Bleomycin, vincristine, mitomycin C, and cis-platinum in gynecologic squamous cell carcinomas: a high incidence of pulmonary toxicity.

Twenty-three patients with gynecologic squamous cell carcinomas (20 cervical, 2 vulvar, 1 ovarian) were treated with bleomycin, vincristine, mitomycin-C, and cis-platinum. Twenty-one patients had prior radiation therapy. Of the 21 evaluable patients, the response rate was 48% with a median duration of 4 months. Toxicity in the 23 patients was high, with the most significant being that of pulmonary toxicity. Eight patients had pulmonary toxicity with 5 of 8 dying a respiratory death while free of disease. Bleomycin is excreted primarily by the kidneys, and its half-life is known to increase in patients with renal insufficiency. Patients with advanced, recurrent cervical cancer who have failed radiation therapy often have underlying renal compromise. Extreme caution should be exercised when administering bleomycin with nephrotoxic chemotherapeutic agents in this setting.