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The effect of pulmonary function testing on bleomycin dosing in germ cell tumours
F T Roncolato1, M Chatfield2, B Houghton3
1Department of Medical Oncology, NHMRC Clinical Trials Centre, Sydney, New South Wales, Australia.
Internal Medicine Journal
|June 16, 2016
Summary
Pulmonary function testing (PFT) can lead to unnecessary bleomycin dose reductions due to asymptomatic DLCO changes. Questioning routine PFT use may improve anti-cancer effects in germ cell tumor patients.
Area of Science:
- Oncology
- Pulmonology
- Pharmacology
Background:
- The role of pulmonary function testing (PFT) in detecting bleomycin-induced pneumonitis remains debated.
- Bleomycin is a key component in BEP chemotherapy for advanced germ cell tumors.
Purpose of the Study:
- To evaluate the impact of PFT on bleomycin dosing in a phase 2 trial of accelerated BEP chemotherapy.
- To assess the utility of PFT in monitoring bleomycin toxicity and its effect on treatment outcomes.
Main Methods:
- A phase 2 trial involving 43 patients with advanced germ cell tumors receiving accelerated BEP chemotherapy.
- Bi-weekly monitoring included clinical assessments, chest X-ray, diffusing capacity of lung for carbon monoxide (DLCO), and forced vital capacity (FVC).
- Bleomycin was discontinued for clinical/radiological toxicity or >25% reduction in DLCO/FVC.
Main Results:
- 80% of planned bleomycin doses were administered; 30% of patients received less than two-thirds of their planned doses, primarily due to DLCO reduction.
- No patients exhibited other signs of pulmonary toxicity.
- Patients with lung metastases were more likely to experience DLCO reduction and receive reduced bleomycin doses.
Conclusions:
- Asymptomatic DLCO reductions led to significant bleomycin dose omissions, impacting 30% of patients.
- A >25% DLCO reduction threshold may be overly sensitive, potentially compromising anti-cancer efficacy.
- Routine PFT use for bleomycin toxicity monitoring warrants reconsideration due to its impact on dosing and potential negative effects on treatment outcomes.
