MM

MM is the name of a chemotherapy treatment used to treat breast cancer. MM is made up of the drugs

• M = Mitoxantrone (mitozantrone)
• M = Methotrexate

You can click on the links to find out the side effects of each individual drug.

There are a number of combinations of drugs for women with breast cancer. MM is just one type of treatment. Your doctor will decide which combination is best to treat your type of breast cancer and stage of breast cancer. There is more information about these combinations in the breast cancer chemotherapy section.

You have MM every 3 weeks (every 21 days) on the first day of each treatment cycle. A usual course of treatment consists of 6 cycles in total. 

You have the drug injections into a vein, usually through a thin, short tube (cannula) put into a vein in your arm on the day of each 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 just before your course of treatment starts and it stays in place as long as you need it.

The side effects of a combination of drugs are usually a mixture of the side effects of each drug. You may get 1 or 2 or a few. The combination of drugs may increase or decrease your chance of getting each side effect. Or it may change the severity. We have listed the side effects associated with MM below. You can use the underlined links to find out more about each effect. For more information where there is no link please see our cancer drug side effects section or click on search at the top of the page.

With these drugs, many people have a temporary drop in the number of blood cells made by the bone marrow, leading to the following side effects. More than 10 in every 100 people have one or more of these.

• 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, sore throat, pain passing urine or feel cold and shivery
• 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, bleeding gums after brushing your teeth, or lots of tiny red spots or bruises on your arms or legs (known as petechia)

Some of these side effects can be life threatening, particularly infections. You should contact your doctor if you have any of these effects. Your doctor will check your blood counts regularly to see how well your bone marrow is working.

Other common side effects include

• Fatigue during and after treatment – most people find their energy levels are back to normal within 6 months to a year
• Your urine may become a blue or green colour for a day or two after treatment – this is just colour from the drugs and nothing to worry about
• Feeling or being sick in about 1 in 3 people, but this is generally well controlled with anti sickness drugs
• A sore mouth and mouth ulcers
• Loss of taste or a metallic taste in your mouth
• Gritty eyes, blurred vision or watery eyes from increased production of tears
• MM may have a harmful effect on a developing baby – it is not advisable to become pregnant or father a child if you are having this treatment. You should talk about contraception with your doctor before having the treatment
• Loss of fertility – we don’t know exactly how this drug affects fertility so do talk with your doctor before starting treatment if having a baby is important to you
•  Women may stop having periods (amenorrhoea) – this may only be temporary

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

• Diarrhoea happens in about 1 in 10 people – drink plenty of fluid and tell your doctor if diarrhoea becomes severe, or continues for more than 3 days
• Skin changes – your skin may darken or lighten, develop an itchy rash, or become more sensitive to sunlight. Use a high factor sunscreen and cover up when you go out
• Coughing or breathlessness
• Changes to liver function – you will have blood tests to see how well your liver is working
• Hair thinning – remember, this is only temporary and it will grow back
• Some people have an allergic reaction while having MM treatment, usually at the first or second treatment – let your treatment team know immediately if you have any skin rashes, itching, feeling hot, shivering, going red in the face, feeling dizzy, headache, shortness of breath, anxiety, or a sudden need to pass urine

Fewer than 1 in 100 people have these.

• For a very small number of people who have mitoxantrone the whites of their eyes take on a slight blue tint – this is temporary
• You may have changes in the way your heart works – your doctors will check your heart function
• Around 1 or 2 in 100 people who have mitoxantrone will get leukaemia some years later

The side effects above 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

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

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

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 and yellow fever. 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 for you to be in contact with other people who've had live vaccines as injections. There can be problems with oral vaccines, but not many people in the UK have oral vaccines 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.