Bleomycin is an anti-cancer chemotherapy drug. Bleomycin is classified as an “antitumor antibiotic”. Antitumor antibiotics are made from natural products produced by species of the soil fungus called Streptomyces.
Bleomycin binds to the cancer cells’ DNA so that the cells cannot divide or grow.
When is bleomycin used?
Bleomycin is bone-marrow sparing, meaning it does not suppress the blood cells within the bone marrow. Bleomycin therefore can be of use when other cytotoxic agents are contraindicated or not suitable to use due to causing more harm to the body. Bleomycin is used for several lymphomas that include:
- Hodgkin lymphoma (HL)
- Non-Hodgkin lymphoma (NHL)
How is it given?
Bleomycin is given as an infusion into the vein (intravenous, IV). Each treatment takes around 20 minutes. There is no oral form of bleomycin.
For the treatment of lymphoma, bleomycin is usually given alongside other chemotherapy drugs as part of a combination chemotherapy protocol.
Side effects of bleomycin
There are several possible side effects that can affect a patient during and after treatment.
There is a chance that bleomycin might cause side effects during or shortly after treatment, however some effects may not occur until months or years after the medicine is used.
Speak to your medical team about early and late effects that may occur from the treatment. Patients should be provided education prior to starting treatment and be advised f how to prevent or act if any side effects are experienced.
Although not all these side effects may occur, if they do occur, they may need medical attention. Most side effects go away shortly after treatment or when treatment is completed. The most common side effects include:
Common side effects
- Fever and chills (occurring within 3 to 6 hours after administration)
- Mouth sores
- Nausea and/or vomiting
- Loss of appetite and/or weight loss
- Can cause temporary hair loss that starts 2-4 post first dose of chemotherapy and usually returns 4-8 weeks after treatment finishes
- Phlebitis (inflammation of veins)
- Skin reactions: redness, darkening of the skin, stretch marks on the skin, skin peeling, thickening of the skin, ulceration
- Nail thickening, nail banding
Side effects are almost always reversible and will go away after treatment is complete. There are many options to help minimize or prevent side effects.
Possible lung problems
Bleomycin can cause lung damage, yet this does not happen often. The risk of lung problems starts during the bleomycin treatment and can continue for many years afterwards. Factors that can increase your risk are:
- Being over 40 years
- Having another lung disease
- Being a smoker (including vaping & other substances)
- Kidney problems
It is advised to stop smoking prior to starting bleomycin and the medical team can help patients with strategies to quit smoking.
Bleomycin can cause lung changes that make patients more open to chest infections, pneumonia, or inflammation of the lungs, called pneumonitis. In rare cases a more serious condition called pulmonary fibrosis can occur. Pulmonary fibrosis is when the lung tissue becomes damaged and scarred. The thickened lung tissue makes it more difficult for the lungs to work properly and it is important to let the medical team know of any of the following symptoms.
- Temperature of 38 C or higher
- Coughing (can also be a dry, or irritating cough)
- Shortness of breath
- Trouble breathing
- Discomfort when breathing
- Chest pain
If your medical team is unavailable , go to the nearest hospital emergency department for help.
Precautions taken by the medical team
There is a maximum amount of bleomycin that patients can receive in a lifetime. The doctor will record the amount that received by a patient to ensure the lifetime dose is not exceeded.
Before receiving bleomycin, the medical team will order a respiratory (lung) function test. These tests check breathing and how well the lungs are working (or functioning). These tests will be repeated at different points through treatment and after the treatment has finished. A chest x-ray may also be ordered and these tests will usually be done:
- Prior to treatment starting to get a baseline result for the lungs
- Part way during treatment (after cycle 2 or 3) to check if there has been any damage without symptoms
- After treatment has completed
- If a patient experiences any symptoms or respiratory changes
What happens after treatment
There are many studies currently investigating bleomycin use around the world. Some of these studies are looking at omitting this drug once a patient achieves a complete metabolic response.
Patients should keep their own record of bleomycin in case there is a need for any hospital treatment that may need oxygen therapy
This can include surgery, or a visit to an emergency department. It is also recommended that patients check with their medical team if they plan to go scuba diving or other activities that involve high levels of oxygen.