Abstract
Bleomycin is an antibiotic with anticancer properties produced by Streptomyces verticillus. It was identified in 1966, and one of its mechanisms of action is breaking the DNA double helix by the production of free radicals, a process that is oxygen and iron dependent. Bleomycin is metabolized in the kidney, with 50% of the dose eliminated within 4 hours after administration. 1 Furthermore, it is inactivated by an enzyme, bleomycin hydrolase, which is present in both in normal and tumor cells. 2 Bleomycin has a long history in cancer treatment, and it has been used as cytotoxic agent against many malignant tumors such as germ cell cancers, lymphomas, Hodgkin’s disease,headandneckcancer,andKaposi’ssarcoma. 3 Amongitsside effects are allergic reactions, mucositis, mild myelosuppression, hyperkeratosis and pigmentation changes of the skin, and, in particular, pulmonaryfibrosis.Itisthelattertoxicitythathasledtoalimitationof the total cumulative dose of bleomycin applied in cancer patients to a maximum of approximately 360 mg. Bleomycin has been most intensively studied in patients with germ cell cancer. The treatment of metastatic germ cell cancer with modern cisplatin-based combination regimens such as cisplatin, etoposide, and bleomycin (PEB) today results in cure in approximately 80% of patients. 4 The factors known to be associated with treatment
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