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The effect of corticosteroid administration on bleomycin lung toxicity
Author(s) -
Jensen J. L.,
Goel R.,
Venner P. M.
Publication year - 1990
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/1097-0142(19900315)65:6<1291::aid-cncr2820650606>3.0.co;2-j
Subject(s) - medicine , bleomycin , toxicity , corticosteroid , pulmonary toxicity , administration (probate law) , lung , lung cancer , pharmacology , chemotherapy , political science , law
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 monoside diffusion capacity (DLco) prompting cessation of blemycin 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.