Cancer is a disease in which cells in the body become abnormal, growing and dividing out of control. According to the American Cancer Society, cancer will affect 1 in 3 people in the United States during their lifetime.

Many different treatment options for cancer exist and new treatments are being developed all the time. Chemotherapy is a type of cancer treatment that uses strong drugs to kill cancer cells, stopping them from growing and dividing.

The different types of chemotherapy drugs are often classified based on their chemical structure or how they work in the body. One type of chemotherapy drug is called an antitumor antibiotic.

In the article below, we’ll look at what antitumor antibiotics are, the different types that are available, when they’re used, and more.

When you hear the term ”antibiotic”, you may think of the drugs that are used to treat bacterial infections. However, antitumor antibiotics aren’t the same thing.

These drugs are derived from compounds that are produced by Streptomyces bacteria, which are actually the source of many of the antibiotics we use today.

In nature, these bacteria use the antibiotics that they produce to inhibit or kill other bacteria in their environment. In the human body, antitumor antibiotics target cancer cells.

Antitumor antibiotics treat cancer by affecting the genetic material within cancerous cells. This prevents cancer cells from growing and spreading.

Generally speaking, antitumor antibiotics can be divided into two groups: anthracyclines and miscellaneous. Let’s explore these groups now.

Anthracyclines

Anthracyclines are grouped together based on similarities in their chemical structure. They work by interacting with DNA and its associated enzymes inside cancer cells.

Because DNA needs to be copied before a cell divides, cancer cells that have been treated with an anthracycline cannot effectively multiply. Additionally, interfering with the replication or maintenance of DNA can also cause cells to die.

Examples of anthracyclines are:

  • daunorubicin (Cerubidine)
  • doxorubicin (Doxil)
  • epirubicin (Ellence)
  • idarubicin (Idamycin)
  • mitoxantrone (Novantrone)
  • valrubicin (Valstar)

Anthracyclines are typically administered intravenously (via an IV). The exception to this is valrubicin, which is used to treat bladder cancer and is given directly into the bladder through a catheter.

The recommended dose of an anthracycline will depend on factors like the type of cancer and if anthracyclines are being used along with another chemotherapy drug.

Miscellaneous

These types of antitumor antibiotics are structurally different from anthracyclines and some may work through a different mechanism.

  • Bleomycin: Bleomycin (Blenoxane) binds to DNA in cancer cells and also causes DNA damage by promoting the production of free radicals. It can be given by IV or by injection into the muscle or under the skin.
  • Dactinomycin: Dactinomycin (Cosmegen) also binds to DNA and prevents mRNA, which is essential for making proteins, from being produced. It’s given via IV.
  • Mitomycin C: Mitomycin C (Mitozytrex, Jelmyto) can bind to and damage DNA within cancer cells. It can be given by IV (Mitozytrex) or through a catheter into the kidney (Jelmyto).

There’s also another type of antitumor antibiotic in this category called plicamycin. While it works in a similar way to dactinomycin, it hasn’t been approved for use in the United States and is still used on an investigational basis.

Similar to the anthracyclines, the recommended dose of these antitumor antibiotics depends on things like the type of cancer and whether other chemotherapy drugs or cancer treatments are being used.

The different types of antitumor antibiotics are used for many types of cancer. Let’s take a look at this now.

Anthracyclines

Anthracyclines are used to treat a wide variety of cancers. The type of anthracycline used depends on what type of cancer a person has.

Doxorubicin can be used for many types of cancers, including:

The other anthracyclines are less broad in scope. For example:

  • Daunorubicin is used to treat ALL and AML.
  • Epirubicin is used to treat breast cancer.
  • Idarubicin is used for AML.
  • Mitoxantrone is used to treat acute non-lymphocytic leukemia (ANLL) and prostate cancer.
  • Valrubicin is used to treat bladder cancer.

Miscellaneous

The non-anthracycline antitumor antibiotics can also be used for a wide variety of cancer types.

Bleomycin is used to treat:

  • lymphoma, both Hodgkin’s and non-Hodgkin’s
  • squamous cell carcinomas of the:
    • head and neck
    • penis
    • cervix
    • vulva
  • metastatic testicular cancer

Dactinomycin is used to treat:

Mitomycin C can be used to treat:

  • bladder cancer
  • metastatic cancers of the stomach or pancreas
  • upper tract urothelial cancer

In general, antitumor antibiotics have many side effects that are often associated with chemotherapy. These include:

Some people should avoid taking antitumor antibiotics, such as:

  • people who are pregnant or breastfeeding
  • those with severe liver disease
  • individuals who’ve had a previous severe allergic reaction, called anaphylaxis, to antitumor antibiotics in the past

Anthracycline and heart damage

A big concern with anthracycline antitumor antibiotics is damage to the heart, particularly if these drugs are given in high doses. Other factors that increase the risk of heart damage are:

Anyone with an existing heart condition or other cardiovascular risk factors should avoid taking anthracyclines.

People taking anthracyclines are typically monitored for signs of heart damage. This can be done through periodically testing cardiac troponin levels and using imaging techniques like echocardiography.

Some medications, such as dexrazoxane and other cardiovascular medications, may help protect you from heart damage due to anthracyclines. Because of their potential toxicity to the heart, a lifetime dose limit is placed on anthracyclines.

Bleomycin and lung damage

The main serious risk that’s associated with bleomycin is lung damage. This is estimated to happen in about 10 percent of people and can lead to pulmonary fibrosis, an irreversible condition where scar tissue builds up in the lungs.

Due to this, people taking bleomycin will be monitored for signs of lung fibrosis. This typically involves the use of pulmonary function tests and imaging technology like X-rays, MRI scans, and CT scans.

Some people should avoid taking bleomycin, such as:

  • anyone with an existing lung condition
  • those who currently smoke or have previously smoked
  • individuals receiving supplemental oxygen therapy

It’s possible that some types of antitumor antibiotics may interact with other medications that you’re taking. This can potentially cause unwanted side effects or impact the way that your cancer treatment works.

When you begin taking an antitumor antibiotic, it’s important to let your doctor know about anything else you’re taking, such as:

  • prescription medications
  • over-the-counter medications
  • dietary supplements
  • herbal products

Your doctor can use this information to determine if the risk for a drug interaction.

Anthracycline drug interactions

Anthracyclines interact with the enzymes CYP3A4 and CYP2D6, which are produced by the liver. They’re important for breaking down drugs and toxins so that they can be eliminated from your body.

Taking anthracyclines with other compounds that interact with these enzymes could impact the levels of anthracyclines in your system. This can affect how your treatment works.

As we mentioned earlier, anthracyclines can also cause damage to the heart. Therefore, they shouldn’t be used with other drugs that may cause heart damage.

You may now be curious about how effective antitumor antibiotics actually are. The answer to this question isn’t straightforward, as it depends on factors, including but not limited to:

  • the type of antitumor antibiotic used
  • the type and extent of the cancer that’s being treated
  • whether it’s combined with other cancer treatments

Antitumor antibiotics: a small research snapshot

A 2019 meta-analysis evaluated the use of anthracyclines in the treatment of breast cancer. It included 19 clinical trials made up of 3,484 individuals with breast cancer.

The study found that the best balance of benefit and risk was a combination of epirubicin with dexrazoxane, a drug that protects the heart from damage. While doxorubicin did well in terms of treatment response, it also ranked worst for the risk of heart damage.

A 2014 study examined treatment with or without anthracyclines in 72 older individuals with large B-cell lymphoma. Here are the results:

  • median overall survival was 28 months in those who received anthracyclines, compared to 13 months for people receiving other treatment types
  • progression-free survival over 2 years in people that took anthracyclines was 64 percent, compared to 55 percent in those with other treatment types
  • a total of 59 participants took anthracyclines, with the following results:
    • 14 participants had some evidence of heart damage
    • 7 participants required a dose reduction of anthracyclines
    • 15 participants couldn’t complete their anthracycline treatment as planned

A 2021 paper described two pilot studies focusing on the use of dactinomycin for AML with a mutated NPM1 gene. This gene mutation is present in one-third of people with newly diagnosed AML.

Out of nine participants, four reached complete remission after one or two cycles of dactinomycin. However, three of these four participants experienced a relapse in the months following dactinomycin treatment.

Antitumor antibiotics are a type of chemotherapy. Generally speaking, they work by disrupting the genetic material within cancer cells.

There are many different antitumor antibiotics. Which one is utilized depends on things like:

  • the type of cancer
  • how far the cancer has spread
  • which treatments, if any, have been used already
  • your age, overall health, and personal preferences

If you’ve been diagnosed with cancer, your doctor will work with you to develop a treatment plan that’s optimal for your individual situation. This treatment plan may or may not include the use of antitumor antibiotics.

In addition to the common side effects of chemotherapy, some antitumor antibiotics can be toxic to the heart or lungs. Ask your doctor about the benefits and risks of antitumor antibiotics if they’re recommended for you.