Dr. med. Dirk Manski



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Bleomycin: Chemotherapie of Germ Cell Tumors

Mechanism of Action of Bleomycin

Bleomycin is a cytostatic agent (glycopeptid antibiotic) from the bacterium Streptomyces verticillus. Bleomycin binds specifically to DNA, causes DNA strand breaks and leads to apoptosis. In high concentrations, bleomycin acts as an endonuclease and cleaves the DNA.

Urologic Indications for Bleomycin

Metastatic germ cell tumors of the testes or extragonadal germ cell tumors.

Pharmacokinetics of Bleomycin

Renal elimination half-life initially 24 min, then 2–4 h. In renal insufficiency, a dosage adjustment is necessary.

Side Effects of Bleomycin

Pulmonary Side Effects:

Bleomycin may cause a subacute or chronic pneumonia (interstitial plasmacellular pneumonia) with fibrosis. In 1% of treated patients, pulmonary side effects are severe and potentially leathal. Risk factors: advanced age, pulmonary disease and cumulative bleomycin dosage more than 300 mg.

Signs and symptoms of bleomycin pneumonia: cough, shortness of breath and fever. Diagnosis is achieved with chest x-ray, CT-thorax and pulmonary function testing. At the first signs of interstitial pneumonia, further bleomycin treatment is contraindicated.

Other Side-Effects of Bleomycin

Interactions with Bleomycin

Avoide nephrotoxic or myelosuppressive agents. No live vaccines.

Contraindications of Bleomycin

Dosage of Bleomycin

PEB-Chemotherapy Regimen

Bleomycin (15 mg/m2) on day 1, 8, and 15 as a i.v. bolus. One cycle of PEB regimen lasts 21 days. Maximum dosage is 3–4 cycles.







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  Deutsche Version: Bleomycin