How it is administered

Bleomycin is provided as a sterile lyophilized powder for reconstitution and is administered by a healthcare professional. It can be given through several routes:

• Intravenous (IV) injection: Slowly injected into a vein, typically over 10 minutes.
• Intramuscular (IM) injection: Injected into a muscle.
• Subcutaneous (SC) injection: Injected under the skin.
• Intrapleural administration: Injected directly into the pleural cavity (the space around the lungs), mainly for treating malignant pleural effusion.

The dose and frequency depend on the condition being treated, body weight, and kidney function. For Hodgkin lymphoma, typical dosing is 0.25 to 0.5 units/kg (10 to 20 units/m²) weekly or twice weekly. Your doctor will determine the best route and schedule for you.

How it works

Bleomycin is a type of chemotherapy known as a cytotoxic glycopeptide antibiotic. While its exact mechanism is not fully understood, it primarily works by interfering with the cancer cell's ability to make DNA, which is essential for cell growth and division.

Bleomycin causes breaks in the DNA strands of cancer cells, especially single-stranded breaks, and to a lesser extent, double-stranded breaks. This damage prevents the cells from replicating and eventually leads to cell death. Bleomycin also has some effect on RNA and protein synthesis, but these are less significant than its impact on DNA.

In laboratory and animal studies, bleomycin has been shown to cause cell cycle arrest, particularly in the G2 and mitosis phases, which are critical points for cell division. When used in the pleural cavity, it also acts as a sclerosing agent, helping to prevent fluid buildup by causing the pleural surfaces to stick together.

Who Should take it

Bleomycin is used as a palliative treatment for several types of cancer, including Hodgkin lymphoma. It can be used alone or in combination with other chemotherapy agents. In Hodgkin lymphoma, it is often part of combination chemotherapy regimens to help control the disease and improve symptoms.

It is also used in the treatment of non-Hodgkin lymphoma, certain types of testicular cancer (such as embryonal cell carcinoma, choriocarcinoma, and teratocarcinoma), and squamous cell carcinomas of the head, neck, penis, cervix, and vulva. Additionally, bleomycin can be used to manage malignant pleural effusion (fluid around the lungs caused by cancer).

Your doctor will determine if bleomycin is appropriate for you based on your specific diagnosis, overall health, and other treatments you may be receiving.

Who should not take it

Bleomycin should not be used in patients who have had a previous hypersensitive or idiosyncratic reaction to the drug. Signs of such a reaction may include severe allergic symptoms like low blood pressure, confusion, fever, chills, or wheezing.

It should be used with extreme caution in patients with significant kidney or lung problems, as these conditions can increase the risk of serious side effects. Bleomycin is not recommended during pregnancy unless absolutely necessary, as it can harm the developing fetus. Women of childbearing age should avoid becoming pregnant while on this medication.

If you have had severe reactions to other chemotherapy drugs or have a history of severe lung disease, inform your doctor before starting bleomycin.

Commonly used with

Bleomycin is often used in combination with other chemotherapy drugs for Hodgkin lymphoma, such as:

• Doxorubicin (Adriamycin)
• Vinblastine
• Dacarbazine

This combination is commonly known as the ABVD regimen. Bleomycin may also be used with other agents for different cancers, depending on the specific treatment protocol.

Commonly tested with

Bleomycin has been studied in combination with various other chemotherapy agents, particularly in regimens for Hodgkin lymphoma and testicular cancer. The most well-known combination is the ABVD regimen (doxorubicin, bleomycin, vinblastine, dacarbazine) for Hodgkin lymphoma.

It has also been tested with cisplatin and etoposide in testicular cancer regimens. In some studies, the safety of combining bleomycin with growth factors like G-CSF (filgrastim) has been evaluated, particularly regarding the risk of lung toxicity.