Is there a role for mitomycin C in metastatic colorectal cancer?

Fluoropyrimidines with oxaliplatin or irinotecan, bevacizumab, cetuximab and panitumumab constitute the drugs currently approved by the FDA for the treatment of patients with metastatic colorectal cancer (mCRC). Patients who have progressed on the approved drugs pose a major challenge for medical oncologists, as the therapeutic choices outside the context of a clinical trial are limited.

Mitomycin C is an old drug that acts synergistically with capecitabine and irinotecan. Relevant studies were identified in PubMed (years 1950 - 2009), Ovid, Cochrane database and the American Society of Clinical Oncology abstracts (years 1995 - 2009) using the following search terms: mitomycin C, fluorouracil, capecitabine, irinotecan, oxaliplatin, and colorectal cancer. Only studies using the combination of mitomycin C with one of the aforementioned agents were selected.

An overview of the clinical trials where mitomycin has been used in combination with modern compounds in the various settings of metastatic colorectal cancer.

Mitomycin C combinations are less efficacious than modern drugs in the first-line treatment of colorectal cancer. However, they are acceptable alternatives for best supportive care in colorectal cancer that is refractory to standard regimens, as they show some modest efficacy at low cost.