# Bleomycin

Source: https://onco.cc/drugs/bleomycin/  
OnCo record `bleomycin` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Bleomycin is the 'B' in BEP for testicular cancer and ABVD for Hodgkin lymphoma; its unique danger is scarring of the lungs, so lung function is monitored and it is often dropped when safe.

## Summary

Approved 1973. BEP (testicular; omitted in EP for good-risk patients with lung risk), ABVD (Hodgkin; omitted after negative interim PET in RATHL), Kaposi sarcoma (bleomycin-vincristine in Africa), sclerotherapy of lymphatic malformations and pleurodesis, electrochemotherapy for cutaneous tumours. Cumulative dose limit ~400 units; pulmonary toxicity 10%, fatal in 1-2%.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-08
- Tags: gap-fill; generic; who-essential
- Brand: Blenoxane
- Modality: Glycopeptide antibiotic (DNA-cleaving)
- Mechanism: Chelates iron and generates free radicals that cause single- and double-strand DNA breaks; inactivated by bleomycin hydrolase, which is scarce in lung and skin (fibrosis, hyperpigmentation).
- Approvals: US 1973: Squamous cell carcinomas, Hodgkin and non-Hodgkin lymphoma, testicular carcinoma, malignant pleural effusion

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Bleomycin
- Label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=bleomycin

## Connected records

- cancers: [Advanced-stage classical Hodgkin lymphoma (stage III to IV)](https://onco.cc/cancers/advanced-stage-classical-hodgkin-lymphoma/), [Choriocarcinoma of the testis](https://onco.cc/cancers/testicular-choriocarcinoma/), [Craniopharyngioma](https://onco.cc/cancers/craniopharyngioma/), [Early-stage classical Hodgkin lymphoma (stage I to II)](https://onco.cc/cancers/early-stage-classical-hodgkin-lymphoma/), [Embryonal carcinoma of the testis](https://onco.cc/cancers/embryonal-carcinoma-testis/), [Extragonadal germ cell tumour](https://onco.cc/cancers/extragonadal-germ-cell-tumour/), [Germ cell tumours of childhood and adolescence (extracranial and CNS)](https://onco.cc/cancers/paediatric-germ-cell-tumours/), [HIV-associated (AIDS-related) lymphomas](https://onco.cc/cancers/hiv-associated-lymphoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Kaposi sarcoma](https://onco.cc/cancers/kaposi-sarcoma/), [Mediastinal germ cell tumour](https://onco.cc/cancers/mediastinal-germ-cell-tumour/), [Non-seminomatous germ cell tumour](https://onco.cc/cancers/non-seminoma/), [Retroperitoneal germ cell tumour](https://onco.cc/cancers/retroperitoneal-germ-cell-tumour/), [Seminoma](https://onco.cc/cancers/seminoma/), [Testicular germ cell tumours](https://onco.cc/cancers/testicular/), [Yolk sac tumour of the testis, postpubertal type](https://onco.cc/cancers/yolk-sac-tumour-postpubertal/)
- technologies: [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [Electrochemotherapy](https://onco.cc/technologies/electrochemotherapy/), [Electrochemotherapy devices (Cliniporator)](https://onco.cc/technologies/electrochemotherapy-devices/), [The cumulative dose that decides whether it comes back](https://onco.cc/technologies/rejuv-recovery-cumulative-dose/)
- terms: [ABVD, BEACOPP and BrECADD (Hodgkin lymphoma regimens)](https://onco.cc/terms/abvd-beacopp/), [Interstitial lung disease (ILD) / pneumonitis](https://onco.cc/terms/ild/), [Late effects of Hodgkin lymphoma treatment, and the follow-up that answers them](https://onco.cc/terms/lymphoma-tx-hodgkin-late-effects/), [The lymphoma regimen alphabet: R-CHOP, pola-R-CHP, DA-EPOCH-R, ABVD, BEACOPP and the rest](https://onco.cc/terms/lymphoma-tx-regimen-alphabet/)
- trials: [ACTG A5263/AMC 066](https://onco.cc/trials/actg-a5263/), [AGCT1531](https://onco.cc/trials/agct1531/), [AHL2011](https://onco.cc/trials/ahl2011/), [AHOD1331](https://onco.cc/trials/ahod1331/), [Bleomycin, Doxycycline, or Talc in Treating Patients With Malignant Pleural Effusions](https://onco.cc/trials/nct00002872/), [Electrochemotherapy With Carboplatinum Plus Bleomycin Versus Bleomycin Alone in Vulvar Cancer](https://onco.cc/trials/nct05395962/), [EORTC/LYSA/FIL H10](https://onco.cc/trials/eortc-h10/), [GETUG 13](https://onco.cc/trials/getug-13/), [GHSG HD10](https://onco.cc/trials/hd10/), [GHSG HD16](https://onco.cc/trials/hd16/), [GHSG HD18](https://onco.cc/trials/hd18/), [RADAR](https://onco.cc/trials/radar-hodgkin/), [RATHL](https://onco.cc/trials/rathl/)
- key papers: [ACTG A5263/AMC 066: three chemotherapy regimens with antiretroviral therapy for advanced AIDS-associated Kaposi sarcoma in resource-limited settings](https://onco.cc/key-papers/paper-actg-a5263-kaposi-sarcoma-resource-limited-krown-lancet-2020/), [Early positron emission tomography response-adapted treatment in stage I and II Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 trial](https://onco.cc/key-papers/paper-eortc-h10-pet-adapted-early-hodgkin-jco-2017/), [PET-adapted treatment for newly diagnosed advanced Hodgkin lymphoma (AHL2011): a randomised, multicentre, non-inferiority, phase 3 study](https://onco.cc/key-papers/paper-ahl2011-pet-adapted-treatment-advanced-hodgkin-lancet-oncol-2019/), [PET-guided treatment in patients with advanced-stage Hodgkin's lymphoma (HD18): final results of an open-label, international, randomised phase 3 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd18-pet-guided-escalated-beacopp-lancet-2017/), [Positron emission tomography-guided treatment in early-stage favorable Hodgkin lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group](https://onco.cc/key-papers/paper-ghsg-hd16-pet-guided-early-favourable-hodgkin-jco-2019/), [Treatment of disseminated germ cell tumours with cisplatin, bleomycin and either vinblastine or etoposide](https://onco.cc/key-papers/paper-williams-bep-vs-pvb-nejm-1987/)
- ideas: [A radiotherapy-free cure for early Hodgkin lymphoma that actually holds](https://onco.cc/ideas/lymphoma-ev-radiotherapy-free-early-hodgkin/)

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