Pulmonary toxicity is dose-limiting and potentially fatal → monitor closely for cough, dyspnoea, and DLCO decline.
Cumulative dose >400 units markedly increases risk of pulmonary fibrosis → track total lifetime dose carefully.
Avoid high concentrations of oxygen (e.g. during anaesthesia) → increases risk of acute lung injury.
Renal impairment increases toxicity → dose reduction required.
Previous bleomycin-induced lung toxicity = absolute contraindication to re-exposure.
Drug class: Cytotoxic antibiotic (antitumour antibiotic)
ATC class: L01DC01
Formulation: Lyophilised powder for injection
Routes: IV, IM, SC, intrapleural, intratumoural
Key characteristic: High affinity for squamous cell tumours
Bleomycin is indicated for the treatment of the following malignant conditions, either alone or as part of combination chemotherapy regimens:
Squamous Cell Carcinomas
Squamous cell carcinoma of the head and neck
Squamous cell carcinoma of the oesophagus
Squamous cell carcinoma of the skin
Squamous cell carcinoma of the penis
Squamous cell carcinoma of the uterine cervix
Germ Cell Tumours
Testicular cancer, including:
Embryonal carcinoma of the testes
Mixed germ cell tumours (e.g. BEP regimen)
Trophoblastic Tumours
Choriocarcinoma
Lymphomas
Hodgkin’s lymphoma
Non-Hodgkin’s lymphoma
Produces remissions in selected cases
Commonly used in combination regimens (e.g. ABVD)
Pleural Malignancy (Palliative Use)
Malignant pleural effusion (as a sclerosing agent)
Important Notes
Generally ineffective in haematopoietic malignancies
Reduced efficacy and increased toxicity after thoracic radiotherapy
Typical dose:
0.25–0.5 units/kg or 10–20 units/m²
Given weekly or twice weekly
Lymphoma patients:
Initial test dose of 1–2 units (risk of anaphylactoid reaction)
Maintenance dosing (Hodgkin’s lymphoma):
1 unit daily or 5 units weekly
⚠️ Cumulative dose caution:
Marked pulmonary toxicity risk beyond 400 units
Renal impairment: Dose reduction required
Creatinine clearance <50 mL/min: Increased toxicity risk
Elderly (>70 years): Higher pulmonary toxicity risk
Previous thoracic radiotherapy: Reduce dose or avoid
Common combinations include:
Cisplatin
Etoposide
Vinblastine
Doxorubicin
Dacarbazine
Administration note: Cisplatin should be given after bleomycin
Hypersensitivity to bleomycin
Pregnancy
Breastfeeding
Prior bleomycin-induced pneumonitis or pulmonary fibrosis
Severe pulmonary disease
Pulmonary monitoring
Baseline and serial chest X-rays
Pulmonary function tests (DLCO preferred)
Renal function: Creatinine and clearance
Clinical: New cough, dyspnoea, basal crepitations
Cumulative dose tracking (essential)
Major / Dose-Limiting
Interstitial pneumonitis
Pulmonary fibrosis (may be fatal)
Common
Fever and chills
Skin hyperpigmentation, rash, ulceration
Stomatitis
Alopecia
Nail changes
Serious
Anaphylactoid reactions (especially in lymphoma patients)
Vascular toxicity (Raynaud-like phenomenon)
Tumour lysis syndrome
Increased pulmonary toxicity with:
Cisplatin
Cyclophosphamide
Methotrexate
Gemcitabine
Thoracic radiotherapy
Oxygen therapy: High concentrations increase lung injury risk
G-CSF: Increased pulmonary toxicity reported
Pregnancy: Contraindicated
Fertility: Risk of irreversible infertility
Renal impairment: Dose reduction required
Elderly: Increased lung toxicity risk
Lung cancer: Use with extreme caution
Stop immediately if:
Pulmonary symptoms develop
DLCO falls below 30–35% of baseline
New pulmonary infiltrates appear
Re-challenge is contraindicated after pulmonary toxicity
https://pi-pil-repository.sahpra.org.za/wp-content/uploads/2022/11/pi-cipla-bleomycin.pdf
| Trade Name | |
|---|---|
| Drug Class | 1 |
| Cost | |
| Company | |
|---|---|
| Drug Rep | Admin |
| Indications | Lymphoma, Head And Neck Cancers, Testicular Cancer |
| Dosage |