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Care During Chemotherapy and Beyond

Bleomycin



Trade Name: Blenoxane ®

Drug Type:

Bleomycin is an anti-cancer ("antineoplastic" or "cytotoxic") chemotherapy drug.  Bleomycin is classified as an "antitumor antibiotic." (For more detail, see "How Bleomycin Works" section below).

What Bleomycin Is Used For:

  • Used in the treatment of squamous cell cancers, melanoma, sarcoma, testicular cancer, Hodgkin's and non-Hodgkin's lymphoma.
  • Also used to treat pleural effusion (build up of fluid in the space between the lining of the lung and the chest wall).

Note:  If a drug has been approved for one use, physicians may elect to use this same drug for other problems if they believe it may be helpful.

How Bleomycin Is Given:

  • As an infusion into the vein (intravenous, IV).
  • As an injection into the muscle (intramuscular, IM).
  • As an injection under the skin (subcutaneous, SubQ).
  • As an intrapleural - into the pleural cavity (the space between the lining of the lung and the chest wall) injection.  This is done to treat a malignant pleural effusion (build up of fluid). This procedure is also known as sclerosis or pleurodesis:
  • A chest tube is inserted into the pleural space.  Any fluid is drained (this may take several days).  The chemotherapy is inserted into the chest tube.
  • The chemotherapy causes the lung to stick to the pleural lining, allowing the lung to re-expand and stay expanded.
  • Intrapleural chemotherapy is used primarily for symptom relief.
  • There is no pill form of Bleomycin.
  • The amount of Bleomycin that you will receive and the method it is given depends on many factors, including your height and weight, your general health or other health problems, and the type of cancer or condition being treated.  Your doctor will determine your dose, schedule, and how it will be given.

Side Effects of Bleomycin:

Important things to remember about the side effects of Bleomycin:

  • Most people do not experience all of the side effects listed.
  • Side effects are often predictable in terms of their onset and duration.
  • 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.
  • There is no relationship between the presence or severity of side effects and the effectiveness of the medication.
  • The side effects of Bleomycin and their severity depend on how much of the drug is given, as well as how it is given.  For example, high doses may produce more severe side effects.

The following side effects are common (occurring in greater than 30%) for patients taking Bleomycin:

These side effects are less common side effects (occurring in about 10-29%) of patients receiving Bleomycin:

  • Nausea and vomiting. 
  • Poor appetite and weight loss.
  • Mouth sores.
  • Lung problems: pneumonitis, rarely pulmonary fibrosis. The incidence of lung problems increases with age and pre-existing lung conditions. There is a maximum lifetime dose of Bleomycin. Your health care professional will monitor the amount of Bleomycin you receive as well as your lung function during treatment.
  • Occasionally this can cause "radiation recall" effect.  (see skin reactions)

Rare but significant side effects may include:

  • Vascular effects leading to heart attack or stroke - potentially life-threatening conditions, or Raynaud's phenomenon (a disorder of the small blood vessels that feed the skin, most commonly affecting the hands and feet).
  • Severe allergic reaction (anaphylaxis) immediate or delayed for several hours.  You will be monitored closely for any signs of allergic reaction (rash, flushing, lowered blood pressure, difficulty breathing).

Not all side effects are listed above. Some that are rare (occurring in less than 10% of patients) are not listed here.  However, you should always inform your health care provider if you experience any unusual symptoms.

When To Contact Your Doctor or Health Care Provider:

Seek emergency help immediately and notify your health care provider, it you experience the following symptoms:

  • Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction). 
  • Fever of 100.4° F (38° C) or higher, chills (possible signs of infection).

The following symptoms require medical attention, but are not an emergency.  Contact your health care provider within 24 hours of noticing any of the following:

  • Nausea (interferes with ability to eat and unrelieved with prescribed medication).
  • Vomiting (vomiting more than 4-5 times in a 24 hour period).
  • Diarrhea (4-6 episodes in a 24-hour period).
  • Unusual bleeding or bruising.
  • Black or tarry stools, or blood in your stools.
  • Blood in the urine.
  • Pain or burning with urination.
  • Extreme fatigue (unable to carry on self-care activities).
  • Mouth sores (painful redness, swelling or ulcers).
  • Swelling, redness and/or pain in one leg or arm and not the other.
  • Yellowing of the skin or eyes.
  • Cough, shortness of breath.

Always inform your health care provider if you experience any unusual symptoms.

Bleomycin Precautions: 

  • Before starting Bleomycin treatment, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).   Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking Bleomycin.
  • Inform your health care professional if you are pregnant or may be pregnant prior to starting this treatment. Pregnancy category D (Bleomycin may be hazardous to the fetus.  Women who are pregnant or become pregnant must be advised of the potential hazard to the fetus).
  • For both men and women: Do not conceive a child (get pregnant) while taking Bleomycin. Barrier methods of contraception, such as condoms, are recommended. Discuss with your doctor when you may safely become pregnant or conceive a child after therapy.
  • Do not breast feed while taking Bleomycin.

Bleomycin Self Care Tips:

  • For flu-like symptoms, keep warm with blankets and drink plenty of liquids.  There are medications that can help reduce the discomfort caused by chills.
  • Ask about taking acetaminophen to help treat/prevent fever.  If o.k., take no more than 3000mg in 24 hour period of time.
  • Drink at least two to three quarts of fluid every 24 hours, unless you are instructed otherwise.
  • To reduce nausea, take anti-nausea medications as prescribed by your doctor, and eat small, frequent meals.  
  • Avoid sun exposure.  Wear SPF 15 (or higher) sunblock and protective clothing.
  • In general, drinking alcoholic beverages should be kept to a minimum or avoided completely.  You should discuss this with your doctor.
  • Get plenty of rest. 
  • Maintain good nutrition.
  • If you experience symptoms or side effects, be sure to discuss them with your health care team.  They can prescribe medications and/or offer other suggestions that are effective in managing such problems.

Monitoring and Testing While Taking Bleomycin:

You will be checked regularly by your health care professional while you are taking Bleomycin, to monitor side effects and check your response to therapy.  Periodic blood work to monitor your complete blood count (CBC) as well as the function of other organs (such as your kidneys and liver) will also be ordered by your doctor.  

Pulmonary function tests to check your lung function may be performed prior to treatment and periodically to monitor your lung function during and after treatment with Bleomycin.    
 
How Bleomycin Works:

Cancerous tumors are characterized by cell division, which is no longer controlled as it is in normal tissue. "Normal" cells stop dividing when they come into contact with like cells, a mechanism known as contact inhibition.  Cancerous cells lose this ability. Cancer cells no longer have the normal checks and balances in place that control and limit cell division.  The process of cell division, whether normal or cancerous cells, is through the cell cycle.  The cell cycle goes from the resting phase, through active growing phases, and then to mitosis (division).

The ability of chemotherapy to kill cancer cells depends on its ability to halt cell division.  Usually, the drugs work by damaging the RNA or DNA that tells the cell how to copy itself in division. If the cells are unable to divide, they die.  The faster the cells are dividing, the more likely it is that chemotherapy will kill the cells, causing the tumor to shrink. They also induce cell suicide (self-death or apoptosis).

Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle specific.  Chemotherapy drugs that affect cells when they are at rest are called cell-cycle non-specific.  The scheduling of chemotherapy is set based on the type of cells, rate at which they divide, and the time at which a given drug is likely to be effective.  This is why chemotherapy is typically given in cycles.

Chemotherapy is most effective at killing cells that are rapidly dividing.  Unfortunately, chemotherapy does not know the difference between the cancerous cells and the normal cells. The "normal" cells will grow back and be healthy but in the meantime, side effects occur.  The "normal" cells most commonly affected by chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea, and/or hair loss.  Different drugs may affect different parts of the body.

Bleomycin is classified as an antitumor antibiotic.  Antitumor antibiotics are made from natural products produced by species of the soil fungus Streptomyces.  These drugs act during multiple phases of the cell cycle and are considered cell-cycle specific.  There are several types of antitumor antibiotics:

  • Anthracyclines:  Doxorubicin, Daunorubicin, Mitoxantrone, and Idarubicin.
  • Chromomycins:  Dactinomycin and Plicamycin.
  • Miscellaneous:  Mitomycin and Bleomycin.

Note:  We strongly encourage you to talk with your health care professional about your specific medical condition and treatments. The information contained in this website is meant to be helpful and educational, but is not a substitute for medical advice.