Cancer chemotherapy cytotoxic antibiotics

Plicamycin is a cytotoxic antibiotic (see Chapter 55 Cancer Chemotherapy) that has been used clinically for two disorders of bone mineral metabolism Paget s disease and hypercalcemia. The cytotoxic properties of the drug appear to involve its binding to DNA and interruption of DNA-directed RNA synthesis. The reasons for its usefulness in the treatment of Paget s disease and hypercalcemia are unclear but may relate to the need for protein synthesis to sustain bone resorption. The doses required to treat Paget s disease and hypercalcemia are about one tenth the amounts required to achieve cytotoxic effects. 

Effects of G-CSF (color) or placebo (black line) on absolute neutrophil count (ANC) after cytotoxic chemotherapy for lung cancer. Doses of chemotherapeutic drugs were administered on days 1 and 3. G-CSF or placebo injections were started on day 4 and continued daily through day 12 or 16. The first peak in ANC reflects the recruitment of mature cells by G-CSF. The second peak reflects a marked increase in new neutrophil production by the bone marrow under stimulation by G-CSF. Treated patients in this study had fewer days of neutropenia, days of antibiotic treatment, and days of hospitalization. They also had a lower incidence of infections. (Normal ANC is 2.2-8.6 x 109/L.) (Modified and reproduced, with permission, from Crawford et al Reduction by granulocyte colony-stimulating factor of fever and neutropenia induced by chemotherapy in patients with small-cell lung cancer. N Engl J Med 1991 325 164.)... 

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