Makindo Medical Notes

A dose of 3g of bleomycin causes lethal fibrosis of all organs. Notably causes pneumonitis in 10% especially with doses > 500 U. The risk of bleomycin-induced pneumonitis is greater in those individuals who are older than forty years of age, have a history of smoking, those with underlying lung disease

About: Always check the BNF link here

• A dose of 3g of bleomycin causes lethal fibrosis of all organs
• Causes less myelosuppression than expected

Mode of action

• Anti-tumour antibiotic
• Causes DNA stranded breaks

Indications/Dose

• Squamous cell carcinoma affecting the mouth, nasopharynx and paranasal sinuses, larynx, oesophagus, external genitalia, cervix or skin. Well-differentiated tumour usually respond better than anaplastic ones.
• Hodgkin's disease and other malignant lymphomas, including mycosis fungoides.
• Non-Hodgkin's disease
• Testicular teratoma/carcinoma
• Malignant effusions of serous cavities.
• Secondary indications in which bleomycin has been shown to be of some value (alone or in combination with other drugs) include metastatic malignant melanoma, carcinoma of the thyroid, lung and bladder.
• Bleomycin is usually administered intramuscularly but may be given intravenously (bolus or drip), intra-arterially, intrapleurally or intraperitoneally as a solution in physiological saline. Local injection directly into the tumour may occasionally be indicated.

Interactions

• See BNF

Cautions

• See BNF

Contraindications

• Acute pulmonary infection or chest X-ray findings suggesting diffuse fibrotic changes or greatly reduced lung function.

Side effects: Pulmonary toxicity, rigors, skin pigmentation, nail changes

• Myelosuppression IS NOT a problem
• Interstitial pneumonia or pulmonary fibrosis (10.2%)
• Sclerosis of skin, pigmentation (40.6%), fever and rigors (39.8%)
• Alopecia (29.5%), anorexia and weight decrease (28.7%)
• General malaise (16.0%), nausea and vomiting (14.6%)
• Stomatitis (13.3%) and nail changes (11.2%).

References

• SPC for Bleomycin