The effect of pulmonary function testing on bleomycin dosing in germ cell tumours.

ABSTRACT

BACKGROUND/AIM: The utility of pulmonary function testing (PFT) to detect bleomycin-induced pneumonitis is controversial. We describe its impact on bleomycin dosing in a phase 2 trial of accelerated BEP (bleomycin, etoposide, cisplatin) for advanced germ cell tumours. METHODS: There were 12 planned weekly bleomycin doses for intermediate-risk and poor-risk disease and nine for good-risk disease. Clinical assessments, chest X-ray, diffusing capacity of lung for carbon monoxide (DLCO) and forced vital capacity (FVC) were performed bi-weekly. Bleomycin was ceased for predefined clinical/radiological evidence of pulmonary toxicity and a >25% reduction in DLCO or FVC. We determined doses planned, received and omitted and patients receiving all, ≥two-thirds, two-thirds of planned bleomycin doses. RESULTS: Of 43 eligible patients, 30% had lung metastases. Of 471, 375 (80%) of planned bleomycin doses were received, and 30% received patient developed other evidence of pulmonary toxicity. Patients with lung metastases were 1.5 times as likely to have a >25% reduction in DLCO (35 vs 24%, P = 0.4) and 1.5 times as likely to receive Patients who received less than full doses of bleomycin had worse outcomes if they were of good or poor prognosis.

CONCLUSION:

Asymptomatic reductions in DLCO caused 20% of bleomycin doses to be omitted and 30% of patients to receive cancer effect, routine use of PFT to monitor for bleomycin toxicity should be questioned.