Bleomycin is well recognized as an active
antineoplastic agent in the treatment of
germ cell tumors. Pulmonary toxicity is the most significant complication of
bleomycin administration. In this report, an attempt is made to modify both the incidence and severity of this side effect. One hundred eleven patients with advanced
germ cell tumors were treated with a
combination chemotherapy program that included the administration of 30 units (U) of
bleomycin as a continuous infusion daily for 3 days every 3 weeks rather than a weekly bolus injection of a total of 360 U (mean dose received, 307 U). Also, 31 patients received high-dose
steroids, which have been shown to modify
bleomycin-induced pulmonary toxicity, for the treatment of
chemotherapy-induced
emesis. Changes in
carbon monoxide diffusion capacity (DLCO) prompting cessation of
bleomycin therapy occurred in 15 cases (
bleomycin was stopped in one case due to
dyspnea and lung infiltrates, and one patient suffered fatal
respiratory failure probably due to
bleomycin lung toxicity). Thus, probable
bleomycin pulmonary toxicity changed the clinical treatment in 15.3% of the cases. On long-term follow-up, only two patients have demonstrated a residual decrease in DLCO. The incidence of a greater than 25% decrease in DLCO was 34% and was not significantly altered by the administration of
steroids (P = 0.96). It is possible, however, that the low incidence of clinically significant and fatal pulmonary toxicity, as experienced in this group of patients, may be related to the infusion of
bleomycin. It also is possible that the reversibility of the decrease in DLCO in 95% of the patients may be related to the duration and schedule of
bleomycin administration. As
bleomycin continues to be an important
drug in the treatment of advanced
germ cell tumors, further studies are warranted to evaluate the role of the continuous infusion of
bleomycin as opposed to bolus
therapy.