Cytotoxic Antibiotics

Authored by Dr Gurvinder Rull, 19 Jan 2012

Reviewed by:
Dr Hannah Gronow, 19 Jan 2012

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This page has been archived. It has not been updated since 19/01/2012. External links and references may no longer work.

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]

  • 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 and 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

  4. Rang HP, Dale MM, Ritter JM and Moore PK. (2003) Pharmacology, 5th ed, Bath, Churchill Livingstone

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