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

Members

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

Method of action

Direct toxic action on cellular DNA.¹

Indications include

• Solid tumours, e.g. 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.

Important interactions and cautions

• 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.

Adverse effects

• 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).

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