carmustine


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Related to carmustine: lomustine, BiCNU, Mechlorethamine

carmustine

 [kahr-mus´tēn]
a cytotoxic alkylating agent of the nitrosourea group, used as an antineoplastic agent, primarily against brain tumors, multiple myeloma, colorectal carcinoma, Hodgkin's disease, and non-Hodgkin's lymphomas. Called also BCNU.

carmustine

Gliadel Wafer

Pharmacologic class: Alkylating agent

Therapeutic class: Antineoplastic

Pregnancy risk category D

FDA Box Warning

• Give under supervision of physician experienced in cancer chemotherapy.

• Most common and severe toxic effect is bone marrow suppression-notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in already compromised patient. Monitor blood counts weekly for at least 6 weeks after dose. Don't give courses more often than every 6 weeks.

Action

Unclear. Thought to interfere with bacterial cell-wall synthesis by cross-linking strands of DNA and disrupting RNA transcription, causing cell to rupture and die. Exhibits minimal immunosuppressant activity.

Availability

Intracavitary wafer implant: 7.7 mg (available in packages of eight wafers)

Powder for injection: 100-mg vials

Indications and dosages

Brain tumor; multiple myeloma; Hodgkin's disease; other lymphomas

Adults and children: 150 to 200 mg/m2 I.V. as a single dose q 6 to 8 weeks, or 75 to 100 mg/m2/day for 2 days q 6 weeks, or 40 mg/m2/day for 5 days q 6 weeks. Repeat dose q 6 weeks if platelet count exceeds 100,000/mm3 and white blood cell (WBC) count exceeds 4,000/mm3.

Adjunct to brain surgery

Adults: Up to 61.6 mg (eight wafers) implanted in surgical cavity created during brain tumor resection

Dosage adjustment

• Based on WBC and platelet counts

Off-label uses

• Mycosis fungoides

Contraindications

• Hypersensitivity to drug
• Radiation therapy
• Chemotherapy
• Pregnancy or breastfeeding

Precautions

Use cautiously in:
• infection; depressed bone marrow reserve; respiratory, hepatic, or renal impairment
• females of childbearing age.

Administration

• Know that drug may be used alone or in conjunction with other treatments, such as surgery or radiation.
• Follow facility policy when preparing, administering, and handling drug.
• Reconstitute drug by dissolving vial of 100 mg with 3 ml of sterile dehydrated alcohol (provided with drug), followed by 27 ml of sterile water for injection; yields solution with concentration of 3.3 mg carmustine/ml. Solution may be further diluted with 5% dextrose injection and delivered by I.V. infusion over 1 to 2 hours.
• Know that infusion lasting less than 1 hour causes intense pain and burning at I.V. site.
• Infuse solution in glass containers only; drug is unstable in plastic I.V. bags.
• Know that skin contact with reconstituted drug may cause transient hyperpigmentation. If contact occurs, wash skin thoroughly with soap and water.
• Be aware that oxidized regenerated cellulose may be placed over wafers to secure them against surgical cavity surface.
• Know that resection cavity should be irrigated after wafer placement and that dura should be closed in watertight fashion.

Adverse reactions

CNS: ataxia, drowsiness

GI: nausea, vomiting, diarrhea, esophagitis, stomatitis, anorexia

GU: azotemia, renal failure, nephrotoxicity

Hematologic: anemia, leukopenia, thrombocytopenia, cumulative bone marrow depression, bone marrow dysplasia

Hepatic: hepatotoxicity

Respiratory: pulmonary fibrosis, pulmonary infiltrates

Skin: alopecia, hyperpigmentation, facial flushing, abnormal bruising

Other: I.V. site pain, secondary malignancies

Interactions

Drug-drug.Anticoagulants, aspirin, nonsteroidal anti-inflammatory drugs: increased risk of bleeding

Antineoplastics: additive bone marrow depression

Cimetidine: potentiation of bone marrow depression

Digoxin, phenytoin: decreased blood levels of these drugs

Live-virus vaccines: decreased antibody response to vaccines, increased risk of adverse reactions

Drug-diagnostic tests.Alkaline phosphatase, aspartate aminotransferase, bilirubin, nitrogenous compounds (urea): increased levels

Hemoglobin, WBCs: decreased values

Drug-behaviors.Smoking: increased risk of respiratory toxicity

Patient monitoring

• Assess baseline kidney and liver function tests.
• Monitor CBC for up to 6 weeks after giving dose to detect delayed bone marrow toxicity.
• Know that pulmonary function tests should be performed before therapy begins and regularly throughout therapy to assess for toxicity.

Patient teaching

• Instruct patient to report signs and symptoms of allergic response and other adverse reactions.
• Inform patient that severe flushing may follow I.V. dose but should subside in 2 to 4 hours.
• Tell patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.
• Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids.
• Instruct patient to monitor urinary output and report significant changes.
• Inform patient that drug may cause hair loss.
• Advise patient that he'll undergo regular blood testing during therapy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and behaviors mentioned above.

car·mus·tine

(kar-mŭs'tēn),
An antineoplastic agent.
Synonym(s): BCNU

carmustine

/car·mus·tine/ (kahr-mus´tēn) a cytotoxic alkylating agent of the nitrosourea group, used as an antineoplastic agent.

carmustine

(kär′mŭs-tēn′)
n.
An antineoplastic drug, C5H9Cl2N3O2, used to treat various malignancies, including Hodgkin and non-Hodgkin lymphomas, melanoma, multiple myeloma, and brain tumors.

carmustine

[kärmus′tin]
a lipid-soluble nitrosourea, 1, 3-bis (2-chloroethyl)-l-nitrosourea, used as a single antineoplastic agent or with other approved chemotherapeutic agents in the treatment of brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. Also called BCNU.

BCNU

A chemotherapeutic related to lomustine (CCNU) and semustine, which partially overlaps the activity/toxicity of alkylating agents.
 
Indications
Hodgkin lymphoma, non-Hodgkin lymphoma, melanoma, myeloma, brain tumours, gastrointestinal carcinomas; BCNU crosses the blood-brain barrier and may be used for meningeal leukaemia and brain tumours.
 
Side effects
Nausea, vomiting, decreased platelets, reduced WBCs, secondary leukaemia, pulmonary fibrosis, renal failure.

carmustine

BCNU Oncology An anticancer alkylating nitrosourea

car·mus·tine

(kahr-mŭs'tēn)
An antineoplastic agent.
Synonym(s): BCNU.

carmustine

An alkylating agent anticancer drug. A brand name is Bicnu.

car·mus·tine

(kahr-mŭs'tēn)
An antineoplastic agent.

carmustine

a nitrosourea, used as an antineoplastic agent. Called also BCNU.
References in periodicals archive ?
ICU/ age, mechanical Complications; y/sex ventilation, d outcome 1/43/M 25/8 Myocarditis, cardiogenic shock; survived 2/48/M 5/4 ARDS; died 3/45/F 40/13 Oseltamivir resistance; died 4/75/M 4/3 ARDS, died 5/29/M 8/0 Pneumomediastinum; pneumopericardium, bronchiolitis obliterans; survived * ALC, absolute lymphocyte count/[micro]L; Neutro, neutropenia; ICU, intensive care unit; APML, acute promyelocytic leukemia; SCT, stem cell transplant; SD, standard dose; HD, high dose; DLBCL, diffuse large B-cell lymphoma; IV, intravenous; BCNU, carmustine.
MGI PHARMA markets Aloxi(R) (palonosetron hydrochloride) Injection and Gliadel(R) Wafer (polifeprosan 20 with carmustine implant) in the United States.
The MIT had asked the patent office to grant an SPC for Gliadel which combines two elements, polifeprosan (an excipient) and carmustine (active ingredient) although the marketing of gliadel has been authorised in Germany since August 1999.
The clinicians say Temozolomide and Carmustine Implants are the biggest breakthroughs in the treatment of brain tumours for 30 years but the medicines have not received backing from the National Institute For Health and Clinical Excellence.
In more recent years, drugs such as vincristine, cyclophosphamide, carmustine and doxorubicin also have been used.
The proprietary Gliadel wafer contains a precise amount of the chemotherapeutic drug carmustine.
The patient was started on six cycles of vincristine, carmustine, and cyclophosphamide on the first day of treatment.
The wafer contains the cancer drug carmustine and up to eight can be implanted in the cavity created when a tumour is surgically removed.
C, 300 nM) and carmustine (BCNU, 50 mM), were examined on PC-3 cells.
Subsequently, stem cells were given after the administration of carmustine and 3 months later after the administration of thiotepa.