This information is about a chemotherapy treatment for lung cancer called MIC.
The drugs that are used
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MIC is named after the initials of the chemotherapy drugs used. These are:
How treatment is given
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MIC treatment can usually be given to you as a day patient or during a short stay in hospital.
Before you start treatment you will need to have a blood test, either on the same day or a few days beforehand. You will also be seen by a doctor, specialist nurse or pharmacist. You will also have tests to check how well your kidneys are working as the chemotherapy can affect them. These may include collecting your urine for 24 hours, or having a specific blood test known as an EDTA test. If the results of your tests are normal, the pharmacy will prepare your chemotherapy drugs. All of this may take a couple of hours.
The nurse will then put a thin, flexible tube (cannula) into a vein in your hand or arm. You may find this uncomfortable or a little painful, but it shouldn't take long. Some people have their chemotherapy given through a fine plastic tube that's inserted under the skin into a vein near their collarbone (central line), or passed through a vein in the crook of their arm (PICC line). Your doctor or nurse will explain more about this to you.
Once your chemotherapy drugs are ready, you'll be given some anti-sickness (anti-emetic) drugs. These are usually given by injection through the cannula, which is connected to a drip (infusion). Some anti-sickness medicines may also be given as tablets.
The chemotherapy drugs are then given separately.
Mitomycin (a purple fluid), is usually given as an infusion. It can also be given as a slow injection into an infusion of salt water (saline).
Ifosfamide (a colourless fluid) is given as an infusion.
Cisplatin (a colourless fluid), is also given as an infusion.
Before and after treatment with cisplatin you'll be given plenty of fluid through the drip to keep your kidneys working normally. This is because cisplatin can sometimes damage the kidneys.
Although the mitomycin is often given first, the drugs may be given in a different order. This won't alter their effectiveness.
If you are having your treatment as a day patient you can then go home, and the cannula will be removed before you go. If you have a central or PICC line it will usually stay in place, ready for the next cycle of your chemotherapy. You'll be shown how to look after the line.
You'll be given a supply of anti-sickness drugs to take home with you. It is important to take these as directed even if you aren't feeling sick, as some anti-sickness drugs are much better at preventing sickness than stopping it once it has started.
How often treatment is given
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You may hear your doctor or nurse use the word 'regimen' (eg the MIC regimen) when talking about your chemotherapy. This just means the whole plan or schedule of the particular treatment you're receiving.
MIC chemotherapy can be given in different ways. You can ask your nurse or doctor to explain how you will have your treatment. Below is a description of one schedule.
On the first day of your treatment you will be given all three drugs, mitomycin, ifosfamide and cisplatin, for one day only. After this you'll have a rest period, with no chemotherapy for the next three weeks. This completes what's called a cycle of your treatment.
After the rest period, the same drugs will be given to you again to begin the next cycle of your treatment. Usually 4-6 cycles of treatment will be given over a period of 3-5 months. This makes up a course of treatment.
Each person’s reaction to chemotherapy is different. Some people have very few side effects, while others may experience more. The side effects described below won't affect everyone who has MIC chemotherapy.
We have outlined the most common side effects but haven't included those that are rare and therefore unlikely to affect you. If you notice any effects that aren't listed below, discuss them with your doctor, chemotherapy nurse or pharmacist.
Risk of infection
MIC can reduce the number of white blood cells, which help to fight infection. White blood cells are produced by the bone marrow. If the number of your white blood cells is low you will be more prone to infections. A low white blood cell count is called neutropenia. This begins seven days after treatment and your resistance to infection is usually at its lowest 10-14 days after chemotherapy. The number of your white blood cells will then increase steadily and usually return to normal before your next cycle of chemotherapy is due.
Contact your doctor or the hospital straight away if:
your temperature goes above 38°C (100.4°F)
you suddenly feel unwell, even with a normal temperature.
You will have a blood test before having more chemotherapy to check the number of white cells. Occasionally, your treatment may need to be delayed if your number of blood cells (blood count) is still low.
Bruising and bleeding
MIC can reduce the production of platelets, which help the blood to clot. Tell your doctor if you have any unexplained bruising or bleeding, such as nosebleeds, bleeding gums, blood spots or rashes on the skin. You can have a platelet transfusion if your platelet count is low.
MIC can reduce the number of red blood cells, which carry oxygen around the body. A low red blood cell count is called anaemia. This may make you feel tired and breathless. Tell your doctor or nurse if you have these symptoms. You may need to have a blood transfusion if the number of red blood cells becomes too low.
Loss of appetite
Some people lose their appetite while they’re having chemotherapy. This can be mild and may only last a few days. If it doesn’t improve you can ask to see a dietitian or specialist nurse at your hospital. They can give you advice on improving your appetite and keeping to a healthy weight. You might also like to read our information about eating well or watch our slideshow about coping with a poor appetite.
Feeling sick (nausea) and being sick (vomiting)
This may begin 2-3 hours after the treatment is given and can last for up to two weeks. Your doctor can prescribe very effective anti-sickness (anti-emetic) drugs to prevent or greatly reduce nausea and vomiting. If the sickness isn't controlled or if it continues, tell your doctor; they can prescribe other anti-sickness drugs that may be more effective.
Some anti-sickness drugs can cause constipation. Let your doctor or nurse know if this is a problem.
Feeling tired is a common side effect of chemotherapy, especially towards the end of treatment and for some weeks after it’s over. It’s important to try to pace yourself and get as much rest as you need. Try to balance this with doing some gentle exercise, such as short walks, which will help. If tiredness is making you feel sleepy, don’t drive or operate machinery.
This usually starts 3-4 weeks after starting treatment, although it may occur earlier. Hair usually falls out completely. You may also have thinning and loss of eyelashes, eyebrows and other body hair. This is temporary and your hair will start to grow again once the treatment has finished. Your hair may grow back straighter, curlier, finer, or a slightly different colour than it was before. Your nurse can give you advice about coping with hair loss.
Your mouth may become sore or dry, or you may notice small ulcers during this treatment. Some people find that sucking on ice may be soothing. Drinking plenty of fluids, and cleaning your teeth regularly and gently with a soft toothbrush, can help to reduce the risk of this happening. Tell your nurse or doctor if you have any of these problems, as they can prescribe mouthwashes and medicine to prevent or clear mouth infections.
You may notice that food tastes different. Normal taste usually comes back after treatment finishes. A dietitian or specialist nurse at your hospital can give you advice about ways of coping with this side effect.
Less common side effects
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Your kidneys may be affected
This doesn't usually cause any symptoms, and the effect is generally mild. Rarely, it may cause permanent damage to the kidneys unless the treatment is stopped.
Before each treatment, you'll have a blood test to check your kidneys. You’ll be given fluid through a drip (infusion) before and after the treatment to keep your kidneys working normally. You may be asked to measure and record what you drink and the amount of urine you pass. It’s important to tell your nurse or doctor if you pass less urine than usual.
If necessary, you may be given medicine to help you to pass urine. You may be asked to drink extra fluid before and after treatment. It's important to do this so let your doctor know if this is a problem, for example, if you are feeling sick.
Irritation of the bladder
Ifosfamide may irritate the bladder. It’s important to drink as much fluid as you can (at least two litres a day) during the treatment. You’ll usually be given fluids through a drip (infusion), along with a drug called mesna (Uromitexan®) to help prevent bladder irritation. Your urine will be measured and tested for blood. If there’s any blood in your urine, you’ll be given more mesna.
Numbness or tingling in hands or feet
This is due to the effect of cisplatin on nerves and is known as peripheral neuropathy. You may also notice that you have difficulty doing up buttons or similar fiddly tasks.
Tell your doctor if you notice any numbness or tingling in your hands or feet. It is important to report your symptoms to your doctor as they may be controlled by slightly lowering the dose of the drug.
This side effect usually improves slowly, a few months after the treatment has finished. Sometimes symptoms can persist, talk to your doctor if this happens.
Changes in hearing
Cisplatin may cause ringing in the ears (tinnitus) and you may lose the ability to hear some high-pitched sounds. Hearing loss can be more severe with higher doses and longer courses of treatment. Very occasionally your sense of balance may be affected. Any hearing loss, and balance changes if they occur, may be permanent. However tinnitus usually improves when treatment ends. Tell your doctor if you notice any loss of hearing or tinnitus.
Changes to the lungs
Mitomycin may cause some changes to the lungs. Tell your doctor if you notice any coughing or breathlessness, or if existing symptoms get worse.
Signs of an allergic reaction include skin rashes and itching, a high temperature, shivering, reddening of the face, dizziness, a headache, breathlessness, anxiety, and a feeling that you want to pass urine. You will be monitored for any signs of an allergic reaction during the treatment. Tell your doctor or nurse about any side effects you have.
It’s important to let your doctor know straight away if you feel unwell or have any severe side effects, even if they’re not mentioned above.
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Leakage into the tissue around the vein (extravasation)
If this happens when mitomycin is being given, the tissue in that area can be damaged. Tell the doctor or nurse immediately if you notice any stinging or burning around the vein while the drug is being given. This is unlikely to happen if the chemotherapy is given through a central or PICC line.
If the area around the injection site becomes red or swollen at any time, you should tell the doctor or nurse on the ward. If you are at home, ring the clinic or ward and ask to speak to the doctor or nurse.
Risk of developing a blood clot
Cancer can increase the risk of developing a blood clot (thrombosis), and chemotherapy may increase this risk further.
A blood clot may cause symptoms such as pain, redness and swelling in a leg, or breathlessness and chest pain. Blood clots can be very serious so it’s important to tell your doctor straight away if you notice any of these symptoms. Most clots can be treated with drugs that thin the blood. The doctor or nurse can give you more information.
Some medicines, including those you can buy in a shop or chemist, can be harmful to take when you are having chemotherapy. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
Your ability to become pregnant or father a child may be affected by this treatment. It's important to discuss fertility with your doctor before starting treatment.
It's not advisable to become pregnant or to father a child while having MIC chemotherapy, as it may harm the developing baby. It's important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
It’s not known whether chemotherapy drugs can be present in semen or vaginal fluids. To protect your partner it’s safest to either avoid sex or use a barrier form of contraception for about 48 hours after chemotherapy.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having chemotherapy treatment. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or troublesome side effects when you’re at home. Your chemotherapy nurse or doctor will give you details of who to contact for advice. This should include ‘out-of hours’ contact details if you need to call someone at evenings, overnight or at the weekend.
This section is based upon our MIC chemotherapy fact sheet, which has been compiled using information from a number of reliable sources including:
British National Formulary. 62nd edition. 2011. British Medical Association and Royal Pharmaceutical Society of Great Britain.
electronic Medicines Compendium (eMC). www.medicines.org.uk (accessed October 2011).
Sweetman, et al. Martindale: The Complete Drug Reference. 37th edition. 2011. Pharmaceutical Press.
Perry MC. The Chemotherapy Source Book. 4th edition. 2007. Lippincott Williams and Wilkins.