Bleomycin alone and in Combination with Methotrexate in the Treatment of Carcinoma of the Esophagus.

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Abstract
The therapeutic results of Bleomycin (BLM) administered alone (29 patients) and in combination with Methotrexate (5 patients) in advanced carcinoma of the esophagus are reviewed. The drug was injected intravenously in five different dose schedules (table 1), as described in previous publications. In combination BLM was given twice weekly at the dose of 10 mg/m2/week intravenously for 1 month. Courses were repeated after an interval of 2–3 weeks. Of 34 patients given BLM alone or in combination, 23 were untreated. The overall response in the group treated with BLM alone was 52 % (table 2). However, complete remission was seen only in 1 patient and more than 50 % remission in 3 patients (CR + PR > 50 %: 14 %). The highest incidence of response was observed with the first dose schedule employed (3/3). The fifth schedule, which is similar to that used by Japanese investigators (10 mg/m2 twice weekly) induced regression in 7/17 patients. The median duration of response ranged in the different schedules from 1 to 2 months. In the small series treated with BLM + MTX 4/5 patients showed regression (CR 1, PR > 50 % 2) with a median duration of 2.7 months. In patients treated with BLM alone pulmonary toxicity confirmed through repeated chest X-rays was observed in 12/29 patients (41 %) after a minimum of 80 mg/m2 and a maximum of 220 mg/m2. This exceedingly high incidence of lung toxicity in relation to the five treatment schedules was as follows: first schedule 3/3, second 1/3, third 1/3, fourth 2/3, fifth 5/17. In 2 patients (both treated with the first dose-schedule) pulmonary toxicity contributed to the cause of death (total dose 120 mg/m2). This report shows that BLM alone produced regressions in about 50 % of patients with advanced epidermoid carcinoma of the esophagus. However, both quality and duration of regression failed to indicate in the present series a useful role of BLM in the control of esophageal carcinoma. The combination of BLM with MTX probably deserves further trials.