Bleomycin pulmonary toxicity: current status and future directions.

Bleomycin is a polypeptide antibiotic that has been used in clinical cancer chemotherapy for over 20 years. Risk factors associated with bleomycin include total dose of drug, age of patient, high-dose oxygen therapy during surgery, and prior and concomitant radiation therapy. Attempts at developing predictive and precise monitoring systems have not been completely successful; however, the combined use of clinical and laboratory tests, such as the DLCO test, can be used to permit safe administration of the drug. Recent work has emphasized the development of new analogues, such as liblomycin, that appear to possess less pulmonary toxicity than does bleomycin, and has focused on understanding the pathogenesis of pulmonary toxicity, particularly as it relates to the immune system.