Cytotoxic Antibiotics

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PatientPlus articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use, so you may find the language more technical than the condition leaflets.

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Cytotoxic antibiotics are used very commonly and widely in many malignancies.

Bleomycin, daunorubicin, doxorubicin, dactinomycin, epirubicin, idarubicin, mitoxantrone and mitomycin.

Direct toxic action on cellular DNA.[1]

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  • Solid tumours, eg bladder, gastric, pancreatic and oesophageal.
  • Acute leukaemias.
  • Lymphomas.
  • Breast cancer.
  • Ovarian cancer - doxorubicin (see National Institute for Health and Clinical Excellence (NICE) guidance).[2]
  • Metastatic germ cell tumours and non-Hodgkin's lymphoma - bleomycin.
  • Radiotherapy - some cytotoxic antibiotics can result in toxicity.
  • Irreversible cardiotoxicity - must be used cautiously in patients with previous cardiac illness.[3] (A liposomal formulation of doxorubicin is available which is associated with less cardiotoxicity.)
  • Liver impairment.
  • Skin reactions - especially with doxorubicin.
  • Myelosuppression - usually occurs at 2-4 weeks with complete recovery by eight weeks.[4] Rare with bleomycin, whereas mitomycin is associated with delayed myelosuppression.
  • Extravasation causes severe skin necrosis.
  • Excreted in bile; therefore, it is necessary to monitor bilirubin levels - if high, dose reduction is needed.
  • Associated with cardiac toxicity - this is rare and includes supraventricular tachycardia (SVT) and cardiomyopathies (related to dose).

Further reading & references

  1. What are the different types of chemotherapy drugs?, American Cancer Society, Apr 2005
  2. Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan; NICE Technology Appraisal, 2005
  3. Safra T; Cardiac safety of liposomal anthracyclines.; Oncologist. 2003;8 Suppl 2:17-24.
  4. Rang HP, Dale MM, Ritter JM and Moore PK. (2003) Pharmacology, 5th ed, Bath, Churchill Livingstone

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Dr Gurvinder Rull
Current Version:
Peer Reviewer:
Dr Hannah Gronow
Document ID:
310 (v3)
Last Checked:
Next Review:

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