II. Indications
- See Intralesional Bleomycin
- Cervical Cancer
- Germ cell malignancy (children)
- Head and Neck Cancers
- Lymphoma
- Penile Cancer
- Squamous Cell Carcinoma
- Testicular Cancer
- Vulvar Cancer
- Miscellaneous
- Malignant Pleural Effusion (used intrapleural as a sclerosing agent)
III. Mechanism
- See Antibiotic Chemotherapy
- Bleomycin is a complex of Glycopeptide Antibiotics (A2, B2) extracted from the bacterium Streptomyces verticillus
- Bleomycin is a G2/M-Phase specific Antineoplastic Agent
- Bleomycin forms complexes with iron and reduces molecular oxygen to superoxide and hydroxyl free radicals
- Induces single and double stranded breaks in DNA
- Other effects
- Lipid peroxidation of cell membrane lipids (cytotoxic effects)
- Carbohydrate oxidation
- Alters Prostaglandin synthesis and degradation
IV. Medications
- Bleomycin Injection Powder for Solution: 15 unit and 30 unit vials
V. Dosing
- See other references for disease specific dosing protocols
- Limit initial dose to <=2 units for first 1-2 doses in Lymphoma patients
- Reduces risk of anaphylactoid reaction (see below)
VI. Adverse Effects
- Alopecia
- Dermatotoxicity
- Hepatotoxicity
- Nephrotoxicity
- Pulmonary Fibrosis
- Highest risk with Bleomycin lifetime cummulative exposure >400 units
- Anaphylactoid Reaction
VII. Safety
- Avoid in Lactation
- Avoid in pregnancy (all trimesters)
- Use reliable Contraception
- Monitoring
- Chest XRays (for pulmonary fibrosis findings)
IX. Resources
- Bleomycin Injection Powder for Solution (DailyMed)