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ANTINEOPLASTIC AND IMMUNOMODULATING AGENTS › ANTINEOPLASTIC AGENTS › CYTOTOXIC ANTIBIOTICS AND RELATED SUBSTANCES › Other cytotoxic antibiotics
bleomycin
L01DC01
Forms & Strengths
- Powder for injection: 15 units
- Solution for injection: 15 units/20 mL
Adult Dosing
- Squamous cell carcinoma, testicular cancer, Hodgkin lymphoma: 0.25 to 0.5 units/kg (10 to 20 units/m2) IV, IM, or SC weekly or twice weekly
- Max lifetime cumulative dose: 400 units due to pulmonary toxicity risk
- Pleurodesis: 60 units in 50-100 mL normal saline via intrapleural instillation
Pediatric Dosing
- Safety and efficacy in pediatric patients not well established
- Lymphomas and germ cell tumors: Dosing adapted from adult regimens on a mg/m2 or unit/m2 body surface area basis, typically 10-15 units/m2
Indications
- Testicular carcinoma (embryonal, choriocarcinoma, teratocarcinoma)
- Squamous cell carcinoma of the head and neck, skin, esophagus, and genitourinary tract
- Hodgkin lymphoma and non-Hodgkin lymphoma
- Malignant pleural effusion (intrapleural sclerosing agent)
Mechanism of Action
- Glycopeptide antibiotic mixture produced by Streptomyces verticillus
- Binds to DNA, causing single- and double-strand breaks via free radical generation
- Inhibits incorporation of thymidine into DNA
- Phase-specific for the G2 and M phases of the cell cycle
Contraindications
- Hypersensitivity to bleomycin or any component
- Acute pulmonary infection or severe baseline pulmonary impairment
- Previous significant bleomycin-induced pulmonary toxicity
Adverse Reactions
- Pulmonary fibrosis and interstitial pneumonitis (dose-limiting, potentially fatal)
- Mucocutaneous toxicity (hyperpigmentation, hyperkeratosis, alopecia, stomatitis, nail changes)
- Fever, chills, and acute infusion-related reactions
- Raynaud phenomenon and vascular toxicity
Drug Interactions
- Oxygen therapy: High concentrations of supplemental oxygen can potentiate bleomycin-induced pulmonary toxicity; maintain lowest effective FiO2
- G-CSF/GM-CSF: May increase severity of pulmonary toxicity
- Cisplatin: Decreases renal clearance of bleomycin, exacerbating pulmonary toxicity
- CYP450 inhibitors/substrates: Minimal direct CYP-mediated interactions, primarily cleared renally
Curated Content: Needs Vetting Before Put to Clinical Use