The treatment of testicular cancer ranks among the greatest achievements of modern oncology. We are currently able to cure more than 90 per cent of patients, even in cases of metastatic disease. BEP chemotherapy, which combines the drugs bleomycin, etoposide and cisplatin, has contributed significantly to this success.

Bleomycin is a highly effective drug, but it also requires special attention. Its most significant side effect is potential lung damage, which can be severe in some cases. This is precisely why doctors carefully monitor patients’ breathing and lung function during treatment.

Why are the lungs sensitive to bleomycin?

The lungs contain only a small amount of the enzyme that breaks down bleomycin. This means that the drug can accumulate in lung tissue to a greater extent than in other organs. The result can be inflammation of the lung tissue, known as bleomycin pneumonitis.

New scientific findings suggest that this is not merely a result of direct cell damage, but also involves a reaction by the immune system. The body responds to damaged lung cells with inflammation, which in some cases can lead to scarring of the lungs.

What symptoms should not be underestimated?

During treatment or in the weeks following its completion, it is advisable to contact your doctor if you experience a new dry cough, shortness of breath, reduced exercise tolerance, a feeling of breathlessness, unexplained fever or chest tightness.

Are smokers at higher risk?

Yes. Although lung damage can also occur in non-smokers, smoking is one of the possible risk factors for pulmonary toxicity. For patients, the period before the start of chemotherapy is therefore an ideal opportunity to give up smoking.

Who is at higher risk?

The risk of pulmonary toxicity may be higher in patients with impaired kidney function (GFR <80 ml/min – approximately 3.3 times higher risk), in older patients (aged over 40 – approximately 2.3 times higher risk), following higher total doses of bleomycin, in those with chronic lung diseases, and in smokers or former heavy smokers (smoking is a significant risk factor, but without a single, precise multiplier).

The future?

We will we be able to predict who is at risk of lung damage? Scientists are intensively investigating new biological markers that could provide an early warning of an increased risk of lung damage. The aim is to identify at-risk patients before symptoms develop and to enable doctors to tailor treatment to each patient’s individual needs.

So when should you be on the lookout?

After testicular cancer treatment, it makes sense to consider low testosterone, especially if you experience prolonged fatigue, low sex drive, decreased performance, low mood, muscle loss, or trouble concentrating. However, these symptoms may have other causes, so a subjective feeling alone is not enough. A laboratory testosterone test is important, ideally supplemented with LH, FSH, and other hormonal parameters as needed. Patients should actively ask about this if they experience any of these symptoms, as after cancer treatment, attention is often focused primarily on disease recurrence and less on quality of life following treatment.

Some good news to conclude?

despite its potential side effects, bleomycin remains one of the drugs that has made a significant contribution to testicular cancer now being one of the most treatable cancers. Most patients undergo treatment without serious complications and return to a full life after completing it.

Author: Assoc. Prof. Katarína Rejleková, MD, PhD