Although bleomycin is used in some chemotherapy treatments, its use can raise concerns for pulmonary health. However, bleomycin did not appear to pose pulmonary consequences in patients with International Germ Cell Cancer Collaborative Group (IGCCCG) good-risk germ cell cancers who underwent post-chemotherapy retroperitoneal lymph node dissection (PC-RPLND), according to a study published in the Journal of Clinical Oncology.

Common chemotherapy treatments for IGCCCG good-risk germ cell cancer include either 4 rounds of etoposide with cisplatin (EP×4) or 3 rounds of bleomycin with etoposide and cisplatin (BEP×3). Using data from the Indiana University Testis Database from 2006 to 2016, the researchers evaluated pulmonary and operative outcomes following PC-RPLD in men treated with BEP×3 (n=191) vs EP×4 (n=43) for IGCCCG good-risk germ cell cancer.

Each patient in both groups was successfully extubated following PC-RPLND, with no reintubations needed. Postoperative intensive care was required for 2 patients in each group for issues unrelated to pulmonary health. Patients taking BEP×3 had a shorter mean number of days requiring supplemental oxygen (0.99 days for BEP×3 vs 1.63 days for EP×4; P=.005).

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Patients taking BEP×3 had shorter surgery times than those using EP×4 (131 minutes vs 170 minutes; P<.01). They also lost less blood (P=.01) and had shorter hospital stays (3.3 vs 3.9 days; P<.01).

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The authors found that bleomycin did not increase pulmonary or operative morbidity in male patients with IGCCCG good-risk germ cell cancers undergoing surgery for PC-RPLND.


Calaway AC, Foster RS, Adra N, et al. Risk of bleomycin-related pulmonary toxicities and operative morbidity after postchemotherapy retroperitoneal lymph node dissection in patients with good-risk germ cell tumorsJ Clin Oncol. 2018;36(29):2950-2954.