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Bleomycin

Intravenous
Subcutaneous
Intramuscular
Intrapleural
Class
DNA crosslinking agents
Subclass
Alkylating agents
Generic name
Bleomycin
Common formulations
Powder for parenteral solution
Dosage and administration
Adults patients
Treatment
Squamous cell penile cancer
•
10-20 unit(s)/m² IV weekly
Non-Hodgkin's lymphoma • Off-label
•
10-20 unit(s)/m² IV q1-2 weeks
Adjunctive treatment
Hodgkin lymphoma
•
5 unit(s)/m² IV weekly one or two doses per week, administered on weeks 2, 4, 6, 8, 10, and 12 of a 12-week cycle
Alternative
•
10 unit(s)/m² IV weekly
Penile cancer • Locally advanced or metastatic
•
10 unit(s)/m² IV q24h on days 1 and 8 of a 21-day treatment cycle, administered for 6 cycles
Testicular cancer
•
30 unit(s) IV q24h on days 1, 8, and 15 of a 21-day treatment cycle, administered for 3 cycles
Kaposi's sarcoma in patients with AIDS • Off-label
•
15 unit(s) IV q2 weeks
Alternative
•
10 unit(s)/m² IV q2 weeks one dose on day 1 of a 2-week therapeutic cycle, repeated for 6 cycles
Non-Hodgkin's lymphoma • Off-label
•
4 unit(s)/m² IV q24h on day 1
Indications for use
Labeled indications
Adults
•
Treatment of Hodgkin lymphoma
•
Treatment of cervical cancer
•
Treatment of head and neck cancer
•
Treatment of malignant pleural effusion
•
Treatment of squamous cell penile cancer
•
Treatment of vulvar cancer
•
Adjunctive treatment for Hodgkin lymphoma
•
Adjunctive treatment for penile cancer (locally advanced or metastatic)
•
Adjunctive treatment for testicular cancer
Off-label indications
Adults
•
Treatment of non-Hodgkin's lymphoma
•
Adjunctive treatment for Kaposi's sarcoma in patients with AIDS
•
Adjunctive treatment for non-Hodgkin's lymphoma
Safety risks
Contraindications
Bleomycin hypersensitivity or idiosyncratic reaction to bleomycin
Extravasation of high doses of a concentrated solution
Warnings and precautions
Pulmonary fibrosis
•
Use caution pre-existing pulmonary disease.
Raynaud's phenomenon
•
Use caution history of a peripheral vascular disease.
Specific populations
Renal impairment
eGFR 30-50 mL/min/1.73 m²
•
Use acceptable. No dose adjustment required.
eGFR 10-30 mL/min/1.73 m²
•
Reduce dose by 25%.
eGFR < 10 mL/min/1.73 m²
•
Reduce dose by 50%.
Renal replacement therapy
Continuous renal replacement
•
Dose as in eGFR 10-30 mL/min/1.73 m². Reduce dose by 25%.
Intermittent hemodialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%.
Peritoneal dialysis
•
Dose as in eGFR < 10 mL/min/1.73 m². Reduce dose by 50%.
Hepatic impairment
Any severity
•
Use acceptable. No dose adjustment required.
Pregnancy and breastfeeding
Pregnancy
All trimesters • Australia Category: D
•
Avoid use. Evidence of fetal harm in humans. This drug can harm a developing fetus.
•
Adequate methods of contraception should be encouraged.
•
If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus.
•
The effects of this drug on fertility are not known.
Breastfeeding
Do not use during breastfeeding.
Unknown amount excreted in breastmilk.
Unknown drug levels in breastfed infants.
Some adverse effects on lactation reported.
Adverse reactions
Very common > 10%
•
Fever
Common 1-10%
•
Anaphylaxis, hyperpigmentation, nail thickening, pneumonia, pulmonary fibrosis, raynaud's phenomenon, red skin, cough, dyspnea, loss of appetite, mouth sores, nausea, vomiting, skin tenderness, skin thickening
Uncommon < 1%
•
↑ liver enzymes, peripheral neuropathy
Unknown frequency
•
HUS, hyperesthesia, hypotension, myocardial infarction, pericarditis, phlebitis, pneumonitis, chest pain, chills, confusion, dyspnea, hair loss, injection site reactions, itching, malaise, weight loss, skin erythema, skin striae, stomatitis, stroke, thrombotic microangiopathy, urticaria, wheezing
Interactions
Drug(s)
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