Early Clinical Experience with Bleomycin in the United Kingdom in Series of 105 Patients

The results of treating a series of 105 patients (79 with advanced squamous cell carcinoma, 21 with advanced lymphoma, and 5 with miscellaneous tumours) with bleomycin are described. The drug was usually given as a single agent. Four patients with squamous cell carcinoma showed complete regression and there was partial regression in 25. Side effects were frequent, particularly skin changes and stomatitis; death from pneumonitis occurred in one patient.     

Bleomycin: female-specific dominant lethal effects in mice.

Limited comparative data in mice indicate that chemical mutagens that induce dominant lethal mutations in males are not necessarily effective in females, but those which are effective in females are generally equally or more effective in males. Recently, however, a few chemicals have been identified that are female-specific with respect to induction of dominant lethal mutations. The antitumor antibiotic adriamycin is among them. Another antitumor antibiotic, bleomycin was examined for its ability to induce dominant lethal mutations in the reproductive cells of male and female mice. No dominant lethal or cytotoxic effects were observed in males treated with bleomycin, even at a maximum tolerated dose. In females, on the other hand, a dose nearly 1/4 of that used in males induced not only a high level of dominant lethal mutations but also killed oocytes in certain stages of follicular development. The effectiveness of bleomycin in inducing dominant lethal mutations in mouse oocytes makes it a valuable tool for investigating whether gonadal transport, inherent differences in the configuration of chromatin in the germ cells of the two sexes or other factors are responsible for the differential susceptibility to bleomycin, which implies potential gender-specific genetic risk in cancer chemotherapy.     

手指引导下行直肠粘膜下注射争光霉素治疗直肠内尖锐湿疣

目的：探讨手指引导下行直肠粘膜下注射争光霉素治疗直肠内尖锐湿疣的疗效。方法：对8例直肠内尖锐湿疣患者在直肠指诊并在手指引导下进行疣体局部直肠粘膜下注射0.1%争光霉素,并进行末次治疗后6个月随访。结果：所有患者在经过1-2次治疗后损害消失,复发率为25%。2例复发患者经过2次以上治疗得到痊愈。所有患者未发现不良反应。结论：手指引导下行直肠粘膜下注射争光霉素治疗直肠内尖锐湿疣是一种安全、有效的治疗方法。     

Trial of the use of bleomycin in combination with other chemopreparations for treating the metastases of squamous cell cancer in various sites

The data on the treatment of 19 patients with squamous cell carcinoma of different sites are presented. A combination of chemotherapeutics, including methotrexate, adriamycin and bleomycin was used. The combination was effective and low toxic. It may be recommended for the treatment of the above form of carcinoma.     

Genotoxicity testing of combined treatment with cisplatin, bleomycin, and 5-fluorouracil in somatic cells of Drosophila melanogaster

The simultaneous treatment with the cross-linking agent cisplatin, the radiomimetic antitumoral drug bleomycin, and the anti-metabolite drug 5-fluorouracil has been used as a regimen to treat patients with squamous cell carcinoma of the head and neck. Considering that these drugs interact directly with DNA, one of the important late-occurring complications from treatment of primary malignancies is the therapy-related secondary cancers as a result of the genotoxic activity of the drugs on normal cells. In this sense, the genotoxicity of this combination was evaluated using the wing somatic mutation and recombination test in Drosophila melanogaster. The mutant spots observed in marker-heterozygous and balancer-heterozygous flies were compared in order to quantitatively and qualitatively estimate the genotoxic effect of these drugs. Cisplatin (0.003 and 0.006mM), bleomycin (0.005 and 0.01mM), and both combinations preferentially induced recombinational events, while mutation is the major event regarding the genetic toxicity of 5-fluorouracil (0.025 and 0.05mM). The combination of these drugs produced synergistic and antagonistic genotoxic effects, depending on the concentrations used, which could impose a higher risk of secondary effects associated with their genotoxic effects, emphasizing the importance of long-term monitoring in patients being treated with these drugs.     

Bleomycin hypersensitivity in dyskeratosis congenita fibroblasts, lymphocytes, and transformed lymphoblasts

We studied the responses of several dyskeratosis congenita (DC) cell lines to the DNA strand-cleaving and base-damaging agent bleomycin. Fibroblasts, peripheral blood lymphocytes, and transformed lymphoblasts of six DC patients and an obligate DC heterozygote showed more chromatid breaks than did respective controls exposed to various concentrations of bleomycin during the G2 phase of the cell cycle (P less than 0.0001). Unsynchronized DC fibroblasts in culture also showed decreased survival, compared to normals, following bleomycin treatment. DC lymphocytes treated with bleomycin for the final 24 h of culture showed more chromatid- and chromosome-type damage than did normals (P less than 0.0001) or G0-treated DC lymphocytes. Spontaneous chromosome breakage was normal in all six DC cell lines. The ability to distinguish affected and heterozygous DC cells without spontaneous chromosome instability from normals on the basis of their bleomycin hypersensitivity provides a marker for future studies of the pathogenesis of this disorder.     

Selective enhancement of bleomycin cytotoxicity by local anesthetics

The cytotoxic effect of the antitumor antibiotic bleomycin toward cultured mouse FM3A cells was greatly enhanced by exposure of the cells to local anesthetics either before or together with treatment with bleomycin. Such local anesthetics include dibucaine, tetracaine, butacaine, lidocaine and procaine. Dibucaine-induced cell sensitization to bleomycin cytotoxicity produced a decrease in cell survival that became dependent on dose and time of bleomycin treatment. This effect of local anesthetics seems to be selective to bleomycin, since dibucaine and lidocaine do not enhance the cytotoxic effect of other antitumor agents including adriamycin, mitomycin C and $\text{cis}$-diamminedichloroplatinum(II).     

Acute leukaemia after busulphan.

During a double-blind study of two years'' cytotoxic chemotherapy with busulphan or cyclophosphamide in patients who had had resection of carcinoma of the bronchus the long-term effects of these two drugs were also studied. Four of the 243 patients treated with busulphan developed leukaemia compared with none of the 234 treated with cyclophosphamide and none of the 249 on placebo. None of these four patients received radiotherapy or other cytotoxic chemotherapy before leukaemia was diagnosed, and all four were among the 19 patients who developed pancytopenia while taking busulphan, five to eight years before leukaemia became clinically apparent. These findings suggest that busulphan is leukaemogenic, though its mode of action is uncertain.     

Bleomycin treatment of A549 human lung cancer cells results in association of MGr1-Ag and caveolin-1 in lipid rafts

Bleomycin treatment of A549 cells induces senescence rather than apoptosis, a more usual response of cancer cells to cytotoxic drugs. We have previously shown that upregulation of caveolin-1, the main structural component of caveolae, plays a key role in this process. In order to gain a better understanding of the molecular basis of this phenomenon, caveolin-1-enriched microdomains of untreated and bleomycin-treated growth-arrested A549 cells were analysed for differential protein expression using 2-D DIGE followed by LC-MS/MS. One of these differentially expressed proteins was found to be the multidrug resistance-associated protein (MGr1-Ag). We show that MGr1-Ag becomes partly localised in lipid rafts following bleomycin treatment, and that MGr1-Ag and caveolin-1 occur in a common protein complex in vivo using co-immunoprecipitation studies. GST pull-down assays demonstrated an increased interaction between MGr1-Ag and caveolin-1 following bleomycin treatment in vitro. Our results reveal MGr1-Ag as a novel lipid raft protein; its increased association with caveolin-1 in bleomycin-induced cell cycle arrest and subsequent cellular senescence might contribute to the success of chemotherapy.     

Antineoplastic antibiotics in the combined chemotherapy of squamous cell carcinoma

Sixty five patients with squamous cell carcinoma of various localization at stages III-IV or with severe relapses were subjected to chemotherapy according to 3 schemes: AMB (adriamycin + methotrexate + bleomycin or bleomycetin), 34 patients; AMBP (adriamycin + methotrexate + bleomycetin + platidiam), 17 patients and AMFP (adriamycin + methotrexate + fluorofur + platidiam), 14 patients. The efficacy of the schemes was 35, 17.7 and 43 per cent respectively. The AMB scheme in treatment of the patients with maxillofacial carcinoma resulted in remission in 8 out of 20 cases (40 per cent). Analysis of the adverse reactions to the chemotherapy showed that all the three schemes were relatively low toxic. The AMB and AMFP schemes may be recommended for treatment of patients with disseminated or inoperable forms of epidermoid tumors in oncological departments.     

Stage-related, cell-mediated cytotoxicity with effector cell analysis and computation of cytotoxic activity of T cells and non-T cells.

Cell-mediated cytotoxicity (CMC) by lymphocytes from patients with oral squamous cell carcinoma, as well as from nonmalignant control donors, was tested by a microcytotoxicity assay against a cultured cell line derived from an oral squamous cell carcinoma. In terms of the degree of CMC, stage-related cytotoxicity was observed. A further study of the effector cell analysis revealed that the cytotoxic effects of lymphocytes from both patients and control donors were largely attributable to non-T cells. However, the effectors were also stage related, and in early stage patients, T-cell-mediated cytotoxicity was super-imposed on non-T-cell-mediated cytotoxicity. This conclusion was further supported by the evidence of elevated cytotoxic activity of T cells in early stage patients, which was computed from simultaneous equations proposed in the present paper for computing the cytotoxic activity of T cells (CTA_T) and non-T cells (CTA_non-T).     

Trial of BCG immunotherapy in the treatment of resectable squamous cell carcinoma of the bronchus (stages I and II)

Summary Thirty-nine patients with squamous cell carcinoma of the bronchus were randomized into two groups after radical surgery. The first group of 18 patients received 75 mg of living BCG on a scratched area once a week; the second group of 21 patients received no further treatment. After 2 years 3 patients of the group treated with BCG are dead and 1 is in relapse; 8 patients of the control group are dead and 2 are in relapse.In this study the hope of survival for more than 2 years for patients with squamous cell carcinoma of the bronchus is 66% in the group of patients treated with BCG, and 38% in the control group. From these results we can see the beneficial effect of BCG as a complementary treatment of surgery for patients with squamous cell carcinoma of the bronchus.     

The Role of Reactive Oxygen Species in the Antitumor Activity of Bleomycin

Calf thymus DNA was incubated with bleomycin and FeCl₃, in the presence of isolated rat liver microsomal NADH-cytochrome b₅ reductase, cytochrome b₅ and NADH which catalyze redox cycling of the bleomycin-Fe-complex. Furthermore, isolated rat liver nuclei were incubated with bleomycin, FeCl₃ and NADH, a system in which redox cycling of bleomycin-Fe leads to DNA damage. In both systems free bases from DNA were released. Furthermore, 8-hydroxy-guanine was also found in the supernatant. On the other hand, 8-hydroxy-deoxyguanosine was detected in DNA of cell nuclei indicating that hydroxylation of the guanine molecule occurred in intact DNA. The release of bases correlated with the release of malondialydehyde as well as with NADH and oxygen consumption. These results indicate that NADH-cytochrome b₅ reductase catalyzes redox cycling of the bleomycin-Fe-complex which results in the formation of reactive oxygen species which oxidize deoxyribose as well as bases of DNA. Both mechanisms may contribute to the cytotoxic and cytostatic effects of bleomycin observed in intact cells.     

Chimiothérapie des tumeurs germinales du testicule

Germ cell tumours of the testis represent a model of curable disease, even in advanced stages. Cisplatinbased combination chemotherapy followed by surgical removal of residual metastatic disease has dramatically improved the prognosis of these patients, as about 90% of them are currently cured. The standard cytotoxic drugs used in first-line treatment are bleomycin, etoposide and cisplatin (the so-called BEP regimen). Treatment strategy is based on assessment of risk factors. Three cycles are generally used in patients with advanced pure seminoma or good-risk metastatic non-seminomatous tumours. Four cycles are required in patients with intermediate-or poor-risk metastatic non-seminomatous tumours, while two cycles of BEP constitute a safe and effective treatment option in early-stage tumours but with a high-risk of metastatic spread defined by a high percentage of embryonal carcinoma and/or the presence of vascular invasion. Cure rates as high as 90% are achieved provided risk factor strategies are accurately applied and standard treatment modalities are respected. All protocol violations can decrease the expected efficacy or induce unnecessary toxicity.     

Potentiation of cytotoxic effect of lymphotoxin by anti-cancer drugs and elevated temperatures

The cytotoxic lymphokine, lymphotoxin (LT), has been shown to possess antitumor effect in vitro and in vivo. We examined the effect of the combination of partially purified LT with anti-cancer drugs and elevated temperatures on mouse transformed fibroblast cell line, L-929, and two human carcinoma of the cervix cell lines, HeLa and ME180. The cells were treated for 7 hr with Adriamycin, cisplatin, or bleomycin. These cells were then incubated for 24 hr in the presence of LT. At the end of the incubation period, cytotoxicity was measured by the neutral red dye uptake assay. There was 10- to 47-fold potentiation of cytotoxicity of LT on L-929 cells. The potentiation of cytotoxicity on human carcinoma of cervix cell lines ranged from 3- to 23-fold. L-929 cells and ME180 cells were incubated for 7 hr at 40 or 42 degrees C followed by 24 hr of incubation in the presence of LT. The elevated temperature treatment also enhanced (5- to 9-fold) the cytotoxic effect of LT. DNA, RNA, and protein syntheses of the ME180 cells was measured following incubation at 42 degrees C. It was observed that all three parameters were suppressed by incubation at this temperature. It was, therefore, possible that the repair of LT damaged cells was hampered by the elevated temperature treatment. It is suggested that LT may have a potential as an anti-tumor agent in combination with selected therapeutic drugs and hyperthermia.     

Bleomycin induces similar survival variations through the cell cycle as do X rays with and without hypertonic shock.

In an earlier report [H. Utsumi and M. M. Elkind, Radiat. Res. 119, 534-541 (1989)], it was shown that the survival of V79 Chinese hamster cells treated with bleomycin was significantly reduced by a posttreatment with anisotonic phosphate-buffered saline in a manner that was qualitatively similar to what had been observed with X rays [H. Utsumi and M. M. Elkind, Radiat. Res. 77, 346-360 (1979)]. This similarity suggested that similarities might exist in the cyclic variation in the suppression of the repair of potentially lethal damage following treatment with bleomycin or X rays. Accordingly, the age-response variations of survival, with or without a posttreatment challenge with hypertonic buffer, were compared in the same experiment when cells were treated with either agent. Although a significant difference was observed near the G1/S-phase border, in general the damage induced by the two agents showed a similar dependence on cell age, and posttreatment with hypertonic buffer enhanced cell killing appreciably following either treatment. The results support the inference that bleomycin is a radiomimetic agent.     

Modular Nanotransporter with P21 Fragment Inhibits DNA Repair after Bleomycin Treatment

Modular nanotransporter (MNT) with C-terminal fragment of the p21 protein was synthesized and characterized, and its effect on DNA lesions was studied. This p21 fragment in MNT can significantly inhibit DNA repair in A431 human carcinoma cells after bleomycin treatment.     

Inhibition of antioxidants and hyperthermia enhance bleomycin-induced cytotoxicity and lipid peroxidation in Chinese hamster ovary cells.

Regional hyperthermia has potential for human cancer treatment, particularly in combination with systemic chemotherapy or radiotherapy. Heat enhances the cytotoxic effect of certain anticancer agents such as bleomycin, but the mechanisms involved in cell killing are currently unknown. Bleomycin generates reactive oxygen species. It is likely that hyperthermia itself also increases oxidative stress in cells. We evaluate whether oxidative stress has a role in the mechanism of cell death caused by bleomycin and heat in Chinese hamster ovary cells. Heat (41 to 44 degrees C) increased cytotoxicity of bleomycin, evaluated by clonogenic cell survival. Decreased levels of cellular antioxidants should create an imbalance between prooxidant and antioxidant systems, thus enhancing cytotoxic responses to heat and to oxidant-generating drugs. We determine the involvement of four major cellular antioxidant defenses, superoxide dismutase (SOD), the glutathione redox cycle (GSH cycle), catalase, and glutathione S-transferase (GST), in cellular sensitivity to bleomycin, alone or combined with hyperthermia. These cellular defenses were inhibited by diethyldithiocarbamate, l-buthionine sulfoximine, aminotriazole, and ethacrynic acid, respectively. We show that levels of antioxidants (SOD, GSH cycle, and GST) affect cellular cytotoxic responses to bleomycin, at normal and elevated temperatures (41 to 44 degrees C), suggesting the involvement of oxidative stress. Bleomycin and iron caused oxidative damage to membrane lipids in intact cells, at 37 and 43 degrees C. Lipid peroxidation was evaluated by fluorescence detection of thiobarbituric acid-reactive products. There was an increase in damage to membrane lipids when the antioxidant defenses, SOD and catalase, were inhibited. The differing effects of antioxidant inhibitors on bleomycin-induced cytotoxicity and membrane lipid damage suggest that different mechanisms are involved in these two processes. However, free radicals appear to be involved in both cases. The marked sensitization of cells by diethyldithiocarbamate, to both bleomycin-induced cytotoxicity and lipid peroxidation, suggests that superoxide could be involved in both of these processes.     

术前预后营养指数对肺鳞状细胞癌患者术后复发及死亡的预测价值分析

摘要 目的：探讨术前预后营养指数（PNI）与肺鳞状细胞癌患者预后的关系及对术后复发、死亡的预测效能。方法：纳入2017年1月-2019年1月在我院接受治疗的78例肺鳞状细胞癌患者,所有患者均具有完整的临床资料及病理信息,对其进行门诊复查随访3年,除去失访病例共纳入76例患者资料,期间共有43例患者复发、37例患者死亡;按照复发及死亡情况将该76例患者分别分为复发组（n=43）及未复发组（n=33）,死亡组（n=37）及存活组（n=39）,分别使用单因素和多因素Logistic回归分析影响肺鳞状细胞癌患者复发及死亡的独立危险因素;采用受试者工作特征（ROC）曲线分别分析PNI在肺鳞状细胞癌患者术后复发及死亡的预测效能及最佳截断值。结果：单因素分析显示,TNM分期、吸烟年限、糖尿病、家族史、PNI是影响肺鳞状细胞癌患者术后复发的相关因素（P＜0.05）;性别、年龄、TNM分期、BMI、吸烟史、吸烟年限及PNI是影响肺鳞状细胞癌患者术后死亡的相关因素（P＜0.05）。多因素Logistic回归模型分析显示,TNM分期为Ⅲ期、吸烟年限较长、家族史是引发肺鳞状细胞癌患者术后复发的独立危险因素,PNI为保护因素（P＜0.05）;另外男性、年龄较大、TNM分期为Ⅲ期、吸烟年限较长是引发肺鳞状细胞癌患者术后死亡的独立危险因素,PNI为保护因素（P＜0.05）;ROC分析显示PNI在预测肺鳞状细胞癌患者术后复发的曲线下面积为0.726,敏感度为0.814,特异度为0.667,最佳截断值为48;PNI在预测肺鳞状细胞癌患者术后存活的曲线下面积为0.787,敏感度为0.838,特异度为0.718,最佳截断值为50。结论：PNI对肺鳞状细胞癌患者术后复发及生存均具有较高的预测效能,提高PNI水平对改善肺鳞状细胞癌患者的预后具有积极作用。     

Prognostic value of p53 overexpression in head and neck carcinomas: a pilot study

OBJECTIVE: To correlate p53 overexpression in squamous cell carcinoma of the head and neck region with the outcome of treatment. STUDY DESIGN: Twenty-five biopsy-proven squamous cell carcinomas of the head and neck region, locally advanced and untreated, were studied. Before treatment, all patients underwent fine needle aspiration from primary and/or metastatic lesions. Smears were prepared from the aspirate for immunostaining, and p53 overexpression was measured semiquantitatively. All patients received a radical dosage of radiation equivalent to 60 Gy for 6 weeks in 30 fractions from a 6-MV linear accelerator. Local-regional disease control was studied, and the mean follow-up duration was one year. The pretreatment values of p53 overexpression were correlated with the outcome of treatment. RESULTS: Overexpression of p53 was found in 36% patients. At the end of 1 year, 6/9 patients showing overexpression were disease free as compared to 5/16 patients without overexpression. The difference was not significant (chi2 test, P>.05). CONCLUSION: Response to radiation therapy is not dependent on p53 overexpression in squamous cell carcinoma of the head and neck region. However, this was only a pilot study, and a large number of cases are needed to establish the prognostic value of p53 overexpression in locally advanced head and neck squamous cell carcinoma.