Cytotoxic chemotherapies have been a mainstay of cancer treatment for over 40 years. As they are typically administered without the use of precision biomarkers, some patients can suffer severe side effects without any benefit. The development of novel biomarkers to enable precision use of these therapies could reduce toxic side effects, improve overall response rates and reduce unnecessary healthcare expenditures. In this study we use chromosomal instability (CIN) signatures to predict a patient's response to platinum-based and doxorubicin chemotherapy. We retrospectively validated our predictor of platinum sensitivity across 41 high grade serous ovarian cancer patients. Additionally, we discovered a new biomarker for doxorubicin sensitivity based on a CIN signature related to focal DNA amplification, which we retrospectively validated across 26 patients treated with doxorubicin following platinum. We also assessed the performance of these predictors using circulating tumour DNA. As multiple CIN signature biomarkers can be quantified using a single genomic test, this represents a unified approach to guide multiple therapy choices for cytotoxic chemotherapies with the potential to shift current one-size-fits all chemotherapy treatment towards precision medicine.