C H A P T E R 1 4
Antineoplastic agents
205
ANTINEOPLASTIC ANTIBIOTICS
Antineoplastic antibiotics (Table 14.3), although selec
tive for bacterial cells, are also toxic to human cells.
Because these drugs tend to be more toxic to cells
that are multiplying rapidly, they are more useful in
the treatment of certain cancers. Antineoplastic anti
biotics include bleomycin (
Blenamax
), dactinomycin
(
Cosmegen
), daunorubicin (generic), doxorubicin (
Adri-
amycin
,
Caelyx
), epirubicin (
Epiccord
), idarubicin
(
Zavedos
), mitomycin (
Mitomycin C
) and mitoxantrone
(generic).
Therapeutic actions and indications
Some antineoplastic antibiotics break up DNA links,
and others prevent DNA synthesis.
The antineoplastic antibiotics are cytotoxic and
interfere with cellular DNA synthesis by inserting them
selves between base pairs in the DNA chain. This, in
turn, causes a mutant DNA molecule, leading to cell
death (see Figure 14.4). See Table 14.3 for usual indi
cations for each antineoplastic antibiotic. Like other
antineoplastics, the main adverse effects of these drugs
are seen in cells that multiply rapidly, such as those in
the bone marrow, GI tract and skin. Their potentially
serious adverse effects may limit their usefulness in
people with pre-existing diseases and in those who are
debilitated and, therefore, more susceptible to these
effects.
Alternative therapies and cancer
The diagnosis of cancer and the sometimes devastating
effects of cancer treatment often drive people to seek
out alternative therapies, either as adjuncts to traditional
cancer therapy or sometimes instead of traditional
therapy. Because Asians and Pacific Islanders often see
drug therapy and other cancer therapies as part of a
“yin/yang” belief system, they may turn to a variety of
herbal therapies to “balance” their systems.
Nurses and midwives should be aware of some
potential interactions that may occur when alternative
therapies are used:
• Echinacea—may be hepatotoxic; increases the risk of
hepatotoxicity when taken with antineoplastics that are
hepatotoxic
• Ginkgo—inhibits blood clotting, which can cause
problems after surgery or with bleeding neoplasms
• Saw palmetto—may increase the effects of various
oestrogen hormones and hormone modulators; advise
people taking such drugs to avoid this herb
• St John’s wort—can greatly increase photosensitivity,
which can cause problems with people who have
received radiation therapy or are taking drugs that
cause other dermatological effects; has been shown to
interfere with the effectiveness of some antineoplastic
agents
If a person has an unexpected reaction to a drug,
ask about whether they are using alternative therapies.
Many of these agents are untested, and interactions and
adverse effects are not well documented.
Cultural considerations
BOX 14.7
TABLE 14.3
DRUGS IN FOCUS Antineoplastic antibiotics
Drug name
Dosage/route
Usual indications
bleomycin (Blenamax)
10,000–20,000 IU/m
2
IM, IV, or SC once or
twice weekly
Palliative treatment of squamous cell
carcinomas, testicular cancers and
lymphomas; used to treat malignant
pleural effusion
Special considerations:
GI
toxicity, severe skin reactions and
hypersensitivity reactions may occur;
pulmonary fibrosis can be a serious
problem—baseline and periodic chest
radiographs and pulmonary function
tests are necessary
dactinomycin (Cosmegen)
Adult: 0.5 mg/day IV for up to 5 days
Paediatric: 0.015 mg/kg/day IV for up to 5 days
or a total dose of 2.5 mg/m
2
/week
Part of combination drug regimen in the
treatment of a variety of sarcomas and
carcinomas; potentiates the effects of
radiation therapy
Special considerations:
bone marrow
suppression and GI toxicity, which may
be severe, limit the dose; effects may not
appear for 1–2 weeks; local extravasation
can cause necrosis and should be treated
with injectable corticosteroids, ice to
the area and restarting of the IV line in a
different vein
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