Intracavitary bleomycin in the management of malignant effusions: a multicenter study

The efficacy of intracavitary bleomycin in preventing the recurrence of malignant effusions following aspiration was assessed in a multicenter study. Of 200 patients treated, 158 were evaluated for response at 30 days. The overall response rate was 58%, with pleural effusions responding better (62%) than peritoneal effusions (47%). Pleural effusions resulting from primary breast tumors showed the best response (72%). No side effects were seen in 79.5% of the 200 patients. Pain and transient fever were reported in 21% of the patients after intraperitoneal instillation but in only 5% of those receiving intrapleural instillations. Nausea was experienced by 5.5% of the patients. There was no evidence of myelosuppression in any patient nor of enhancement of myelosuppression in the 57 patients receiving concurrent cytotoxic therapy. There was one possible treatment-related death in an elderly man given 120 mg of bleomycin intrapleurally. This leads us to recommend that the maximum dose should be 60 mg, especially as the response rate was not improved by doses greater than 60 mg. We conclude that bleomycin should be the agent of choice when the instillation of a cytotoxic agent following the drainage of a malignant effusion is indicated, since it is effective in preventing recurrence of the effusion, is generally free from systemic effects, and can be given to myelosuppressed patients or those already undergoing systemic cytotoxic therapy.