II. Indications

  1. See Intralesional Bleomycin
  2. Cervical Cancer
  3. Germ cell malignancy (children)
  4. Head and Neck Cancers
  5. Lymphoma
  6. Penile Cancer
  7. Squamous Cell Carcinoma
  8. Testicular Cancer
  9. Vulvar Cancer
  10. Miscellaneous
    1. Malignant Pleural Effusion (used intrapleural as a sclerosing agent)

III. Mechanism

  1. See Antibiotic Chemotherapy
  2. Bleomycin is a complex of Glycopeptide Antibiotics (A2, B2) extracted from the bacterium Streptomyces verticillus
  3. Bleomycin is a G2/M-Phase specific antineoplastic agent
  4. Bleomycin forms complexes with iron and reduces molecular oxygen to superoxide and hydroxyl free radicals
    1. Induces single and double stranded breaks in DNA
    2. Other effects
      1. Lipid peroxidation of cell membrane lipids (cytotoxic effects)
      2. Carbohydrate oxidation
      3. Alters Prostaglandin synthesis and degradation

IV. Medications

  1. Bleomycin Injection Powder for Solution: 15 unit and 30 unit vials

V. Dosing

  1. See other references for disease specific dosing protocols
  2. Limit initial dose to <=2 units for first 1-2 doses in Lymphoma patients
    1. Reduces risk of anaphylactoid reaction (see below)

VI. Adverse Effects

  1. Alopecia
  2. Dermatotoxicity
  3. Hepatotoxicity
  4. Nephrotoxicity
  5. Pulmonary Fibrosis
    1. Highest risk with Bleomycin lifetime cummulative exposure >400 units
  6. Anaphylactoid Reaction
    1. Altered Mental Status
    2. Chills
    3. Fever
    4. Hypotension
    5. Wheezing

VII. Safety

  1. Avoid in Lactation
  2. Avoid in pregnancy (all trimesters)
    1. Use reliable Contraception
  3. Monitoring
    1. Chest XRays (for pulmonary fibrosis findings)

VIII. Drug Interactions

  1. Bleomycin decreases other drug levels
    1. Digoxin
    2. Phenytoin

IX. Resources

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