The effect of corticosteroid administration on bleomycin lung toxicity

Article Abstract:

Bleomycin is an effective chemotherapeutic agent for the treatment of germ cell tumors, and is usually used in combination with cisplatin and vinblastine. Unfortunately, bleomycin can be seriously toxic to the lungs. The exact incidence is not known, but roughly 6 percent of patients treated with bleomycin develop pulmonary disease, and an additional 7 percent have asymptomatic changes that are visible on X-ray. It is clear, however, that 1 to 2 percent of the patients treated with bleomycin die of causes related to pulmonary insufficiency. Some of the early lung changes involve edema and infiltration of macrophages. Such symptoms suggest the use of steroids to mitigate bleomycin toxicity, but the possible benefits of steroids remain controversial. To examine this issue, the histories of 111 patients were examined and tabulated with respect to bleomycin therapy and steroid administration. Corticosteroids were given to 57 patients, usually as prednisone, hydrocortisone, or dexamethasone. Many of the patients receiving higher doses of steroids were being given dexamethasone for nausea associated with their chemotherapy. Carbon monoxide diffusion capacity had been monitored in the patients, and fifteen patients were removed from bleomycin treatment on this basis. Bleomycin therapy was terminated in one patient due to breathing problems, and one patient died apparently due to pulmonary toxicity. These findings indicate a 15.3 percent incidence of toxicity in the cases reviewed. There was no evidence that the patients receiving corticosteroids were afforded any protection against lung toxicity. Considering the fact that the use of bleomycin is considered important for all patients with advanced germ cell tumors, the drug will no doubt continue to be widely prescribed. Since there is no evidence that steroids are of any benefit, the only practical approach is constant awareness of the potential for bleomycin-related pulmonary toxicity, and to frequently monitor pulmonary function both by chest radiograph and carbon monoxide diffusion capacity. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Germ cell tumors, Germinoma, Adrenocortical hormones, Bleomycin

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A new approach to chemoembolization for unresectable hepatocellular carcinoma using aclarubicin microspheres in combination with cisplatin suspended in iodized oil

Article Abstract:

Hepatocellular carcinoma, a common form of primary liver cancer, may be curable when the tumor is surgically removable. However, the fraction of cases that are surgically treatable is not high, ranging from 10 to 60 percent. Even when the tumor is surgically resectable, the chance for recurrence in the remaining liver tissue is still high. One of the possible treatment methods for unresectable liver cancer is transcatheter embolization. When this method was first developed, a gelatin sponge was simply inserted into the arterial branch bringing blood to the cancer, blocking it and temporarily starving the tumor of oxygen. This method has enjoyed several improvements, however, since it was first developed and is now often combined with chemotherapeutic attacks on the cancer. In the present study, tiny microspheres composed of aclarubicin, a newer chemotherapeutic drug, was administered in combination with cisplatin by chemoembolization. The drugs were suspended in iodized oil, which has been found to preferentially collect in the new blood vessels feeding a cancer as well as in the tissue spaces surrounding such new blood vessels. A total of 62 patients treated with the method could be evaluated for their responses to treatment. Thirty-one patients had partial responses to treatment. In 17 cases, only minor responses were observed, and in 13 patients there were no observable responses, but the progression of the tumor was temporarily halted. In one case, disease progression continued despite treatment. There were 1, 10, 26, and 29 patients with cancer Stages I through IV, respectively. The one-year survival rate was 81 percent, and the three-year survival rate for these patients was 51 percent. These results are superior to those that have been obtained either by aclarubicin microspheres alone or chemotherapeutic agents in iodize oil alone. (Consumer Summary produced by Reliance Medical Information, Inc.)

Dosage and administration, Chemotherapy, Liver cancer

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