bluey-green colour (due to the mitoxantrone) for up to 24 hours after you have had treatment.
Skin changes You may develop an itchy rash. Your doctor can prescribe medicine to help with this. Rarely, your skin may darken. If it does it usually goes back to normal a few months after treatment has finished. Your skin may temporarily have a blue tinge because of the mitoxantrone. Your tears and the whites of your eyes may also be slightly blue in colour.
During treatment, and for several months afterwards, you will be more sensitive to the sun and your skin may burn more easily. You can still go out in the sun, but always wear a high protection factor suncream and cover up with clothes and a hat.
Your kidneys may be affected Your kidneys will be checked by a blood test before each treatment.
Changes in nails Your nails may become darker and white lines may appear on them. These changes usually grow out over a few months once the treatment has finished.
Changes to the lungs Mitomycin may cause some changes to lung tissue. Tell your doctor if you notice any coughing or breathlessness.
Your liver may be temporarily affected MMM may cause changes in the way that your liver works, although it will return to normal when the treatment has finished. This is unlikely to cause you any harm but your doctor will monitor this carefully. Samples of your blood will be taken from time to time to check your liver function.
Always let your doctor or nurse know about any side effects that you have. There are usually ways in which they can be controlled or improved.
Other medicines Some other medicines can be harmful to take when you are having chemotherapy. Let your doctor know about any medications you are taking, including non-prescribed drugs such as complementary therapies and herbal drugs.
Leakage into the tissue around the vein If mitomycin leaks into the tissue around the vein it can damage the cells in that area. If you notice any stinging or burning around the vein while the drug is being given tell the doctor or nurse immediately.
Fertility Your ability to become pregnant 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 while taking this treatment, as the developing foetus may be harmed. It is important to use effective contraception while taking these drugs, and for at least a few months afterwards. Again, discuss this with your doctor or nurse.
Loss of periods Due to the effect of chemotherapy on the ovaries you may find that your periods become irregular and may eventually stop. In younger women this may be temporary but if you are closer to your menopause it may be permanent. This will result in menopausal symptoms such as hot flushes, sweats and vaginal dryness.
This section is based upon our MMM chemotherapy factsheet which has been compiled using information from a number of reliable sources, including:
For further references, please see the general bibliography.
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