Anti-Tumor Abs

Question 1

What drugs are in the anti-tumor antibody class?

Answer 1

Drugs in this class are:
- Bleomycin

Question 2

What is the brand name of Bleomycin?

Answer 2

The brand name of this generic drug is:
- Blenoxane

Question 3

What is the generic of name of Blenoxane?

Answer 3

The generic name of this brand name drug is:
- Bleomycin

Question 4

What are the main indications for use of Bleomycin?

Answer 4

The main indications of this drug are:
- Hodgin Lymphoma
- Testicular Cancer
- Ovarian Germ Cell Cancer

Question 5

What is the class and MOA of Bleomycin?

Answer 5

This drug in the following class:
- Anti-tumor antibody

This drug’s MOA is as follows:
- Inhibits synthesis of DNA by binding to DNA leading to single- and double-strand breaks.

Question 6

What are the notable monitoring parameters for Bleomycin?

Answer 6

The notable monitoring parameters for this drug are:
- Pulmonary function tests before, during and after chemotherapy

Question 7

What drug(s) notably require monitoring for pulmonary function tests?

Answer 7

Drug(s) requiring this monitoring are:
- Bleomycin

Question 8

What is the emetic potential of Bleomycin?

Answer 8

The emetic potential of this drug is:
- Minimal

Question 9

Describe the extravasation risk and management strategies for Bleomycin.

Answer 9

The extravasation risk and mangement strategies for this drug are as follows:
- None; N/A

Question 10

Describe the administration of Bleomycin.

Answer 10

The administration of this drug is described as follows:
- Can be given IM, SubQ, and intrapleural
- Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering test dose of 2 units or less before the first 2 doses. If no acute reaction occurs, then the regular dosage schedule may be followed. Monitor carefully, particularly following the first 2 doses.

Question 11

Describe the metabolism of Bleomycin.

Answer 11

The metabolism of this drug is as follows:
- Metabolized by enzymatic inactivation by bleomycin hydrolase which is widely distributed in normal tissues (except for the skin and lungs)
- Cleared/excreted in urine

Question 12

What are the notable ADRs of Bleomycin?

Answer 12

The notable ADRs of this drug are:
- Pulmonary toxicity (Bleomycin hydrolase is not found in the lungs).
- Interstitial pneumonitis is the most common form of bleomycin pulmonary toxicity but it can also progress to pulmonary fibrosis
which is irreversible and potentially fatal.
- A severe idiosyncratic reaction consisting of HTN, mental confusion, fever, chills, and wheezing has been reported in approximately 1% of lymphoma patients treated with Bleomycin

Question 13

What drug(s) is notable for causing pulmonary toxicity?

Answer 13

The drugs notable for cause this condition are:
- Bleomycin

Question 14

Describe the strategy and rationale for management of pulmonary toxicity caused by Bleomycin.

Answer 14

The strategy and rationale for management of this condition caused by this drug are:
- Routinely follow pulmonary function tests, including DLCO (diffusing capacity of the lung for carbon monoxide) during therapy and discontinue if there are significant changes in pulmonary function, including a decrease
in DLCO of 40-60%.

Question 15

What are the risk factors for developing pulmonary toxicity with Bleomycin?

Answer 15

Risk factors for developing this ADR with this drug/class are:
- Age >70 years
- Cumulative lifetime dose of >400 units
- Use of GCSF

Question 16

What is the threshold lifetime dose of Bleomycin?

Answer 16

The threshold lifetime dose of this drug is:
- 400 units
- Beyond this, the risk of pulmonary toxicity increases

Question 17

Describe the half-life of Bleomycin.

Answer 17

The half-life of the this drug is described as follows:
- ~2 hours but increases exponentially as CrCl decreases

Question 18

What are the clinical pearls of Bleomycin?

Answer 18

The clinical pearls of this drug are as follows:
- Guidelines do not recommend the routine use of GCSF during bleomycin therapy when used for the treatment
of lymphoma especially since ABVD (Doxorubicin + Bleomycin + Vinblastine + Dacarbazine) can be safely given at full dose intensity without GCSF use.
- No increased risk of pulmonary toxicity with GCSF + Bleomycin for the treatment of testicular cancer, thus use of GCSF is acceptable (although still not recommended as primary prophylaxis).
- In patients on ABVD for Hodgkin lymphoma, bleomycin can be dropped if there is a positive response (Deauville 1 or 2) on interim PET scan after 2 cycles. In this situation, continuing with just AVD for the remaining cycles is safer (from a pulmonary toxicity standpoint) but no less effective.
- Due to the possibility of an anaphylactoid reaction, the manufacturer recommends administering a test dose before the first 2 doses