Mifamurtide (Specialist drug)

How it works

It is a synthetic analogue of a bacterial cell-wall component that activates monocytes and macrophages, stimulating an immune response against residual tumour cells.

Prescribing in practice

• Infusion-related and systemic inflammatory reactions are common, so it is given as a controlled intravenous infusion with monitoring; it should be avoided in patients with significant respiratory disease such as asthma due to bronchospasm risk.
• It should not be given concurrently with high-dose NSAIDs or ciclosporin and other calcineurin inhibitors, which may interfere with its activity.
• It is administered within a specialist osteosarcoma protocol alongside combination chemotherapy.

Monitoring

Monitor for infusion reactions, fever, respiratory symptoms and signs of systemic inflammation during and after each infusion.

Counselling the patient

• Expect chills, fever and tiredness around infusions; tell the team if they are severe or you become breathless.
• Report wheeze or chest tightness, particularly if you have asthma.
• Attend all scheduled infusions to complete the planned course.

Evidence & guidelines

Approved as an adjunct in non-metastatic resectable osteosarcoma; use follows NICE and specialist commissioning arrangements.