# Mitomycin C

Source: https://onco.cc/drugs/mitomycin/  
OnCo record `mitomycin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The chemotherapy given with radiation to cure anal cancer without surgery, used as a bladder instillation after tumour resection, and since 2020-25 in gel form for upper-tract and recurrent bladder cancers.

## Summary

Approved 1974 (gastric, pancreatic). Anal SCC chemoradiation (Nigro, ACT II), intravesical single instillation after TURBT for NMIBC, hyperthermic intravesical and HIPEC use (appendiceal/PMP), ophthalmic antifibrotic. Mitomycin gel (Jelmyto, 2020) for low-grade upper-tract urothelial carcinoma and intravesical gel (Zusduri, 2025) for recurrent low-grade intermediate-risk NMIBC. Haemolytic uraemic syndrome and pulmonary toxicity at cumulative doses.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill; generic
- Brand: Mutamycin / Jelmyto / Zusduri
- Modality: Alkylating antibiotic (bioreductive)
- Mechanism: Reduced intracellularly to a bifunctional alkylator that cross-links DNA at CpG sites; preferentially activated in hypoxic cells, making it a radiosensitiser.
- Approvals: US 1974: Disseminated gastric or pancreatic adenocarcinoma (with other agents); US 2020: Low-grade upper tract urothelial carcinoma (mitomycin pyelocalyceal gel); US 2025: Recurrent low-grade intermediate-risk NMIBC (intravesical gel)

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Mitomycin_C
- Label: Jelmyto (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=Jelmyto
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=mitomycin

## Connected records

- cancers: [Anal cancer (squamous cell carcinoma)](https://onco.cc/cancers/anal/), [Appendiceal adenocarcinoma (mucinous and non-mucinous, including signet ring cell)](https://onco.cc/cancers/appendiceal-adenocarcinoma/), [Appendiceal cancer and pseudomyxoma peritonei](https://onco.cc/cancers/appendiceal/), [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Colorectal cancer](https://onco.cc/cancers/colorectal/), [Conjunctival melanoma](https://onco.cc/cancers/conjunctival-melanoma/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Localised anal squamous cell carcinoma (stage I to III)](https://onco.cc/cancers/localised-anal-cancer/), [Low-grade appendiceal mucinous neoplasm and pseudomyxoma peritonei](https://onco.cc/cancers/low-grade-appendiceal-mucinous-neoplasm/), [Non-muscle-invasive bladder cancer](https://onco.cc/cancers/non-muscle-invasive-bladder-cancer/), [Squamous cell carcinoma of the urethra](https://onco.cc/cancers/urethral-squamous-cell-carcinoma/), [Urethral cancer](https://onco.cc/cancers/urethral/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [HIPEC / PIPAC (intraperitoneal chemotherapy)](https://onco.cc/technologies/hipec/), [HIPEC perfusion pumps and PIPAC nebulisers](https://onco.cc/technologies/hipec-pipac-devices/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Intravesical therapy (BCG, chemotherapy, devices, gene and viral therapy)](https://onco.cc/technologies/bcg-and-intravesical-therapy/)
- trials: [A Study of TAR-200 Versus Intravesical Chemotherapy in Participants With Recurrent High-Risk Non-Muscle-Invasive Bladder Cancer (HR-NMIBC) After Bacillus Calmette-Guérin (BCG)](https://onco.cc/trials/nct06211764/), [ACT II](https://onco.cc/trials/act-ii/), [Clinical Trial Evaluating Low Dose G-FLIP Plus Mitomycin C for Stage IV Pancreatic Cancer](https://onco.cc/trials/nct06233877/), [Efficacy and Safety of Pembrolizumab (MK-3475) in Combination With Chemoradiotherapy (CRT) Versus CRT Alone in Muscle-invasive Bladder Cancer (MIBC) (MK-3475-992/KEYNOTE-992)](https://onco.cc/trials/nct04241185/), [Efficacy of the Use of Neoadjuvant With/Without Hyperthermic Intraperitoneal Chemotherapy in the Treatment of Locally Advanced Colon Cancer](https://onco.cc/trials/nct06783491/), [Enfortumab Vedotin in Combination With Pembrolizumab vs. Concurrent Chemoradiotherapy (cCRT) in People With Muscle Invasive Bladder Cancer (EV-309)](https://onco.cc/trials/nct07566156/), [Netherlands Cancer Institute HIPEC trial](https://onco.cc/trials/netherlands-hipec/), [Phase II Trial of Lung Chemoemobolization](https://onco.cc/trials/nct05672108/), [Pressurized Intraperitoneal Aerosolized Chemotherapy With Mitomycin for the Treatment of Unresectable Appendix or Colorectal Cancer With Peritoneal Metastases,](https://onco.cc/trials/nct07271355/), [PROPHYLOCHIP-PRODIGE 15](https://onco.cc/trials/prophylochip/)
- key papers: [ACT II: mitomycin or cisplatin chemoradiation with or without maintenance chemotherapy for squamous cell carcinoma of the anus](https://onco.cc/key-papers/paper-act-ii-anal-cancer-chemoradiation-lancet-oncol-2013/), [The Chicago Consensus on peritoneal surface malignancies: management of appendiceal neoplasms](https://onco.cc/key-papers/paper-chicago-consensus-appendiceal-neoplasms-cancer-2020/)

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