Bleomycin therapy in advanced Hodgkin's disease and epidermoid cancers

Bleomycin was used to treat 31 patients with a variety of advanced, previously treated malignancies, with particular emphasis on Hodgkin's disease and epidermoid cancers. Bleomycin was administered either twice weekly, 15 mg per dose, or in 5‐day courses, 105 mg total dose per course. Three of 10 patients with Hodgkin's disease had good responses, lasting 6, 10, and 12 weeks. Three other patients with Hodgkin's disease had transient responses. There was a suggestion, in Hodgkin's disease, of the superiority of the twice weekly to daily drug administration. One patient with an epidermoid cancer of the skin had a good response lasting 9 weeks. No responses were seen in epidermoid cancer of the head and neck (five patients), or epidermoid cancer of the cervix and vagina (five patients). Eleven of 14 patients followed with serial pulmonary function tests developed 20‐50% decreases in either diffusion capacity or forced vital capacity as compared to pretreatment determinations. Only one, however, developed clinical pulmonary toxicity. This patient died from probable bleomycin pneumonia, at a total dose of 255 mg. Skin changes were seen in 75% of patients and mucosal toxicity in 30%. Seven additional patients with epidermoid cancers received a combination of bleomycin and methotrexate, sequentially. They developed severe skin and mucosal toxicity. However, six of seven had tumor responses, and further studies of less toxic combinations of these drugs are warranted.