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Mifamurtide (Mepact)

Mifamurtide (pronounced mee-fam-ure-tide) is also called by its brand name, Mepact.

It is a treatment for osteosarcoma, a type of bone cancer. It is for children and young people aged between 2 and 30 years. You have it with chemotherapy after surgery to help lower the risk of the cancer coming back.

How mifamurtide works

Mifamurtide is a targeted cancer drug. It boosts the immune system to kill cancer cells. It makes the immune system produce certain types of white blood cells called monocytes and macrophages.

How you have mifamurtide

You have the treatment through a drip into your arm or hand. A nurse puts a small tube (a cannula) into one of your veins and connects the drip to it.

You might need a central line. This is a long plastic tube that gives the drugs into a large vein, either in your chest or through a vein in your arm. It stays in while you’re having treatment, which may be for a few months.

Diagram showing a central line

When you have mifamurtide

You have the treatment twice a week, at least 3 days apart. You have it for 12 weeks.

Then you have it once a week for another 24 weeks. This makes 36 weeks in total (about 8 months).

You have each infusion over 1 hour.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

Side effects

We haven't listed all the side effects. It's very unlikely that you will have all of these side effects, but you might have some of them at the same time.

How often and how severe the side effects are can vary from person to person. They also depend on what other treatments you're having. For example, your side effects could be worse if you're also having other drugs or radiotherapy.

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you closely during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

  • you have severe side effects 
  • your side effects aren’t getting any better
  • your side effects are getting worse

Early treatment can help manage side effects better. 

Contact your doctor or nurse immediately if you have signs of infection, including a temperature above 37.5C or below 36C.

Common side effects

These effects happen in more than 10 in 100 people (10%). You might have one or more of them. They include: 

Breathlessness and looking pale 

You might be breathless and look pale due to a drop in red blood cells. This is called anaemia.

Tiredness and weakness (fatigue)

Tiredness and weakness (fatigue) can happen during and after treatment - doing gentle exercises each day can keep your energy up. Don't push yourself, rest when you start to feel tired and ask others for help.

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. Avoiding fatty or fried foods, eating small meals and snacks, drinking plenty of water, and relaxation techniques, can all help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treating it once it has started.

Loss of appetite

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

Headaches and dizziness

Let your doctor or nurse know if you have headaches. They can give you painkillers. Don’t drive or operate machinery if you feel dizzy.

Sweating

You might sweat more than usual. Talk to your doctor if this becomes a problem for you.

Fast heartbeat (palpitations)

Talk to your doctor about this. 

Changes in blood pressure

During treatment, your blood pressure may be lower or higher than normal. Tell your nurse if you feel dizzy, faint, or if you have headaches, nosebleeds, blurred or double vision, or shortness of breath. Your blood pressure usually goes back to normal while you are on treatment or when treatment ends.

Cough and breathlessness

Talk to your doctor about this.

Flu like symptoms

This can happen a few hours after treatment. It may include headaches, muscle aches (myalgia), a high temperature and shivering. Taking paracetamol every 6 to 8 hours can help.

Constipation

Constipation is easier to sort out if you treat it early. Drink plenty of fluids and eat as much fresh fruit and vegetables as you can. Try to take gentle exercise, such as walking. Tell your doctor or nurse if you are constipated for more than 3 days. They can prescribe a laxative.

Diarrhoea

Contact your advice line if you have diarrhoea, such as if you've had 4 or more loose watery poos (stools) in 24 hours. Or if you can't drink to replace the lost fluid. Or if it carries on for more than 3 days.

Your doctor may give you anti diarrhoea medicine to take home with you after treatment. Eat less fibre, avoid raw fruits, fruit juice, cereals and vegetables, and drink plenty to replace the fluid lost.

Pain in different parts of the body

You might have pain your back, muscles or tummy (abdomen). Talk to the team looking after you about this. 

Occasional side effects

These side effects happen in between 1 and 10 in 100 people (1 to 10%). You might have one or more of them. They include:

  • bruising, bleeding gums, or nosebleeds (due to a drop in the level of platelets in your body)
  • confusion
  • difficulty sleeping (insomnia)
  • pain where the cancer is (cancer pain)
  • depression and anxiety
  • blurred vision
  • hearing loss
  • ringing in the ears (tinnitus)
  • loss of balance
  • indigestion
  • skin changes such as rash, itching, and dry skin
  • hair thinning
  • periods stopping
  • low levels of potassium in the blood which can cause cramps and weakness
  • tingling or numbness in fingers or toes (peripheral neuropathy)
  • skin sensation changes
  • drowsiness or sleepiness
  • inflammation of the mouth, foodpipe and bowel
  • pain passing urine and blood in the urine
  • cold sores (Herpes simplex virus)
  • fluid build up in the lungs, legs, feet or arms
  • shaking (tremor)
  • increased risk of getting an infection
  • weight loss
  • inflammation around the drip site
  • feeling cold
  • muscle spasms
  • blue skin or lips due to low oxygen
  • loss of fluid in your body (dehydration)
  • redness (flushing of the skin)

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.

Pregnancy and contraception

It is unknown whether treatment may or may not harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment.

Talk to your doctor or nurse about effective contraception you can use during treatment. Ask how long you should use it before starting treatment and after treatment has finished.

Fertility 

It is not known whether this treatment affects fertility in people. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

Always tell other doctors, nurses, pharmacists or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and the shingles vaccine (Zostavax).

You can:

  • have other vaccines, but they might not give you as much protection as usual
  • have the flu vaccine (as an injection)
  • be in contact with other people who have had live vaccines as injections

Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as oral polio or the typhoid vaccine.

This also includes the rotavirus vaccine given to babies. The virus is in the baby’s poo for up to 2 weeks and could make you ill. So avoid changing their nappies for 2 weeks after their vaccination if possible. Or wear disposable gloves and wash your hands well afterwards.

You should also avoid close contact with children who have had the flu vaccine nasal spray. You should do so for 2 weeks following their vaccination if you have a severely weakened immune system.

More information about this treatment

For further information about this treatment go to the electronic Medicines Compendium (eMC) website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.

Information and help