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Bleomycin

Bleomycin is an anti-cancer agent. It is a glycosylated linear nonribosomal peptide antibiotic produced by the bacterium Streptomyces verticillus. The drug is used in the treatment of lymphomas (especially Hodgkin's disease), squamous cell carcinomas, and testicular cancer as well as pleurodesis. more...

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History

Bleomycin was first discovered in 1962 when the Japanese scientist Hamao Umezawa found anti-cancer activity while screening culture filtrates of S. verticullus. Umezawa published his discovery in 1966. The drug was launched in Japan by Nippon Kayaku in 1969. In the US bleomycin gained FDA approval in July 1973. It was initially marketed in the US by the Bristol-Myers Squibb precursor Bristol Laboratories under the brand name Blenoxane.

Suppliers

Bristol-Myers Squibb still supplies Blenoxane. There are also generic versions of bleomycin available from Bedford, Sicor and Mayne Pharma.

Mechanism of action

Bleomycine acts by induction of DNA strand breaks. Some studies suggest that bleomycin also inhibits incorporation of thymidine into DNA strands. Bleomycin is a metal-chelating molecule that is also thought to produce superoxide and hydroxide free radicals, through action as a pseudoenzyme, which also damage the DNA.

Side effects

The most serious complication of bleomycin is pulmonary fibrosis and impaired lung function. Other side-effects include fever, rash, hyperpigmentation, alopecia, and Raynaud's phenomenon.

Read more at Wikipedia.org

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Treatment Of Symptomatic Malignant Pleural Effusions With Bleomycin - Abstract
From CHEST, 10/1/00 by Shabir Bhimji

Shabir Bhimji, MD(*) and Lionel Zumbro, MD. Cardiothoracic Surgery, Medical College of Georgia, Augusta, GA.

PURPOSE: The optimal duration and treatment of malignant pleural effusion (MPE) has not been resolved. In this study, we evaluated the efficacy of bleomycin as a sclerosing agent in patients with a MPE.

METHODS: Seventy nine consecutive patients with a known malignancy (37 breast, 17 ovarian, 6 lymphoma, 19 lung) and a symptomatic pleural effusion underwent tube thoracostomy and bleomycin pleurodesis. The average time of onset of effusion from diagnosis was 44 months. The median age of patients was 57 years. A thoracostomy tube was placed; in each patient and drainage continued until lung re-expansion occurred. Bleomycin (60 units) was instilled into the pleural cavity only after the pleural effusion was completely drained. Repeat bleomycin was undertaken if the patient did not have a temperature spike.

RESULTS: The mean volume drained after chest tube placement was 2.7 liters over 2 days. All patients became asymptomatic after drainge of the MPE. All except 2 patients developed a fever after instillation of bleomycin. Over a one month period, a complete response (no recurrence) was obtained in 68 patients and a partial response (re-accumulation of pleural fluid) in 9 patients. Seventy one patients were discharged home within 3 days. Three recurrences required repeat thoracostomy tube and bleomyein pleurodesis. One patient required video assisted pleurodesis and one patient required a partial pleurectomy. There were two in hospital deaths because of extensive metastatic disease and pleurodesis was halted.

CONCLUSION: Bleomycin pleurodesis can palliate the majority of patients with a MPE. It significantly improves symptoms and even quality of life. Even though it is expensive, bleomycin is safe and effective as a sclerosing agent.

CLINICAL IMPLICATIONS: Bleomycin is highly effective and safe as sclerosing agent for the treatment of MPE.

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