Skip to main content

Bleomycin (Monograph)

Brand name: Blenoxane
Drug class: Antineoplastic Agents
VA class: AN200
CAS number: 9041-93-4

Medically reviewed by Drugs.com on Jul 24, 2023. Written by ASHP.

Warning

  • Administer only under supervision of qualified clinicians experienced in use of cytotoxic therapy and only in a setting where adequate diagnostic and treatment facilities are readily available.121

  • Risk of developing pulmonary toxicity (e.g., pneumonitis, pulmonary fibrosis), particularly in geriatric patients >70 years of age and in patients receiving total bleomycin dosage >400 units.121 (See Pulmonary Toxicity under Cautions.)

  • Risk of severe idiosyncratic reaction (e.g., hypotension, mental confusion, fever, chills, wheezing) in patients with Hodgkin’s or non-Hodgkin’s disease.121 (See Sensitivity Reactions under Cautions.)

Introduction

Antineoplastic agent; mixture of basic cytotoxic glycopeptide antibiotics produced by Streptomyces verticillus (bleomycin A2 and bleomycin B2 are the major components).121

Hodgkin’s Disease

Treatment of Hodgkin’s disease.121 122 142 143 144 217

Combination therapy for induction of remissions is superior to single-drug therapy.142 143 144

Various combination regimens are used.142 143 144

Commonly used in combination with doxorubicin, vinblastine, and dacarbazine (ABVD regimen).121 122 142 143 144 217

Non-Hodgkin’s Disease

Has been used for treatment of non-Hodgkin’s lymphoma.121 122

Second- or third-generation combination regimens containing bleomycin no more effective than the standard CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisone) for the treatment of advanced intermediate-grade or high-grade non-Hodgkin’s lymphoma.235 236 237 238 239

Testicular Cancer

Treatment of testicular embryonal cell carcinoma, choriocarcinoma, and teratocarcinoma.121 123 126 127 128 129 130 132 140

Combination chemotherapy with bleomycin, cisplatin, and etoposide is a regimen of choice for the treatment of advanced nonseminomatous testicular carcinoma.122 123 126 127 128 129 130 132

Combination chemotherapy with bleomycin, cisplatin, and etoposide is used for the treatment of disseminated seminoma testis.123 128 129 131 132 140

Pleural Effusions

Intracavitary injection as a sclerosing agent for intrapleural management and prevention of recurrent pleural effusions (pleurodesis) caused by metastatic tumors.121

At least as effective and possibly better tolerated than intrapleural tetracycline.121 147 148 149 151 154 155 156

Intrapleural talc may be preferred because of cost considerations.c d e f g

Has been used for intrapleural management of pneumothorax† [off-label] associated with AIDS Pneumocystis jiroveci (Pneumocystis carinii) pneumonia.108 112

Head and Neck Cancer

Palliative treatment of squamous cell carcinomas of the head and neck (including mouth, tongue, tonsils, nasopharynx, oropharynx, sinuses, palate, lip, buccal mucosa, gingiva, epiglottis, larynx, skin).121

Poorer response to bleomycin in patients who have received prior radiation therapy for the treatment of head and neck cancer.121

Combination chemotherapy with cisplatin, methotrexate, and vincristine for advanced head and neck cancer.122 225

Cervical Cancer

Has been used for palliative treatment of squamous cell carcinoma of the cervix.121

Not considered a drug of choice for the treatment of advanced cervical cancer.232

Penile or Vulval Cancer

Palliative treatment of squamous cell carcinomas of the penis and vulva (in combination with other antineoplastic agents).121 234

AIDS-related Kaposi’s Sarcoma

Has been used for the palliative treatment of AIDS-related Kaposi’s sarcoma† [off-label] (alone or in combination with doxorubicin, and a vinca alkaloid).122 146 172 173 174 175 176 177

Has been used as monotherapy for palliative treatment of early-stage disease.146 169 170 171

Bleomycin combination chemotherapy has been considered a regimen of choice for advanced disease,122 146 175 177 but a liposomal anthracycline currently considered first-line therapy.146 185

Ovarian Cancer

Has been used for the treatment of ovarian germ cell tumors† [off-label] (in combination with cisplatin and etoposide).122 216

Intracranial Germ Cell Tumors

Has been used for the treatment of intracranial germ cell tumors† [off-label] (in combination with cisplatin and vinblastine).122 178

Bleomycin Dosage and Administration

General

Sensitivity Testing

Premedication

Administer by IV, IM, sub-Q, or intrapleural (intracavitary) injection.121

IV Administration

Administer by IV injection once or twice weekly.121

For solution and drug compatibility information, see Compatibility under Stability.

Reconstitution

Add a minimum of 5 or 10 mL of 0.9% sodium chloride injection to the vial labeled as containing 15 or 30 units, respectively, to provide a solution containing not more than 3 units/mL.121

Rate of Administration

Administer IV slowly over a 10-minute period.121

IM Administration

Administer by IM injection once or twice weekly.121

Reconstitution

Add 1–5 or 2–10 mL of sterile water for injection, 0.9% sodium chloride injection, or bacteriostatic water for injection to the vial containing 15 or 30 units, respectively, to provide solutions containing 3–15 units/mL.121

Sub-Q Administration

Administer by sub-Q injection once or twice weekly.121

Reconstitution

Add 1–5 or 2–10 mL of sterile water for injection, 0.9% sodium chloride injection, or bacteriostatic water for injection to the vial containing 15 or 30 units, respectively, to provide solutions containing 3–15 units/mL.121

Intrapleural Administration

Administer as a single bolus dose by intrapleural (intracavitary) injection through a thoracostomy tube.121

Drain pleural fluid via the thoracostomy by gravity or suction prior to instillation;102 103 104 110 118 119 120 121 confirmation of complete expansion of the lungs is recommended.121 148 153

Initiate therapy when chest tube drainage <100 mL in a 24 hour period or 100–300 mL in 24 hours under certain special circumstances.121

Reconstitution

Dissolve 60 units in 50–100 mL of 0.9% sodium chloride injection.121

Dosage

Available as bleomycin sulfate; dosage expressed in terms of bleomycin.121

Consult published protocols for the dosage of bleomycin and other chemotherapeutic agents and the method and sequence of administration.121

Adults

Hodgkin’s Disease

Increased sensitivity risk in lymphomas; administer test doses.121 (See Sensitivity Testing under Dosage and Administration.)

IV, IM, or Sub-Q

0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121

Following a 50% regression of tumor size, a maintenance dose of 1 unit daily or 5 units weekly can be given.121

Improvement unlikely to occur if not evident by week 2 of therapy.121

Non-Hodgkin’s Lymphoma

Increased sensitivity risk in lymphomas; administer test doses.121 (See Sensitivity Testing under Dosage and Administration.)

IV, IM, or Sub-Q

0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121

Testicular Cancer
IV, IM, or Sub-Q

0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121

Improvement in testicular cancer disease unlikely to occur if not evident by week 2 of therapy.121

Squamous Cell Carcinomas
IV, IM, or Sub-Q

0.25–0.5 units/kg (10–20 units/m2) once or twice weekly.121

Improvement in squamous cell carcinomas may not be evident for 3 weeks after initiation of therapy.121

Pleural Effusions
Intrapleural

50–60 units diluted and instilled into the chest through a thoracostomy tube followed by clamping of the tube, periodic rotation (optional)148 149 of the patient during the next 4 hours, and subsequent removal of the fluid.101 104 105 107 110 113 118 119 120 121

Length of time the chest tube remains in the pleural space after instillation of the drug should be individualized depending on the clinical status of the patient;121 allowing the chest tube to remain for at least 4 days after instillation may prevent pneumothorax.153

Dosage Modification for Toxicity

Contraindications to Continued Therapy121133

Pulmonary:

Clinical manifestations or radiologic evidence of pulmonary toxicity unless drug excluded as cause

Pulmonary diffusion capacity for carbon monoxide (DLco) <30–35% of the pretreatment value

Cardiovascular:

Intractable pain or ECG changes suggestive of pericarditis
Reduce Infusion Rate or Discontinue121133

Dermatologic:

Mucocutaneous toxicity (e.g., erythema, rash, striae, vesiculation, hyperpigmentation, and skin tenderness)

Pulmonary:

Rapid decline in forced vital capacity

Cardiovascular:

Acute chest pain syndrome suggestive of pleuropericarditis

Further courses of bleomycin therapy do not appear to be contraindicated, but careful evaluation of the patient must precede continuation of therapy.121

Prescribing Limits

Adults

IV, IM, or Sub-Q

Pulmonary toxicity: Administer cumulative dosages >400 units with great caution.121

When bleomycin is used in conjunction with other antineoplastic agents, pulmonary toxicity may occur at lower cumulative dosages of bleomycin.121

Intrapleural

Generally, maximum of 1 unit/kg or 40 units/m2 in geriatric patients.b

Special Populations

Renal Impairment

No dosage adjustment established by manufacturer for mild to moderate renal impairment; use with extreme caution in severe renal impairment.121

Detailed Bleomycin dosage information

Cautions for Bleomycin

Contraindications

Warnings/Precautions

Warnings

Patient Monitoring

Has a low therapeutic index; monitor patients carefully and frequently during and after therapy.121

Sensitivity Reactions

Severe Idiosyncratic Reactions

Potentially life-threatening, severe idiosyncratic (anaphylactoid) reactions (see Boxed Warning);121 may be immediate or delayed for several hours, and usually occurs after the first or second dose.121 Monitor carefully.121 (See Sensitivity Testing under Dosage and Administration.)

Treatment of anaphylactoid reactions is supportive and symptomatic and may include volume expansion, vasopressor therapy, antihistamines, and corticosteroids.121

Major Toxicities

Pulmonary Toxicity

Risk of dose- and age-related pulmonary toxicity (see Boxed Warning); use with extreme caution in compromised pulmonary function.121

Most severe toxicity.121

Pneumonitis can progress to potentially fatal pulmonary fibrosis.121

Most frequently with total dosages >400 units, but can occur with lower dosages.121

Risk may be increased with filgrastim or other cytokines.121

Dyspnea and fine rales are early manifestations.121

Perform chest radiographs every 1–2 weeks and sequential measurement of pulmonary diffusion capacity for carbon monoxide (DLco) monthly during therapy.121

Dosage modification or drug discontinuance may be necessary.121 (See Dosage Modification for Toxicity under Dosage and Administration.)

Cardiovascular Toxicity

Risk of pleuropericarditis and/or vascular toxicities (e.g., MI, cerebrovascular accident, thrombotic microangiography, cerebral arteritis).121

Sudden onset of acute chest pain may be first sign of pleuropericarditis.121

Dosage modification may be necessary in patients experiencing acute chest pain syndrome suggestive of pleuropericarditis.121 133

Raynaud's phenomenon, possibly due to bleomycin, combination therapy (e.g., vinblastine, cisplatin), underlying cancer or vascular compromise, or combination of factors.121 134 135 136 137

Dermatologic and Mucocutaneous Toxicity

Risk of developing dose-related adverse mucocutaneous effects (e.g., erythema, rash, striae, vesiculation, hyperpigmentation, skin tenderness, and less commonly hyperkeratosis, nail changes, alopecia, pruritus, stomatitis).121

Usually occurs during the second or third week of bleomycin therapy after a cumulative dose of 150–200 units.121

Most frequent toxicity, occurring in 50% of patients.121

Discontinuance of bleomycin may be necessary.121

Renal and Hepatic Toxicity

Begins as deterioration in renal or liver function tests; may occur anytime after bleomycin initiation.121

Febrile Reactions

Fever and chills are frequent, mainly with large single doses within a few hours of administration and persisting for 4–12 hours.b

General Precautions

Surgery

Sensitizes lung tissue to damaging effects of oxygen administered during surgery; lung damage can occur at Fl O2 concentrations that are usually considered safe.121

Maintain Fl O2 at concentrations approximating that of room air (25%) during surgery and the postoperative period and monitor carefully fluid replacement, focusing more on colloid administration rather than crystalloid.121

Intrapleural Risks

Rarely, pulmonary toxicity.121

Local pain.121

Hypotension, which may require treatment.121

Very rarely, death, but patients were very seriously ill prior to treatment.121

Specific Populations

Pregnancy

Category D.121

Lactation

Not known whether bleomycin is distributed into milk.121 Use not recommended.121

Pediatric Use

Safety and efficacy not established in pediatric patients.121

Geriatric Use

Greater risk of pulmonary toxicity in patients >70 years of age than in younger patients.240

Titrate dosage carefully.240

Renal Impairment

Use with extreme caution in patients with clinically important renal impairment.121

Common Adverse Effects

With IV administration, fever, chills, vomiting, and anorexia/weight loss (which may persist long after discontinuance of therapy).121 Mucocutaneous and dermatologic effects are most common and pulmonary toxicity is most serious.121 (See Major Toxicities under Cautions.)

With intracavitary administration into the pleural space, chest pain and fever.104 121 147 148 150 153 159 160 161 166

Specific Drugs

Drug

Interaction

Comments

Antineoplastic agents

Increased risk of bleomycin-induced pulmonary toxicity121

Use with caution; pulmonary toxicity possible at lower total bleomycin dosages121

Filgrastim and other cytokines

Increased risk of bleomycin-induced pulmonary toxicity121

Use with caution; pulmonary toxicity possible at lower total bleomycin dosages121

Vitamins (e.g., vitamin C, riboflavin)

Bleomycin shown to be inactivated in vitro by ascorbic acid and riboflavin233

Bleomycin Pharmacokinetics

Absorption

Not appreciably absorbed orally; must be administered parenterally for systemic effect.121

Following intrapleural administration, systemic absorption is about 45%.121 150 153

Onset

Improvement in Hodgkin’s disease or testicular cancer usually evident within 2 weeks.121

Improvement in squamous cell carcinoma usually evident within 3 weeks.121

Distribution

Extent

Distributed mainly into skin, lungs, kidneys, peritoneum, and lymphatics in animals.121

Concentrations higher in tumor cells of skin and lungs relative to hematopoietic tissue.b

Elimination

Metabolism

Metabolic fate not determined.b

Elimination Route

Excreted principally in urine (60–70%) as active drug.b

Half-life

Clcr>35 mL/minute: serum or plasma terminal half-life of about 2 hours.121

Clcr<35 mL/minute: terminal half-life inversely related to creatinine clearance.121

Special Populations

Moderately severe renal impairment (Clcr <35 mL/minute) decreases renal clearance; accumulation may occur with severe renal impairment.112 121

Stability

Storage

Parenteral

Powder for Injection

2–8°C; do not use after the expiration date is reached.121

Reconstituted Solutions

Use reconstituted solutions stored at room temperature within 24 hours.121 b

Although stable for 2 weeks at room temperature or 4 weeks at 2–8°C, reconstituted solutions contain no preservatives; discard within 24 hours of reconstitution.b

Compatibility

Parenteral

Inactivated by agents containing sulfhydryl groups, hydrogen peroxide, and ascorbic acid.b

Forms Schiff base-type adducts with dextrose.106

Solution Compatibility

CompatibleHID 121

Sodium chloride 0.9%

Incompatible106 121

Dextrose 5% in water
Drug Compatibility
Admixture CompatibilityHID

Compatible

Amikacin sulfate

Dexamethasone sodium phosphate

Diphenhydramine HCl

Fluorouracil

Gentamicin sulfate

Heparin sodium

Hydrocortisone sodium phosphate

Streptomycin sulfate

Tobramycin sulfate

Vinblastine sulfate

Vincristine sulfate

Incompatible

Aminophylline

Ascorbic acid injection

Cefazolin sodium

Diazepam

Hydrocortisone sodium succinate

Methotrexate

Mitomycin

Nafcillin sodium

Penicillin G sodium

Terbutaline sulfate
Y-Site CompatibilityHID

Compatible

Allopurinol sodium

Amifostine

Aztreonam

Cefepime HCl

Cisplatin

Cyclophosphamide

Doxorubicin HCl

Doxorubicin HCl liposome injection

Droperidol

Etoposide phosphate

Filgrastim

Fludarabine phosphate

Fluorouracil

Gemcitabine HCl

Granisetron HCl

Heparin sodium

Leucovorin calcium

Melphalan HCl

Methotrexate sodium

Metoclopramide HCl

Mitomycin

Ondansetron HCl

Paclitaxel

Piperacillin sodium–tazobactam sodium

Sargramostim

Teniposide

Thiotepa

Vinblastine sulfate

Vincristine sulfate

Vinorelbine tartrate

Actions

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

* available from one or more manufacturer, distributor, and/or repackager by generic (nonproprietary) name

Bleomycin Sulfate

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Parenteral

For injection

15 units (of bleomycin)*

Blenoxane

Bristol-Myers Squibb

Bleomycin Sulfate for Injection

Bedford

30 units (of bleomycin)*

Blenoxane

Bristol-Myers Squibb

Bleomycin Sulfate for Injection

Bedford

AHFS DI Essentials™. © Copyright 2024, Selected Revisions August 1, 2007. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

† Off-label: Use is not currently included in the labeling approved by the US Food and Drug Administration.

References

Only references cited for selected revisions after 1984 are available electronically.

100. Bechard DE, Fairman RP, DeBlois GG et al. Fatal pulmonary fibrosis from low-dose bleomycin therapy. South Med J. 1987; 80:646-9. http://www.ncbi.nlm.nih.gov/pubmed/2437659?dopt=AbstractPlus

101. Ostrowski MJ. An assessment of the long-term results of controlling the reaccumulation of malignant effusions using intracavity bleomycin. Cancer. 1986; 57:721-7. http://www.ncbi.nlm.nih.gov/pubmed/2417681?dopt=AbstractPlus

102. Kessinger A, Wigton RS. Intracavitary bleomycin and tetracycline in the management of malignant pleural effusions: a randomized study. J Surg Oncol. 1987; 36:81-3. http://www.ncbi.nlm.nih.gov/pubmed/2443762?dopt=AbstractPlus

103. Paladine W, Cunningham TJ, Sponzo R et al. Intracavitary bleomycin in the management of malignant effusions. Cancer. 1976; 38:1903-8. http://www.ncbi.nlm.nih.gov/pubmed/62609?dopt=AbstractPlus

104. Hausheer FH, Yarbro JW. Diagnosis and treatment of malignant pleural effusion. Semin Oncol. 1985; 12:54-75. http://www.ncbi.nlm.nih.gov/pubmed/2579439?dopt=AbstractPlus

105. Ruckdeschel J, Moores D, Lee J et al. Management of malignant pleural effusions (MPE): a randomized comparison of tetracycline (TETRA) and bleomycin (BLEO). Proc ASCO. 1990; 9. Abstract No. 1247.

106. Koberda M, Zieske PA, Raghavan NV et al. Stability of bleomycin sulfate reconstituted in 5% dextrose injection or 0.9% sodium chloride injection stored in glass vials or polyvinyl chloride containers. Am J Hosp Pharm. 1990; 47:2528-9. http://www.ncbi.nlm.nih.gov/pubmed/1703725?dopt=AbstractPlus

107. Ostrowski MJ. Intracavitary therapy with bleomycin for the treatment of malignant pleural effusions. J Surg Oncol. 1989; (Suppl 1):7-13.

108. Hnatiuk OW, Dillard TA, Oster CN. Bleomycin sclerotherapy for bilateral pneumothoraces in a patient with AIDS. Ann Intern Med. 1990; 113:988-90. http://www.ncbi.nlm.nih.gov/pubmed/1700656?dopt=AbstractPlus

109. Benvenuto JA, Anderson RW, Kerkof K et al. Stability and compatibility of antitumor agents in glass and plastic containers. Am J Hosp Pharm. 1981; 38:1914-8. http://www.ncbi.nlm.nih.gov/pubmed/7325172?dopt=AbstractPlus

110. Ostrowski MJ, Priestman TJ, Houston RF et al. A randomized trial of intracavitary bleomycin and Corynebacterium parvum in the control of malignant pleural effusions. Radiother Oncol. 1989; 14:19-26. http://www.ncbi.nlm.nih.gov/pubmed/2467327?dopt=AbstractPlus

111. Stajich GV, Miyahara RK, Alonso K. In vitro evaluation of bleomycin-induced cell lethality from plastic and glass containers. DICP. 1991; 25:14-6. http://www.ncbi.nlm.nih.gov/pubmed/1706902?dopt=AbstractPlus

112. Reviewers’ comments (personal observations).

113. Moores DW. Malignant pleural effusion. Semin Oncol. 1991; 18(Suppl 2):59-61. http://www.ncbi.nlm.nih.gov/pubmed/1704153?dopt=AbstractPlus

114. Hamed H, Fentiman IS, Chaudar MA et al. Comparison of intracavitary bleomycin and talc for control of pleural effusions secondary to carcinoma of the breast. Br J Surg. 1989; 76:1265-7.

115. Lees AW, Hoy W. Management of pleural effusions in breast cancer. Chest. 1979; 75:51-3. http://www.ncbi.nlm.nih.gov/pubmed/421524?dopt=AbstractPlus

116. Ostrowski MJ, Halsall GM. Intracavity bleomycin in the management of malignant effusions: a multicenter study. Cancer Treat Rep. 1982; 66:1903-7. http://www.ncbi.nlm.nih.gov/pubmed/6182995?dopt=AbstractPlus

117. Alberts DS, Chen HS, Mayersohn M et al. Bleomycin pharmacokinetics in man. II. Intracavitary administration. Cancer Chemother Pharmacol. 1979; 2:127-32. http://www.ncbi.nlm.nih.gov/pubmed/93985?dopt=AbstractPlus

118. Siegel RD, Schiffman FJ. Systemic toxicity following intracavitary administration of bleomycin. Chest. 1990; 98:507. http://www.ncbi.nlm.nih.gov/pubmed/1695874?dopt=AbstractPlus

119. Ruckdeschel JC, Moores D, Lee JY et al. Intrapleural therapy for malignant pleural effusions: a randomized comparison of bleomycin and tetracycline. Paper presented in part at the Proceedings of the American Society of Clinical Oncology, Washington, DC, 22 May 1990 and at the Annual Meeting of the American College of Chest Physicians, Toronto, Canada, 1990 Oct 25.

120. Ruckdeschel JC, Moores DW. Recent findings in the clinical management of malignant pleural effusions: continuing medical education monograph. Albany, NY: The Albany Medical College; 1990 May (publication No. N-W268).

121. Bristol-Myers Squibb. Blenoxane (bleomycin sulfate for injection, USP) prescribing information. Princeton, NJ; 1999 Apr.

122. Anon. Drugs of choice for cancer chemotherapy. Med Lett Drugs Ther. 2000; 42:83-92. http://www.ncbi.nlm.nih.gov/pubmed/10994034?dopt=AbstractPlus

123. Testicular cancer. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2001 Aug.

124. Ozols RF, Yagoda A. Genitourinary cancer. In: Pinedo HM, Longo DL, Chabner BA, eds. Cancer chemotherapy and biologic response modifiers. Annual 9. New York: Elsevier Science Publishers B.V. (Biomedical Division); 1987:280-302.

125. Ozols RF, Yagoda A. Genitourinary cancer. In: Pinedo HM, Longo DL, Chabner BA, eds. Cancer chemotherapy and biologic response modifiers. Annual 10. New York: Elsevier Science Publishers B.V. (Biomedical Division); 1988:271-90.

126. Bergmann KA. Current concepts in clinical therapeutics: Testicular cancer. Clin Pharm. 1987; 6:693-706. http://www.ncbi.nlm.nih.gov/pubmed/2445518?dopt=AbstractPlus

127. Priest ER, Vogelzang NJ. Optimal drug therapy in the treatment of testicular cancer. Drugs. 1991; 42:52-64. http://www.ncbi.nlm.nih.gov/pubmed/1718685?dopt=AbstractPlus

128. Peckham MJ, Barrett A, Liew KH et al. The treatment of metastatic germ-cell testicular tumours with bleomycin, etoposide and cis-platin (BEP). Br J Cancer. 1983; 47:613-9. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2011384&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/6189504?dopt=AbstractPlus

129. Williams SD, Birch R, Einhorn LH et al. Treatment of disseminated germ-cell tumors with cisplatin, bleomycin, and either vinblastine or etoposide. N Engl J Med. 1987; 316:1435-40. http://www.ncbi.nlm.nih.gov/pubmed/2437455?dopt=AbstractPlus

130. Oncolytic drugs: principles of cancer chemotherapy. In: Drug evaluations subscription. Chicago, IL; American Medical Association, III/ONC-1:27, Summer 1993.

131. Oncolytic drugs: antineoplastic agents: antibiotics, alkaloids, and enzymes. In: Drug evaluations subscription. Chicago, IL; American Medical Association, III/ONC-4:8-9, Spring 1993.

132. Loehrer PJ, Williams SD, Einhorn LH. Testicular cancer: the quest continues. J Natl Cancer Inst. 1988; 80:1373-83. http://www.ncbi.nlm.nih.gov/pubmed/3050140?dopt=AbstractPlus

133. White DA, Schwartzberg LS, Kris MG et al. Acute chest pain syndrome during bleomycin infusions. Cancer. 1987; 59:1582-5. http://www.ncbi.nlm.nih.gov/pubmed/2435402?dopt=AbstractPlus

134. Vogelzang NJ, Bosl GJ, Johnson K et al. Raynaud’s phenomenon: a common toxicity after combination chemotherapy for testicular cancer. Ann Intern Med. 1981; 95:288-92. http://www.ncbi.nlm.nih.gov/pubmed/6168223?dopt=AbstractPlus

135. Vogelzang NJ, Torkelson JL, Kennedy BJ. Hypomagnesemia, renal dysfunction, and Raynaud’s phenomenon in patients treated with cisplatin, vinblastine, and bleomycin. Cancer. 1985; 56:2765-70. http://www.ncbi.nlm.nih.gov/pubmed/2413982?dopt=AbstractPlus

136. Adoue D, Arlet P. Bleomycin and Raynaud’s phenomenon. Ann Intern Med. 1984; 100:770. http://www.ncbi.nlm.nih.gov/pubmed/6201095?dopt=AbstractPlus

137. Doll DC, List AF, Greco FA et al. Acute vascular ischemic events after cisplatin-based combination chemotherapy for germ-cell tumors of the testis. Ann Intern Med. 1986; 105:48-51. http://www.ncbi.nlm.nih.gov/pubmed/2424354?dopt=AbstractPlus

138. Cantwell BMJ, Harris AL, Patrick D et al. Hemorrhagic cystitis after iv bleomycin, vinblastine, cisplatin, and etoposide for testicular cancer. Cancer Treat Rep. 1986; 70:548-9. http://www.ncbi.nlm.nih.gov/pubmed/2421895?dopt=AbstractPlus

139. Talcott JA, Garnick MB, Stomper PC et al. Cavitary lung nodules associated with combination chemotherapy containing bleomycin. J Urol. 1987; 138:619-20. http://www.ncbi.nlm.nih.gov/pubmed/2442421?dopt=AbstractPlus

140. Loehrer PJ, Birch R, Williams SD et al. Chemotherapy of metastatic seminoma: the Southeastern Cancer Study Group experience. J Clin Oncol. 1987; 5:1212-20. http://www.ncbi.nlm.nih.gov/pubmed/2442317?dopt=AbstractPlus

141. Gerl A, Clemm C, Schleuning M et al. Fatal cerebrovascular accident associated with chemotherapy for testicular cancer. Eur J Cancer. 1993; 29A:1220-1. http://www.ncbi.nlm.nih.gov/pubmed/7686022?dopt=AbstractPlus

142. Urba WJ, Longo DL. Hodgkin’s disease. N Engl J Med. 1992; 326:678-87. http://www.ncbi.nlm.nih.gov/pubmed/1736106?dopt=AbstractPlus

143. DeVita VT Jr, Hubbard SM. Hodgkin’s disease. N Engl J Med. 1993; 328:560-5. http://www.ncbi.nlm.nih.gov/pubmed/8426624?dopt=AbstractPlus

144. Adult Hodgkin’s disease. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2001 Sep.

145. Food and Drug Administration. Orphan designations pursuant to Section 526 of the Federal Food and Cosmetic Act as amended by the Orphan Drug Act (P.L. 97-414), to June 28, 1996. Rockville, MD; 1996 Jul.

146. Kaposi’s sarcoma. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2001 May.

147. Ruckdeschel JC, Moores D, Lee JY et al. Intrapleural therapy for malignant pleural effusions: a randomized comparison of bleomycin and tetracycline. Chest. 1991; 100:1528-35. http://www.ncbi.nlm.nih.gov/pubmed/1720370?dopt=AbstractPlus

148. Andrews CO, Gora ML. Pleural effusions: pathophysiology and management. Ann Pharmacother. 1994; 28:894-903. http://www.ncbi.nlm.nih.gov/pubmed/7524816?dopt=AbstractPlus

149. Fenton KN, Richardson JD. Diagnosis and management of malignant pleural effusions. Am J Surg. 1995; 170:69-74. http://www.ncbi.nlm.nih.gov/pubmed/7793501?dopt=AbstractPlus

150. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Ann Intern Med. 1994; 120:56-64. http://www.ncbi.nlm.nih.gov/pubmed/8250457?dopt=AbstractPlus

151. Fuller DK. Controversy over sclerotherapy for malignant pleural effusions. Ann Intern Med. 1994; 121:150. http://www.ncbi.nlm.nih.gov/pubmed/7517112?dopt=AbstractPlus

152. Vaughan LM, Sahn SA. Controversy over sclerotherapy for malignant pleural effusions. Ann Intern Med. 1994; 121:151.

153. Windsor PG, Como JA, Windsor KS. Sclerotherapy for malignant pleural effusions: alternatives to tetracycline. South Med J. 1994; 87:709-14. http://www.ncbi.nlm.nih.gov/pubmed/7517579?dopt=AbstractPlus

154. DeVries BC, Bitran JD. On the management of malignant pleural effusions. Chest. 1994; 105:1-2. http://www.ncbi.nlm.nih.gov/pubmed/7506134?dopt=AbstractPlus

155. Keller SM. Current and future therapy for malignant pleural effusion. Chest. 1993; 103(Suppl):63-7S.

156. Lynch TJ Jr. Management of malignant pleural effusions. Chest. 1993; 103(Suppl):385-9S.

157. Audu PBD, Sing RF, Mette SA et al. Fatal diffuse alveolar injury following use of intrapleural bleomycin. Chest. 1993; 103:1638. http://www.ncbi.nlm.nih.gov/pubmed/7683596?dopt=AbstractPlus

158. Ruckdeschel JC. Controversy over sclerotherapy for malignant pleural effusions. Ann Intern Med. 1994; 121:150. http://www.ncbi.nlm.nih.gov/pubmed/7517113?dopt=AbstractPlus

159. Kitamura S, Sugiyama Y, Izumi T et al. Intrapleural doxycycline for control of malignant pleural effusion. Curr Ther Res. 1981; 30:515-21.

160. Mansson T. Treatment of malignant pleural effusion with doxycycline. Scand J Infect Dis Suppl. 1988; 53:29-34. http://www.ncbi.nlm.nih.gov/pubmed/3166542?dopt=AbstractPlus

161. Walker-Renard PB, Vaughan LM, Sahn SA. Chemical pleurodesis for malignant pleural effusions. Arch Intern Med. 1994; 120:56-64.

162. Homma T, Yoneda S, Komuro Y et al. Pharmacokinetics and pleural reaction of doxycycline after intrapleural administration. Gan To Kagaku Ryoho (Japanese with English abstract.). 1983; 10(4 Part 2):1129-34.

163. Gericke KR. Doxycycline as a sclerosing agent. Ann Pharmacother. 1992; 26:648-49. http://www.ncbi.nlm.nih.gov/pubmed/1375521?dopt=AbstractPlus

164. Hatta T, Tsubota N, Yoshimura M et al. [Intapleural minocycline for postoperative air leakage and control of malignant pleural effusion]. Kyobu Geka (Japanese with English abstract). 1990; 43:283-6.

165. Ruckdeschel JC. Management of malignant pleural effusion: an overview. Semin Oncol. 1988; 15(Suppl 3):24-8. http://www.ncbi.nlm.nih.gov/pubmed/3293215?dopt=AbstractPlus

166. Vaughan LM, Walker PB, Sahn SA. Alternatives to tetracycline pleurodesis. Ann Pharmacother. 1992; 26:562-3. http://www.ncbi.nlm.nih.gov/pubmed/1576396?dopt=AbstractPlus

167. Heffner JE, Unruh LC. Tetracycline pleurodesis: adios, farewell, adieu. Chest. 1992; 101:5-7. http://www.ncbi.nlm.nih.gov/pubmed/1729109?dopt=AbstractPlus

168. Rusch VW. The optimal treatment of malignant pleural effusions: a continuing dilemma. Chest. 1991; 100:1483-4. http://www.ncbi.nlm.nih.gov/pubmed/1720369?dopt=AbstractPlus

169. Caumes E, Guermonprez G, Katlama C et al. AIDS-associated mucocutaneous Kaposi’s sarcoma treated with bleomycin. AIDS. 1992; 6:1483-7. http://www.ncbi.nlm.nih.gov/pubmed/1283521?dopt=AbstractPlus

170. Lassoued K, Clauvel JP, Katlama C et al. Treatment of the acquired immune deficiency syndrome-related Kaposi’s sarcoma with bleomycin as a single agent. Cancer. 1990; 66:1869-72. http://www.ncbi.nlm.nih.gov/pubmed/1699652?dopt=AbstractPlus

171. Remick SC, Reddy M, Herman D et al. Continuous infusion bleomycin in AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1994; 12:1130-6. http://www.ncbi.nlm.nih.gov/pubmed/7515412?dopt=AbstractPlus

172. Laubenstein LJ, Krigel RL, Odajnyk CM et al. Treatment of epidemic Kaposi’s sarcoma with etoposide or a combination of doxorubicin, bleomycin, and vinblastine. J Clin Oncol. 1984; 2:1115-20. http://www.ncbi.nlm.nih.gov/pubmed/6208343?dopt=AbstractPlus

173. Gelmann EP, Longo D, Lane HC et al. Combination chemotherapy of disseminated Kaposi’s sarcoma in patients with the acquired immune deficiency syndrome. Am J Med. 1987; 82:456-62. http://www.ncbi.nlm.nih.gov/pubmed/2435150?dopt=AbstractPlus

174. Gill P, Rarick M, Bernstein-Singer M et al. Treatment of advanced Kaposi’s sarcoma using a combination of bleomycin and vincristine. Am J Clin Oncol. 1990;13:315-9.

175. Gill PS, Rarick M, McCutchan JA et al. Systemic treatment of AIDS-related Kaposi’s sarcoma: results of a randomized trial. Am J Med. 1991; 90:427-33. http://www.ncbi.nlm.nih.gov/pubmed/1707230?dopt=AbstractPlus

176. Rarick MU, Gill PS, Montgomery T et al. Treatment of epidemic Kaposi’s sarcoma with combination chemotherapy (vincristine and bleomycin) and zidovudine. Ann Oncol. 1990; 1:147-9. http://www.ncbi.nlm.nih.gov/pubmed/1706615?dopt=AbstractPlus

177. Northfelt DW. Treatment of Kaposi s sarcoma: current guidelines and future perspectives. Drugs. 1994; 48:569-82. http://www.ncbi.nlm.nih.gov/pubmed/7528130?dopt=AbstractPlus

178. Matsutani M, Sano K, Takakura K et al. Primary intracranial germ cell tumors: a clinical analysis of 153 histologically verified cases. J Neurosurg. 1997; 86:446-55. http://www.ncbi.nlm.nih.gov/pubmed/9046301?dopt=AbstractPlus

179. Northfelt DW. Efficacy of Doxil (doxorubicin HCl liposome injection) in the treatment of refractory AIDS-related Kaposi’s sarcoma. In: Doxil Clinical Series. Vol 1, No 3. Menlo Park, CA: Sequus Pharmaceuticals, Inc; 1996:1-8.

180. Coleman R. Treatment of refractory AIDS-related Kaposi’s sarcoma with Doxil (doxorubicin HC liposome injection): a pharmacy perspective. In: Doxil Clinical Series. Vol 1, No 4. Menlo Park, CA: Sequus Pharmaceuticals, Inc; 1996:1-12.

181. Dezube BJ. Safety assessment: Doxil (doxorubicin HCl liposome injection) in refractory AIDS-related Kaposi’s sarcoma. In: Doxil Clinical Series. Vol 1, No 2. Menlo Park, CA: Sequus Pharmaceuticals, Inc; 1996:1-8.

182. Alza Pharmaceuticals, Inc. Doxil (doxorubicin HCl liposome injection) prescribing information. Palo Alto, CA; 1999 Jul.

183. Sequus Pharmaceuticals, Menlo Park, CA: Personal communication.

184. Stewart S, Jablonowski H, Goebel FD et al. Randomized comparative trial of pegylated liposomal doxorubicin versus bleomycin and vincristine in the treatment of AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1998; 16:683-91. http://www.ncbi.nlm.nih.gov/pubmed/9469358?dopt=AbstractPlus

185. Northfelt DW, Dezube BJ, Thommes JA et al. Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi’s sarcoma: results of a randomized phase III clinical trial. J Clin Oncol. 1998; 16:2445-51. http://www.ncbi.nlm.nih.gov/pubmed/9667262?dopt=AbstractPlus

186. Bogner JR, Kronawitter U, Rolinski B et al. Liposomal doxorubicin in the treatment of advanced AIDS-related Kaposi sarcoma. J Acquir Immune Defic Syndr. 1994; 7:463-8. http://www.ncbi.nlm.nih.gov/pubmed/8158540?dopt=AbstractPlus

187. Esser S, Bleil M, Reimann G et al. Long term treatment with liposomal doxorubicin in patients with AIDS-related Kaposi s sarcoma. In: XI International Conference on AIDS, 1996: Vancouver, BC; 1996 Jul 7–12. Abstract No. Th.A.4077.

188. Northfelt DW, Martin FJ, Working P et al. Doxorubicin encapsulated in liposomes containing surface-bound polyethylene glycol: pharmacokinetics, tumor localization, and safety in patients with AIDS-related Kaposi s sarcoma. J Clin Pharmacol. 1996; 36:55-63. http://www.ncbi.nlm.nih.gov/pubmed/8932544?dopt=AbstractPlus

189. Gruenaug M, Bogner JR, Loch O et al. Liposomal doxorubicin in pulmonary Kaposi’s sarcoma: improved survival as compared to patients without liposomal doxorubicin. In: XI International Conference on AIDS, 1996: Abstracts-on-disk. Vancouver, BC; 1996 Jul 7–12. Abstract No. Tu.B.2221.

190. Harrison M, Tomlinson D, Stewart S. Liposomal-entrapped doxorubicin: an active agent in AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1995; 13:914-20. http://www.ncbi.nlm.nih.gov/pubmed/7707119?dopt=AbstractPlus

191. Moran TA. Treatment of refractory AIDS-related Kaposi’s sarcoma with Doxil (doxorubicin HCl liposome injection): a nursing perspective. In: Doxil Clinical Series. Vol 1, No 5. Menlo Park, CA: Sequus Pharmaceuticals, Inc; 1996:1-8.

192. Gill PS, Rarick MU, Espina B et al. Advanced acquired immune deficiency syndrome-related Kaposi’s sarcoma: results of pilot studies using combination chemotherapy. Cancer. 1990; 65:1074-8. http://www.ncbi.nlm.nih.gov/pubmed/1689209?dopt=AbstractPlus

193. De Wit R, Schattenkerk JKME, Boucher CAB et al. Clinical and virological effects of high-dose recombinant interferon-α in disseminated AIDS-related Kaposi’s sarcoma. Lancet. 1988; 2:1214-7. http://www.ncbi.nlm.nih.gov/pubmed/2903953?dopt=AbstractPlus

194. Groopman JE, Gottlieb MS, Goodman J et al. Recombinant alpha-2 interferon therapy for Kaposi’s sarcoma associated with the acquired immunodeficiency syndrome. Ann Intern Med. 1984; 100:671-6. http://www.ncbi.nlm.nih.gov/pubmed/6712031?dopt=AbstractPlus

195. Mayer-da-Silva A, Stadler R, Imcke E et al. Disseminated Kaposi’s sarcoma in AIDS: histogenesis-related populations and influence of long-term treatment with rIFN-αA. J Invest Dermatol. 1987; 89:618-24. http://www.ncbi.nlm.nih.gov/pubmed/3680987?dopt=AbstractPlus

196. Groopman JE. Biology and therapy of epidemic Kaposi’s sarcoma. Cancer. 1987; 59:633-7. http://www.ncbi.nlm.nih.gov/pubmed/10822462?dopt=AbstractPlus

197. Volberding PA, Mitsuyasu R. Recombinant interferon alpha in the treatment of acquired immune deficiency syndrome—related Kaposi’s sarcoma. Semin Oncol. 1985; 12:2-6. http://www.ncbi.nlm.nih.gov/pubmed/3909416?dopt=AbstractPlus

198. Mitsuyasu RT, Taylor JMG, Glaspy J et al. Heterogeneity of epidemic Kaposi’s sarcoma: implications for therapy. Cancer. 1986; 57:1657-61. http://www.ncbi.nlm.nih.gov/pubmed/3081246?dopt=AbstractPlus

199. Safai B. Pathophysiology and epidemiology of epidemic Kaposi’s sarcoma. Semin Oncol. 1987; 14(Suppl 3):7-12. http://www.ncbi.nlm.nih.gov/pubmed/3299718?dopt=AbstractPlus

200. Krown SE. The role of interferon in the therapy of epidemic Kaposi’s sarcoma. Semin Oncol. 1987; 14(Suppl 3):27-33. http://www.ncbi.nlm.nih.gov/pubmed/2440110?dopt=AbstractPlus

201. Gelmann EP, Preble OT, Steis R et al. Human lymphoblastoid interferon treatment of Kaposi’s sarcoma in the acquired immune deficiency syndrome: clinical response and prognostic parameters. Am J Med. 1985; 78:737-41. http://www.ncbi.nlm.nih.gov/pubmed/3838854?dopt=AbstractPlus

202. Kovacs JA, Deyton L, Davey R et al. Combined zidovudine and interferon-α therapy in patients with Kaposi’s sarcoma and the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1989; 111:280-7. http://www.ncbi.nlm.nih.gov/pubmed/2757312?dopt=AbstractPlus

203. Krown SE, Real FX, Vadhan-Raj S et al. Kaposi’s sarcoma and the acquired immune deficiency syndrome: treatment with recombinant interferon alpha and analysis of prognostic factors. Cancer. 1986; 57:1662-5. http://www.ncbi.nlm.nih.gov/pubmed/3081247?dopt=AbstractPlus

204. Krown SE, Gold JWM, Niedzwiecki D et al. Interferon-α with zidovudine: safety, tolerance, and clinical and virologic effects in patients with Kaposi sarcoma associated with the acquired immunodeficiency syndrome (AIDS). Ann Intern Med. 1990; 112:812-21. http://www.ncbi.nlm.nih.gov/pubmed/1971504?dopt=AbstractPlus

205. Karp JE, Groopman JE, Broder S. Cancer in AIDS In: DeVita VT Jr, Hellman S, Rosenberg SA, eds. Cancer: principles and practice of oncology. 4th ed. Philadelphia: JB Lippincott Company; 1993:2093-2110.

206. Anon. Treatment of AIDS-related Kaposi’s sarcoma. Am J Hosp Pharm. 1989; 46:1211.

207. Abrams DI, Volberding PA. Alpha interferon therapy of AIDS-associated Kaposi’s sarcoma. Semin Oncol. 1986; XIII(Suppl 2):43-7.

208. Reviewers’ comments (personal observations) on Interferon 10:00.

209. NeXstar Pharmaceuticals, Inc. DaunoXome (daunorubicin citrate liposome injection) prescribing information. San Dimas, CA; 1999 Apr.

210. Presant CA, Scolaro M, Kennedy P et al. Liposomal daunorubicin treatment of HIV-associated Kaposi’s sarcoma. Lancet. 1993; 341:1242-3. http://www.ncbi.nlm.nih.gov/pubmed/8098393?dopt=AbstractPlus

211. Gill PS, Wernz J, Scadden DT et al. Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi’s sarcoma. J Clin Oncol. 1996; 14:2353-64. http://www.ncbi.nlm.nih.gov/pubmed/8708728?dopt=AbstractPlus

212. Schurmann D, Dormann A, Grunewald T et al. Successful treatment of AIDS-related pulmonary Kaposi’s sarcoma with liposomal daunorubicin. Eur Respir J. 1994; 7:824-5. http://www.ncbi.nlm.nih.gov/pubmed/8005268?dopt=AbstractPlus

213. Shields PG, Dawkins F, Holmlund J et al. Low-dose multidrug chemotherapy plus pneumocystis carinii pneumonia prophylaxis for HIV-related Kaposi’s sarcoma. J Acquir Immune Defic Syndr. 1990; 3:695-700. http://www.ncbi.nlm.nih.gov/pubmed/1693677?dopt=AbstractPlus

214. Miles SA, Mitsuyasu RI, Aboulafia DM. AIDS-related malignancies. In: deVita VT Jr, Hellman S, Rosenberg SA eds. Cancer: principles and practice of oncology. 5th ed. Philadelphia: Lippincott-Raven Publishers; 1997:2445-67.

215. Ligand Pharmaceuticals, Inc. Panretin (alitretinoin) gel prescribing information. San Diego, CA; 1999 Jan.

216. Ovarian germ cell tumor. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2001 Sep.

217. Canellos GP, Anderson JR, Propert KJ et al. Chemotherapy of advanced Hodgkin’s disease with MOPP, ABVD, or MOPP alternating with ABVD. N Engl J Med. 1992; 327:1478-84. http://www.ncbi.nlm.nih.gov/pubmed/1383821?dopt=AbstractPlus

218. Duggan DB, Petroni GR, Johnson JL et al. Randomized comparison of ABVD and MOPP/ABV hybrid for the treatment of advanced Hodgkin’s disease: report of an intergroup trial. J Clin Oncol. 2003; 21:607-14. http://www.ncbi.nlm.nih.gov/pubmed/12586796?dopt=AbstractPlus

219. Noppen M, Degreve J, Mignolet M et al. A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions. Acta Clin Belg. 1997; 52:258-62. http://www.ncbi.nlm.nih.gov/pubmed/9489119?dopt=AbstractPlus

220. Zimmer PW, Hill M, Casey K et al. Prospective randomized trial of talc slurry vs bleomycin in pleurodesis for symptomatic malignant pleural effusions. Chest. 1997; 112:430-4. http://www.ncbi.nlm.nih.gov/pubmed/9266880?dopt=AbstractPlus

221. Hamed H, Fentiman IS, Chaudary MA et al. Comparison of intracavitary bleomycin and talc for control of pleural effusions secondary to carcinoma of the breast. Br J Surg. 1989; 76:1266-7. http://www.ncbi.nlm.nih.gov/pubmed/2481558?dopt=AbstractPlus

222. Grossi F, Pennucci MC, Tixi L et al. Management of malignant pleural effusions. Drugs. 1998; 55:47-58. http://www.ncbi.nlm.nih.gov/pubmed/9463789?dopt=AbstractPlus

223. Patz EF Jr, McAdams HP, Erasmus JJ et al. Sclerotherapy for malignant pleural effusions: a prospective randomized trial of bleomycin vs doxycycline with small-bore catheter drainage. Chest. 1998; 113:1305-11. http://www.ncbi.nlm.nih.gov/pubmed/9596311?dopt=AbstractPlus

224. Comis RL, chair. Phase III randomized study of bleomycin vs doxycycline vs talc for malignant pleural effusions. Protocol IDs: E-8592, NCI-P96-0076, NCCTG-942853. From PDQ Clinical Trials (database). Bethesda, MD: National Library of Medicine; 1999 Nov.

225. Clavel M, Vermorken JB, Cognetti F et al. Randomized comparison of cisplatin, methotrexate, bleomycin and vincristine (CABO) versus cisplatin and 5-fluorouracil (CF) versus cisplatin (C) in recurrent or metastatic squamous cell carcinoma of the head and neck. A phase III study of the EORTC Head and Neck Cancer Cooperative Group. Ann Oncol. 1994; 5:521-6. http://www.ncbi.nlm.nih.gov/pubmed/7522527?dopt=AbstractPlus

226. Shimizu Y, Akiyama F, Umezawa S et al. Combination of consecutive low-dose cisplatin with bleomycin, vincristine, and mitomycin for recurrent cervical carcinoma. J Clin Oncol. 1998; 16:1869-78. http://www.ncbi.nlm.nih.gov/pubmed/9586903?dopt=AbstractPlus

227. Omura GA, Blessing JA, Vaccarello L et al. Randomized trial of cisplatin versus cisplatin plus mitolactol versus cisplatin plus ifosfamide in advanced squamous carcinoma of the cervix: a Gynecologic Oncology Group study. J Clin Oncol. 1997; 15:165-71. http://www.ncbi.nlm.nih.gov/pubmed/8996138?dopt=AbstractPlus

228. Kumar L, Pokharel YH, Kumar S et al. Single agent versus combination chemotherapy in recurrent cervical cancer. J Obstet Gynaecol Res. 1998; 24:401-9. http://www.ncbi.nlm.nih.gov/pubmed/10063235?dopt=AbstractPlus

229. Buxton EJ. Experience with bleomycin, ifosfamide, and cisplatin in primary and recurrent cervical cancer. Semin Oncol. 1992; 19(2 Suppl 5):9-18. http://www.ncbi.nlm.nih.gov/pubmed/1384148?dopt=AbstractPlus

230. Alberts DS, Kronmal R, Baker LH et al. Phase II randomized trial of cisplatin chemotherapy regimens in the treatment of recurrent or metastatic squamous cell cancer of the cervix: a Southwest Oncology Group Study. J Clin Oncol. 1987; 5:1791-5. http://www.ncbi.nlm.nih.gov/pubmed/2445932?dopt=AbstractPlus

231. Thigpen T, Vance R, Khansur T et al. The role of ifosfamide and systemic therapy in the management of carcinoma of the cervix. Semin Oncol. 1996; 23(3 Suppl 6):56-64. http://www.ncbi.nlm.nih.gov/pubmed/8677451?dopt=AbstractPlus

232. Reviewers’ comments (personal observations) on cervical cancer.

233. Food and Drug Administration. MedWatch—Safety-related drug labeling changes: M.V.I. Pediatric (multivitamin) injection [September 21, 2000]. From FDA web site. http://www.fda.gov/Safety/MedWatch/SafetyInformation/default.htm

234. Penile cancer. From: PDQ. Physician data query (database). Bethesda, MD: National Cancer Institute; 2003 Jun 20.

235. Linch DC, Vaughan Hudson B, Hancock BW et al. A randomised comparison of a third-generation regimen (PACEBOM) with a standard regimen (CHOP) in patients with histologically aggressive non-Hodgkin’s lymphoma: a British National Lymphoma Investigation report. Br J Cancer. 1996; 74:318-22. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2074593&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/8688344?dopt=AbstractPlus

236. Cooper IA, Wolf MM, Robertson TI et al. Randomized comparison of MACOP-B with CHOP in patients with intermediate-grade non-Hodgkin’s lymphoma. The Australian and New Zealand Lymphoma Group. J Clin Oncol. 1994; 12:769-78. http://www.ncbi.nlm.nih.gov/pubmed/7512131?dopt=AbstractPlus

237. Fisher RI, Gaynor ER, Dahlberg S et al. Comparison of a standard regimen (CHOP) with three intensive chemotherapy regimens for advanced non-Hodgkin’s lymphoma. N Engl J Med. 1993; 328:1002-6. http://www.ncbi.nlm.nih.gov/pubmed/7680764?dopt=AbstractPlus

238. Gordon LI, Harrington D, Andersen J et al. Comparison of a second-generation combination chemotherapeutic regimen (m-BACOD) with a standard regimen (CHOP) for advanced diffuse non-Hodgkin’s lymphoma. N Engl J Med. 1992; 327:1342-9. http://www.ncbi.nlm.nih.gov/pubmed/1383819?dopt=AbstractPlus

239. Messori A, Vaiani M, Trippoli S et al. Survival in patients with intermediate or high grade non-Hodgkin’s lymphoma: meta-analysis of randomized studies comparing third generation regimens with CHOP. Br J Cancer. 2001; 84:303-7. http://www.pubmedcentral.nih.gov/picrender.fcgi?tool=pmcentrez&artid=2363752&blobtype=pdf http://www.ncbi.nlm.nih.gov/pubmed/11161392?dopt=AbstractPlus

240. Food and Drug Administration. MedWatch—Safety-related drug labeling changes: Bleomycin [March 2003]. From FDA web site. http://www.fda.gov/Safety/MedWatch/SafetyInformation/default.htm

HID. Trissel LA. Handbook on injectable drugs. 14th ed. Bethesda, MD: American Society of Health-System Pharmacists; 2007:213-8.

b. AHFS drug information 2004. McEvoy GK, ed. Bleomycin. Bethesda, MD: American Society of Health-System Pharmacists; 2004:896-9.

c. National Cancer Institute. Cardiopulmonary Syndroms PDQ. Accessed 2004 May 1. http://www.cancer.gov/cancerinfo/pdq/supportivecare/cardiopulmonary/healthprofessional

d. Shaw P, Agarwal R. Pleurodesis for malignant pleural effusions. Cochrane Database Syst Rev. 2004;(1): CD002916.

e. Ong KC, Indumathi V, Raghuam J et al. A comparative study of pleurodesis using talc slurry and bleomycin in the management of malignant pleural effusions. Respirology. 2000 Jun; 5(2): 99-103.

f. Noppen M, Degreve J, Mignolet M et al. A prospective, randomised study comparing the efficacy of talc slurry and bleomycin in the treatment of malignant pleural effusions. Acta Clin Belg. 1997; 52: 258-62. http://www.ncbi.nlm.nih.gov/pubmed/9489119?dopt=AbstractPlus

g. Diacon AH, Wyser C, Bollger CT et al. Prospective randomized comparison of thoracoscopic talc poudrage under local anesthesia versus bleomycin instillation for pleurodesis in malignant pleural effusions. Am J Respir Crit Care Med. 200 Oct; 162(4 Part 1): 1445-9.

Medical Disclaimer