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Antitumor antibiotics
- 1. AntiTumor AntiBiotics Dr. Mohammed Fathy, MD Lecturer of Clinical Oncology Zagazig University
- 2. Type Introduction Cycle non-specific Phase specific Cycle specific Bleomycin All Antitumor Antibiotics
- 3. Mechanism of action Introduction (Cont.,) 1- Interfere with mRNA transcription Interfere with DNA replication 2- DNA strand break Free radicals generation DNA Intercalation 3- Inhibit Topoisomerase
- 4. Introduction (Cont.,) Mechanism of action
- 5. Introduction (Cont.,) Mechanism of action
- 6. Include Introduction (Cont.,) Bleomycin Actinomycin D Mitoxantrone Anthracyclines MitomycinMithramycin Daunorubicin Doxorubicin Liposomal Doxorubicin Epirubicin Idarubicin
- 7. Indications Doxorubicin Breast CAF FAC CHOP AC Lymphoma Toxicity MyelosuppressionDose Limiting Cardiomyopathy Alopecia Administration Slowly pushed through a running intravenous line ABVD STS Holoxan+Adri Bone sarcoma Cis+Adri Vesicant Radiation‐ recall reaction Using extravasation precautions Continuously infused through a central venous line
- 8. Doxorubicin (Cont.,) Adriamycin (Pfizer) Trade name Adricin (EUP) Supplied as Vials 20 mg 50 mg Storage at 2-8oC or below 25oC Reconstitute NS 2mg/dl Dilute NS Reconstituted solution Stable for 15 days refrigerated or for 7 days at room temperature Adriblastina (Pharmaca) Powder or solution Compatible In solution with vincristine (CIV)
- 10. Liposomal Doxorubicin (Cont.,) Doxil (Janssen) Trade name Supplied as Vials 20 mg 50 mg Storage Avoid freezing Dilute D5% Reconstituted solution Administer immediately or diluted drug may be stored for 24 hours refrigerated at 2–8°C Caelyx (Shering Plough) solution 250-500 mL Inspect for any particulate matter or discoloration
- 11. Indications Epirubicin Breast CEF FEC ECF EC Gastric cancer Toxicity MyelosuppressionDose Limiting Cardiomyopathy Nausea & Vomiting Administration ECX Using extravasation precautions 900mg/m2 Intravenously over 5 minutes
- 12. Epirubicin (Cont.,) Ellence (Pfizer) Trade name Supplied as Vials 50 mg 200 mg Storage at 2-8oC or below 25oC Reconstitute NS or D5% Dilute Pharmarubicin (Pharmaca) Powder or solution Incompatible Heparin NS or D5%
- 13. Indications Bleomycin BEP ABVD Hodgkin’s Lymphomas Toxicity Hypersensitivity reactionsDose Limiting Bleomycin pneumonitis Administration Monitoring CO‐diffusing capacity Vesicant 2 unit test dose is given before first treatment. Routine pulmonary function tests : limited value Testicular carcinoma Pulmonary fibrosis & insufficiency
- 14. Bleomycin (Cont.,) Blenoxane (Bristol-Myers-Squibb) Trade name Supplied as Vials 15U Storage at 2-8oC or below 25oC Reconstitute Sterile water or NS Reconstituted solution Stable for 24 hours at room temperature Bleomycin (Baxter) Powder Never use D5%
- 15. Indications Actinomycin D EMA-CO Single Trophoblastic neoplasms Toxicity MyelosuppressionDose Limiting Administration Vesicant Premedicate patients é antiemetics Using extravasation precautions
- 16. Actinomycin D (Cont.,) Cosmegen (MSD) Trade name Supplied as Vials 500mcg Storage below 25oC Reconstitute Sterile water Dilute Dacilon (Orion) Powder D5% or NS
- 17. Indications Mitoxantrone Breast cancer Toxicity MyelosuppressionDose Limiting Administration Blue discoloration of urine, sclera, fingernails, & over venous site of injection (48hrs) 30‐minute infusion Using extravasation precautions Prostate cancer
- 18. Mitoxantrone (Cont.,) Novantrone (Merk) Trade name Supplied as Vials 20 mg Storage At room temperature. Stable at room temperature for at least 24 hours Dilute Mitoxantrone (Baxter) Solution D5% or NS (at least 50 ml) Santrone (EUP) 25 mg 30 mg Refrigerated precipitate redissolved at room temperature Reconstituted solution Blue color
- 20. Mitomycin (Cont.,) Mutamycin (Bristol-Myers-Squibb) Trade name Supplied as Vials 5 mg Storage below 25oC Reconstitute Sterile water or NS or D5% Dilute Mitomycin (medac) Powder D5% or NS Mitomycin-C (Biochem) 20 mg 40 mg Reconstituted solution Stable for 14 days refrigerated or for 7 days at room temperature