MMM | Cancer Research UK
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What MMM is

MMM is the name of a chemotherapy treatment for breast cancer. It is made up of the drugs 

  • Mitoxantrone (mitozantrone)
  • Mitomycin C
  • Methotrexate

How you have MMM

You have MMM in three week cycles (every 21 days). A usual course of treatment consists of 6 cycles in total. You have mitoxantrone and methotrexate every 3 weeks and mitomycin C every 6 weeks.

You have the drugs into your bloodstream (intravenously). You can have them through a thin, short tube (a cannula) put into a vein in your arm each time you have treatment. Or you may have them through a central line, a portacath, or a PICC line. These are long, plastic tubes that give the drugs directly into a large vein in your chest. You have the tube put in before or during your course of treatment and it stays in place as long as you need it.

You can read our information about having chemotherapy into a vein.

The side effects of MMM are listed below. You can use the underlined links to find out more about each effect. Where there is no link please see our cancer drugs side effects section or use the search box at the top of the page.


Common side effects

More than 10 in every 100 people have one or more of the side effects listed below.

  • An increased risk of getting an infection from a drop in white blood cells – it is harder to fight infections and you can become very ill. You may have headaches, aching muscles, a cough, a sore throat, pain passing urine, or you may feel cold and shivery. If you have a severe infection this can be life threatening. Contact your treatment centre straight away if you have any of these effects or if your temperature goes above 38°C. You will have regular blood tests to check your blood cell levels
  • Tiredness and breathlessness due to a drop in red blood cells (anaemia) – you may need a blood transfusion
  • Bruising more easily due to a drop in platelets – you may have nosebleeds, or bleeding gums after brushing your teeth. Or you may have lots of tiny red spots or bruises on your arms or legs (known as petechia)
  • Tiredness (fatigue) during and after treatment – most people find their energy levels are back to normal within 6 months to a year
  • Loss of appetite
  • Feeling or being sick – this is generally well controlled with anti sickness medicines
  • Loss of taste or a metallic taste in your mouth
  • Mouth sores and ulcers
  • Diarrhoea – drink plenty of fluids and tell your doctor or nurse if diarrhoea becomes severe or continues for more than 3 days
  • Gritty eyes, blurred vision or watery eyes from an increased production of tears
  • Urine may become a blue or green colour for 1 or 2 days after mitoxantrone treatment but this won't harm you
  • Women may stop having periods (amenorrhoea) but this may be temporary
  • Loss of fertility – you may not be able to become pregnant or father a child after this treatment. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment

Occasional side effects

Between 1 and 10 in every 100 people have one or more of these.

  • Inflammation around the drip siteif you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse straight away
  • Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished. You will have regular blood tests to check how well your kidneys are working
  • Sensitivity to sunlight – don’t sit out in the sun and cover up or use sun block on exposed skin
  • A skin rash, which may be itchy
  • Your nails may become darker
  • Coughing or breathlessness, caused by changes to lung tissue
  • Liver changes that are very mild and unlikely to cause symptoms – the liver will almost certainly go back to normal when treatment ends. You will have regular blood tests to check how well your liver is working
  • Darkening or lightening of the skin
  • An allergic reaction – tell your nurse straight away if you have sudden skin rashes, itching, or swelling of the lips, face or throat
  • Hair loss or thinning

Rare side effects

Fewer than 1 in 100 people have these effects.

  • The whites of the eyes temporarily take on a slight blue tint – avoid wearing contact lenses while you have this
  • Mitoxantrone can damage heart muscle – this is usually temporary but for some people it may be permanent. You will have regular heart checks before and after your treatment
  • 1 or 2 out of 100 people who have mitoxantrone will get leukaemia some years later – your doctors will monitor your blood for this

Important points to remember

You may have a few of the side effects mentioned here. They may be mild or more severe. A side effect may get better or worse through your course of treatment. Or more side effects may develop as the course goes on. This depends on

  • How many times you've had the drug before
  • Your general health
  • The amount of the drug you have (the dose)
  • Other drugs you are having

Coping with side effects

Talk to your doctor, pharmacist or nurse about all your side effects so they can help you manage them. They can give you advice or reassure you. Your nurse will give you a contact number to ring if you have any questions or problems. If in doubt, call them.

Other medicines

Tell your doctor about any other medicines you are taking, including vitamins, herbal supplements and over the counter remedies. Some drugs can react together.

Pregnancy and contraception

This drug may harm a baby developing in the womb. It is important not to become pregnant while you are having treatment and for a few months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.


Do not breastfeed during this treatment because the drug may come through in the breast milk.


Immunisations and chemotherapy

You should not have immunisations with live vaccines while you are having chemotherapy or for at least 6 months afterwards. In the UK, these include rubella, mumps, measles (usually given together as MMR), BCG, yellow fever and Zostavax (shingles vaccine).

You can have other vaccines, but they may not give you as much protection as usual until your immune system has fully recovered from your chemotherapy. It is safe to have the flu vaccine.

It is safe for you to be in contact with other people who've had live vaccines as injections. There can be problems with vaccines you take by mouth (oral vaccines), but not many people in the UK have these now. So there is usually no problem in being with any baby or child who has recently had any vaccination in the UK. You might need to make sure that you aren't in contact with anyone who has had oral polio, cholera or typhoid vaccination recently, particularly if you live abroad.


Related information


More information about MMM drugs

This page does not list all the very rare side effects of this treatment that are very unlikely to affect you. For further information look at the Electronic Medicines Compendium website at

If you have a side effect not mentioned here that you think may be due to this treatment you can report it to the Medicines Health and Regulatory Authority (MHRA) at

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Updated: 24 February 2015