{"entity":{"id":"bleomycin-omission-caution","kind":"pairing","name":"Caution: bleomycin lung toxicity, especially with brentuximab or G-CSF","aka":[],"tldr":"Bleomycin scars the lungs; combining it with brentuximab was fatal in early trials, and PET-adapted therapy now lets most patients skip it.","summary":"Bleomycin scars the lungs, and this caution pairing warns that the risk is compounded when it is combined with brentuximab vedotin or given alongside G-CSF. In the phase 1 study of brentuximab plus ABVD, pulmonary toxicity was frequent and some patients died, so the phase 3 ECHELON-1 trial dropped bleomycin and used brentuximab with AVD. The RATHL trial showed that bleomycin can be omitted after a negative interim PET scan, so PET-adapted therapy now lets most patients with Hodgkin lymphoma avoid it; the rationale is additive pneumotoxicity and the small contribution bleomycin makes once PET2 is negative. Toxicity also rises with age, renal impairment, G-CSF and oxygen exposure, and the record is also linked from the record on germ cell tumours of childhood and adolescence.","asOf":"2026-09-07","links":[{"label":"ClinicalTrials.gov NCT00678327: RATHL","url":"https://clinicaltrials.gov/study/NCT00678327"},{"label":"ClinicalTrials.gov NCT01712490: ECHELON-1","url":"https://clinicaltrials.gov/study/NCT01712490"}],"tags":[],"related":[],"cancers":["hodgkin-lymphoma"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":["rathl","echelon-1"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"a":"brentuximab-vedotin","b":"pet-adapted-therapy","rationale":"Additive pneumotoxicity; bleomycin adds little efficacy once PET2 is negative.","evidence":"Phase 1 toxicity signal; RATHL phase 3 non-inferiority.","pairingType":"caution"},"route":"/pairings/bleomycin-omission-caution/","neighbours":{"cancer":[{"id":"advanced-stage-classical-hodgkin-lymphoma","kind":"cancer","name":"Advanced-stage classical Hodgkin lymphoma (stage III to IV)","route":"/cancers/advanced-stage-classical-hodgkin-lymphoma/"},{"id":"paediatric-germ-cell-tumours","kind":"cancer","name":"Germ cell tumours of childhood and adolescence (extracranial and CNS)","route":"/cancers/paediatric-germ-cell-tumours/"},{"id":"hodgkin-lymphoma","kind":"cancer","name":"Hodgkin lymphoma","route":"/cancers/hodgkin-lymphoma/"}],"trial":[{"id":"echelon-1","kind":"trial","name":"ECHELON-1","route":"/trials/echelon-1/"},{"id":"rathl","kind":"trial","name":"RATHL","route":"/trials/rathl/"}],"drug":[{"id":"brentuximab-vedotin","kind":"drug","name":"Brentuximab vedotin","route":"/drugs/brentuximab-vedotin/"}],"technology":[{"id":"pet-adapted-therapy","kind":"technology","name":"PET-adapted (response-adapted) therapy","route":"/technologies/pet-adapted-therapy/"}]}}