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Frequency and risk factors of bleomycin-induced pulmonary toxicity in South Indian patients with germ-cell tumors


1 Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
2 Department of Radio Diagnosis, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
3 Department of Clinical Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India
4 Department of Medical Oncology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry, India

Correspondence Address:
Kesavan Ramasamy,
Department of Pharmacology, Jawaharlal Institute of Postgraduate Medical Education and Research, Gorimedu, Puducherry
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcrt.JCRT_348_19

Aim: Bleomycin, etoposide, and cisplatin (BEP) regimen is the standard treatment for germ-cell tumors (GCTs). Bleomycin-induced pulmonary toxicity (BPT) is fatal and dose-limiting toxicity associated with this regimen. In this study, we aimed to identify the frequency and risk factors of BPT in South Indian GCT patients receiving BEP regimen. Patients and Methods: The study was carried out in the Department of Medical Oncology, Regional Cancer Centre at a tertiary care hospital in South India. All the patients with GCT (testicular and ovarian) who were receiving BEP regimen from December 2014 to May 2018 were included in the study. BPT was defined as the presence of radiological features and/or clinical symptoms during or post-treatment. Results: BPT was observed in 11 (27%) patients of 41 analyzed patients. Five (12%) patients developed BPT during treatment whereas six (15%) patients developed BPT post-treatment. Cumulative bleomycin dose ≥240 mg (relative risk 3.8, confidence interval: 1.2–12.2,P =0.02) was found to increase the risk of BPT. Three-year overall survival in patients with and without toxicity was 82% and 93%, respectively. Conclusions: The frequency of BPT in the study population is 27%, and cumulative bleomycin dose ≥240 mg has been found to be associated with increased risk of developing BPT. BPT does not negatively impact survival outcome in GCT patients receiving BEP regimen.


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