Skin toxicity bleomycin

A potentially fatal lung toxicity occurs in 10 to 20% of patients receiving bleomycin. Patients particularly at risk are those who are over 70 years of age and have had radiation therapy to the chest. Rarely, bleomycin also may cause allergic pneumonitis. Bleomycin skin toxicity is manifested by hyperpigmentation, erythematosus rashes, and thickening of the skin over the dorsum of the hands and at dermal pressure points, such as the elbows. Many patients develop a low-grade transient fever within 24 hours of receiving bleomycin. Less common adverse effects include mucositis, alopecia, headache, nausea, and arteritis of the distal extremities. 

Bleomycin Oxygen free radicals bind to DNA causing single- and double-strand DNA breaks Hodgkin s and non-Hodgkin s lymphoma, germ cell cancer, head and neck cancer Allergic reactions, fever, hypotension Skin toxicity, pulmonary fibrosis, mucositis, alopecia... 

Plasma digoxin levels may decrease when the drug is administered with bleomycin. When bleomycin is used witii cisplatin, there is an increased risk of bleomycin toxicity Pulmonary toxicity may occur when bleomycin is administered with other antineoplastic drugs. Plicamycin, mitomycin, mitoxantrone, and dactino-mycin have an additive bone marrow depressant effect when administered with other antineoplastic drugs. In addition, mitomycin, mitoxantrone, and dactinomycin decrease antibody response to live virus vaccines. Dactinomycin potentiates or reactivates skin or gastrointestinal reactions of radiation therapy There is an increased risk of bleeding when plicamycin is administered witii aspirin, warfarin, heparin, and the NSAIDs. 

Bleomycin hydrolase, which inactivates bleomycin, is an enzyme that is abundant in liver and kidney but virtually absent in lungs and skin the latter two organs are the major targets of bleomycin toxicity. It is thought that bleomycin-induced dermal and pulmonary toxici-ties are related to the persistence of relatively high local concentrations of active drug. 

Generic Name Bleomycin Trade Name Blenoxane Primary Antineoplastic Indication(s) Carcinoma of head, neck, cervical region, skin, penis, vulva, and testicle Hodgkin disease non-Hodgkin lymphomas Common Adverse Effects Pulmonary toxicity [interstitial pneumonitis] skin disorders [rash, discoloration] mucosal lesions fever Gl distress general weakness and malaise... 

Adverse effects Pulmonary toxicity is the most serious adverse effect, progressing from rales, cough, and infiltrate to potentially fatal fibrosis. Mucocutaneous reactions and alopecia are common. Hypertrophic skin changes and hyperpigmentation of the hands are prevalent. There is a high incidence of fever and chills and a low incidence of serious anaphylactoid reactions. Bleomycin is unusual in that myelosuppression is rare. 

Bleomycin is inactivated within cells by the enzyme aminohy-drolase. This enzyme is widely distributed, but is present in only low concentrations in the skin and the lungs, explaining the predominant toxicities of bleomycin to those sites. The presence of hydrolase enzymes in tumor cells is the primary mechanism of resistance to bleomycin. Cells can also become resistant by repairing the DNA breaks produced by bleomycin. ... 

Bleomycin is inactivated in many normal tissues by deaminase. Thus, toxicity focuses on lungs and skin, which lack deaminase. Bleomycin is often used in combination therapy because it does not immunosuppress. 

Bleomycin is much used in the clinic because of its rapid attack on solid forms of cancer. It is one of the very few anti-cancer drugs that does not attack the bone-marrow. Its characteristic toxicity (fibrosis of the lung, and some effect on skin) is not shared with the few other drugs that are effective against solid tumours, such as doxorubicin and cisplatin. Hence, bleomycin is given (parenterally) in conjunction with one of these, so that the anti-cancer effect is additive whereas the toxicity to healthy cells in minimized (Carter and Blum, 1976 Carter /a/., 1976). 

Skin, eye and respiratory tract irritant. Possible human carcinogen (applies to Bleomycin complex). Pulmonary toxicity reported when used therapeutically. LD50 (mus, ipr) 130 mg/kg LD50 (mus, ivn) 120 mg/kg. EC5988500... 

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