Annals of Oncology 14:91-96, 2003
© 2003 European Society for Medical Oncology
Original Paper |
Predicting the risk of bleomycin lung toxicity in patients with germ-cell tumours
1 Academic Unit of Radiotherapy and Clinical Oncology, 2 Department of Computing and Information, 3 Bob Champion Research Unit, The Institute of Cancer Research, Royal Marsden NHS Trust, Sutton, UK
Received 12 April 2002; revised 28 June 2002; accepted 17 July 2002
Background:
Bleomycin pulmonary toxicity (BPT) has been known since the early clinical trials of bleomycin in the 1960s. Postulated risk factors include cumulative bleomycin dose, reduced glomerular filtration rate (GFR), raised creatinine, older age and supplemental oxygen exposure.
Patients and methods:
From our prospectively collected testicular cancer research database, we reviewed 835 patients treated at the Royal Marsden NHS Trust (Sutton, UK) with bleomycin-containing regimens for germ-cell tumours between January 1982 and December 1999, to identify those with BPT.
Results:
Fifty-seven (6.8%) patients had BPT, ranging from X-ray/CT (computed tomography) changes to dyspnoea. There were eight deaths (1% of patients treated) directly attributed to BPT. The median time from the start of bleomycin administration to documented lung toxicity was 4.2 months (range 1.2–8.2). On multivariate analysis, the factors independently predicting for increased risk of BPT were GFR <80 ml/min [hazard ratio (HR) 3.3], age >40 years (HR 2.3), stage IV disease at presentation (HR 2.6) and cumulative dose of bleomycin >300 000 IU (HR 3.5).
Conclusions:
Patients with poor renal function are at high risk of BPT, especially if they are aged >40 years, have stage IV disease at presentation or receive >300 000 IU of bleomycin. In such cases alternative drug regimens or dose restriction should be considered.
Key words: bleomycin, germ-cell tumours, glomerular filtration rate, pulmonary toxicity
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