Bleomycin

Bleomycin is a type of chemotherapy drug. It is a treatment for a number of types of cancer. You might have it as part of a clinical trial for some types of cancer.

How does bleomycin work?

Bleomycin is a type of antibiotic that is poisonous to cells. This drug destroys quickly dividing cells such as cancer cells.

How do you have bleomycin?

You might have bleomycin in the following ways:

Into a muscle

You might have it as an injection into a muscle (intramuscular injection).

Into your bloodstream

You might have treatment through a long plastic tube that goes into a large vein in your chest. The tube stays in place throughout the course of treatment. This can be a:

• central line
• PICC line
• portacath

If you don't have a central line

You might have treatment through a thin short tube (a cannula) that goes into a vein in your arm. You have a new cannula each time you have treatment.

Into a tumour

Some people may have bleomycin as an injection directly into a tumour.

Into a cavity

Sometimes, bleomycin is injected through a tube into a body cavity in the chest or abdomen. This is called an intracavity injection. You usually only have this once or twice.

How often do you have bleomycin?

Bleomycin is often given as a course of several cycles of treatment. This means you have the drug and then a rest to allow your body to recover.

The treatment plan depends on which type of cancer you have. You usually have bleomycin alongside other chemotherapy drugs as part of combination chemotherapy treatments.

Tests

You have blood tests before and during your treatment. They check your levels of blood cells and other substances in the blood. They also check how well your liver and kidneys are working.

What are the side effects of bleomycin?

Side effects can vary from person to person. They also depend on what other treatments you're having. 

When to contact your team

Your doctor, nurse or pharmacist will go through the possible side effects. They will monitor you during treatment and check how you are at your appointments. Contact your advice line as soon as possible if:

• you have severe side effects 

• your side effects aren’t getting any better

• your side effects are getting worse

Early treatment can help manage side effects better. 

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects. But you might have some of them at the same time.

We haven't listed all the side effects here. Remember it is very unlikely that you will have all of these side effects, but you might have some of them at the same time.

Common side effects

These side effects happen in more than 10 in 100 people (more than 10%). You might have one or more of them. They include:

Lung changes

You might develop a cough or breathing problems. This could be due to infection, such as pneumonia or inflammation of the lungs (pneumonitis). It might also be because of scarring on the lung (called fibrosis).

Less commonly you might develop a life-threatening breathing problem this is called acute respiratory distress syndrome (ARDS) or lung failure.

Let your team know straight away if you suddenly become breathless, have changes in your breathing, feel faint due to not being able to breath properly, feel drowsy or confused or are getting very tired.

Skin changes

Skin problems include reddening of the skin, stretch marks, blistering, itching and darker skin. Your skin might have areas of thickening and your fingertips might be tender or swell. 

Less commonly you might have hardening of the skin or develop a raised itchy rash known as hives.

These symptoms usually goes back to normal when you finish treatment. Tell your nurse or doctor if these symptoms develop and they can give you medicine to help.

Hair loss

You could lose all your hair. This includes your eyelashes, eyebrows, underarms, legs and sometimes pubic hair. Your hair will usually grow back once treatment has finished but it is likely to be softer. It may grow back a different colour or be curlier than before. 

Loss of appetite and weight loss

You might lose your appetite for various reasons when you are having cancer treatment. Sickness, taste changes or tiredness can put you off food and drinks.

You might also lose weight

Feeling or being sick

Feeling or being sick is usually well controlled with anti sickness medicines. It might help to avoid fatty or fried foods, eat small meals and snacks and take regular sips of water. Relaxation techniques might also help.

It is important to take anti sickness medicines as prescribed even if you don’t feel sick. It is easier to prevent sickness rather than treat it once it has started.

Sore mouth and ulcers

Mouth sores and ulcers can be painful. It helps to keep your mouth and teeth clean, drink plenty of fluids and avoid acidic foods such as lemons. Chewing gum can help to keep your mouth moist. Tell your doctor or nurse if you have ulcers.

Occasional side effects

These side effects happen in between 1 and 10 out of every 100 people (between 1 and 10%). You might have one or more of them. They include:

• headaches
• allergic reaction that can cause a rash, shortness of breath, redness or swelling of the face and dizziness - some allergic reactions can be life threatening, alert your nurse or doctor if notice any of these symptoms (whilst having treatment or soon afterwards)
• blood clots that can be life threatening; signs are pain, redness and swelling where the clot is. Feeling breathless can be a sign of a blood clot in the lung. Contact your advice line or doctor straight away if you have any of these symptoms
• high temperature (fever) and chills
• feeling generally unwell (malaise)
• fluid build in different parts of the body (oedema)

Rare side effects

These side effects happen in fewer than 1 in 100 people (less than 1%). You might have one or more of them. They include:

• low blood pressure symptoms might include feeling dizzy, sick, confused, feeling weak and tired
• changes to passing urine such as passing to much or too little, retaining urine in your bladder or you might find it painful to pass urine
• diarrhoea
• changes to the way the liver works
• pain in area of cancer
• an autoimmune condition called scleroderma – you might have areas of hardened skin or damage to other connective tissues
• increased risk of getting an infection
• bruising, bleeding gums or nosebleeds
• dizziness
• confusion
• muscle or joint pain
• painful cracking at the corners of your mouth
• fluid filled blister at pressure points
• inflammation of the vein (phlebitis)
• thickening of the walls of the veins
• changes to the colour or appearance of your nails

Coping with side effects

We have more information about side effects and tips on how to cope with them.

What else do I need to know?

Other medicines, foods and drink

Cancer drugs can interact with medicines, herbal products, and some food and drinks. We are unable to list all the possible interactions that may happen. An example is grapefruit or grapefruit juice which can increase the side effects of certain drugs.

Tell your healthcare team about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies. Also let them know about any other medical conditions or allergies you may have.

Pregnancy and contraception

This treatment might harm a baby developing in the womb. It is important not to become pregnant, or father a child while you're having treatment, and for 6 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment. 

Loss of fertility

You may not be able to become pregnant or get someone pregnant after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future.

Men might be able to store sperm before starting treatment. And women might be able to store eggs or ovarian tissue. But these services are not available in every hospital, so you would need to ask your doctor about this.    

Breastfeeding

It is not known whether this drug comes through into the breast milk. Doctors usually advise that you don’t breastfeed during this treatment.

Treatment for other conditions

If you are having tests or treatment for anything else, always mention your cancer treatment. For example, if you are visiting your dentist.

Immunisations

Don’t have immunisations with live vaccines while you’re having treatment and for up to 12 months afterwards. The length of time depends on the treatment you are having. Ask your doctor or pharmacist how long you should avoid live vaccinations.

In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and one of the shingles vaccines called Zostavax.

You can have:

• other vaccines, but they might not give you as much protection as usual
• the flu vaccine (as an injection)
• the coronavirus (COVID-19) vaccine - talk to your doctor or pharmacist about the best time to have it in relation to your cancer treatment

Members of your household who are aged 5 years or over are also able to have the COVID-19 vaccine. This is to help lower your risk of getting COVID-19 while having cancer treatment and until your immune system recovers from treatment.

Contact with others who have had immunisations - You can be in contact with other people who have had live vaccines as injections. Avoid close contact with people who have recently had live vaccines taken by mouth (oral vaccines) such as the oral typhoid vaccine. Sometimes people who have had the live shingles vaccine can get a shingles type rash. If this happens they should keep the area covered.

If your immune system is severely weakened, you should avoid contact with children who have had the flu vaccine as a nasal spray as this is a live vaccine. This is for 2 weeks following their vaccination.

Babies have the live rotavirus vaccine. The virus is in the baby’s poo for about 2 weeks and could make you ill if your immunity is low. Get someone else to change their nappies during this time if you can. If this isn't possible, wash your hands well after changing their nappy.

More information about this treatment

For further information about this treatment and possible side effects go to the electronic Medicines Compendium (eMC) website. You can find the patient information leaflet on this website.

You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.