Bleomycin


Bleomycin (Bleomycin™ or Blenoxane™) is a cytotoxic antibiotic produced by Streptomyces verticillus. Its chemical formula is very complex.

Its mechanism of action is not fully understood: it would appear to be a direct attack on DNA structure in the form of a simple break on both strands.

Indications

Main indications (always as a component of a polychemotherapy protocol)

Epidermoid carcinoma

Hodgkin's and non Hodgkin's lymphoma

Testis cancer

Dosage

Bleomycin can be administrated either by intravenous, subcutaneous or intramuscular injection.

The usual dosage is 10 to 20 mg/m2 per day for one to five consecutive days.

Main toxicities

Only specific toxicities (or major toxicities) are described here. Other common chemotherapy toxicities are described in the chapter on chemotherapy toxicity.

General manifestations

They are frequent and include hyperthermia which should systematically be prevented via the simultaneous administration of antihistamine drugs. More severe reactions are occasionally observed including exceptional anaphylactic reactions.

Pulmonary fibrosis

Pulmonary fibrosis of bleomycin is generally a chronic cumulative toxicity which occurs after a total dose superior to 300 mg. Some patients are more at risk than others: patients aged over 70 years, or those with a history of: associated or previous pulmonary radiotherapy, altered renal function, other pulmonary disease, anaesthesia with high concentrations of oxygen (hence the importance of the anaesthesiologist’s awareness of bleomycin prescription).

Pulmonary fibrosis can be less severe if bleomycin is administered in a continuous infusion.

Such fibrosis is symptomatic in 10% of cases and lethal in 1% of cases.

Exceptional acute fibrosis may occur if it appears during the first days of bleomycin treatment. Such fibrosis requires immediate treatment interruption and vigorous rehabilitation including high doses of corticosteroids. In certain cases, fibrosis can be lethal.

Arterial toxicity

Rare Raynaud syndromes.

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