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Treatment of almost all medical conditions has been affected by the COVID-19 pandemic. NICE has issued rapid update guidelines in relation to many of these. This guidance is changing frequently. Please visit https://www.nice.org.uk/covid-19 to see if there is temporary guidance issued by NICE in relation to the management of this condition, which may vary from the information given below.
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