- Class: Antitumor antibiotic – glycopeptide antibiotic
- Type: IV, IM, SC, or intralesional chemotherapy
Mechanism of Action (MOA)
- Binds to DNA → induces single- and double-strand breaks via free radical formation
- Inhibits DNA synthesis and transcription
- Cell cycle phase-specific: mainly G2 phase
Clinical Uses
- Hodgkin lymphoma – part of ABVD regimen
- Testicular cancer – part of BEP regimen
- Squamous cell carcinomas – sometimes used intralesionally
- Other malignancies – off-label use in pleurodesis or skin cancers
Dosing (Adults)
- IV/IM: 10–20 units/m² once weekly or 15 units/m² on specific chemotherapy schedules
- Max cumulative dose: ~400 units (due to pulmonary toxicity risk)
- Dose adjustments: renal impairment (drug cleared renally)
Toxicities
- Pulmonary toxicity – interstitial pneumonitis, fibrosis (dose-limiting, often irreversible)
- Skin: hyperpigmentation, rash, erythema
- Mucositis: oral and mucosal ulcers
- Fever and chills – common infusion reaction
- Rare: anaphylaxis, Raynaud’s phenomenon
- Myelosuppression: mild compared to other cytotoxics
Monitoring
- Pulmonary function tests (PFTs) or baseline chest X-ray before therapy
- Monitor for cough, dyspnea, or new respiratory symptoms
- CBC (myelosuppression usually mild)
- Renal function (drug is renally cleared)
- Cumulative dose tracking to avoid exceeding 400 units
Summary
Bleomycin (Blenoxane®) is an antitumor antibiotic used mainly in Hodgkin lymphoma and testicular cancer. Key concerns are pulmonary toxicity, mild myelosuppression, infusion reactions, and skin toxicity, requiring baseline pulmonary assessment, ongoing monitoring of respiratory symptoms, and careful cumulative dose tracking.