MMM

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

• Mitoxantrone (mitozantrone)
• Mitomycin C
• Methotrexate

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

You usually have chemotherapy in cycles of treatment. 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, on day 1 of each cycle. You have 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 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 of the effects. The combination of drugs may increase or decrease your chance of getting each side effect. Or may change the severity. 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.

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

Temporary drop in the number of blood cells made by the bone marrow, causing

• 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. The effects on the bone marrow can be severe and long lasting with mitomycin C. They may begin about 3 weeks after treatment and last until 8 weeks after treatment. Your blood will be checked 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
• Loss of appetite
• Feeling or being sick but this is generally well controlled with anti sickness medicines
• Loss of fertility – we don’t know exactly how these drugs affect 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
• MMM may have a harmful effects on a developing baby – do talk to your doctor about contraception before having treatment if there is any chance that you or your partner could become pregnant
• Loss of taste or a metallic taste in your mouth
• Mouth sores and ulcers
• Diarrhoea – drink plenty of fluid and tell your doctor 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 one or two days after mitoxantrone treatment, but this is nothing to worry about

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

• Inflammation around the drip site – if you notice any signs of redness, swelling or leaking at your drip site, tell your chemotherapy nurse immediately
• Kidney changes that are mild and unlikely to cause symptoms may occur – they will almost certainly go back to normal when treatment is finished, but 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 is finished, but you will have regular blood tests to check how well your liver is working
• Darkening or lightening of the skin
• An allergic reaction, including skin rashes and itching, a high temperature, shivering, redness of the face, a feeling of dizziness, headache, breathlessness, anxiety, and a need to pass urine.
•  Hair loss or thinning

Fewer than 1 in 100 people have these.

• 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. Your doctor will check your heart 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

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.