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Cytotoxic antibiotics are used very commonly and widely in many malignancies.
Method of action
Direct toxic action on cellular DNA.
- Solid tumours, eg bladder, gastric, pancreatic and oesophageal.
- Acute leukaemias.
- Breast cancer.
- Ovarian cancer - doxorubicin (see National Institute for Health and Clinical Excellence (NICE) guidance).
- Metastatic germ cell tumours and non-Hodgkin's lymphoma - bleomycin.
Important interactions and cautions
- Radiotherapy - some cytotoxic antibiotics can result in toxicity.
- Irreversible cardiotoxicity - must be used cautiously in patients with previous cardiac illness. (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. 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 and references
Ovarian cancer (advanced) - paclitaxel, pegylated liposomal doxorubicin hydrochloride and topotecan; NICE Technology Appraisal, 2005
Safra T; Cardiac safety of liposomal anthracyclines. Oncologist. 2003
Rang HP, Dale MM, Ritter JM and Moore PK. (2003) Pharmacology, 5th ed, Bath, Churchill Livingstone