Care During Chemotherapy and Beyond
Trade name: BiCNU®
Drug type: Carmustine is an anti-cancer ("antineoplastic" or "cytotoxic")
chemotherapy drug. This medication is classified as an "alkylating agent."
(For more detail, see "How this drug works" section below).
What this drug is used for:
- Used to treat certain types of brain tumors; glioblastoma, brainstem glioma, medulloblastoma,
astrocytoma, ependymoma and metastatic brain tumors.
- Other cancers treated with carmustine include multiple myeloma, Hodgkin's disease,
non-Hodgkin's lymphomas, melanoma, lung cancer, colon cancer.
Note: If a drug has been approved for one use, physicians
sometimes elect to use this same drug for other problems if they believe it may
How this drug is given:
- Carmustine is usually given by an infusion into a vein (intravenous, IV).
- There is no pill form of this medication.
- There is a form of this medication (Gliadel® wafer)
that can be placed and left in the cavity after surgical removal of a brain tumor.
The carmustine wafer allows for delivery of the drug directly to the site of the
brain tumor. (See separate listing "carmustine wafer" for more details regarding
- The amount of carmustine that you will receive depends on many factors, including
your height and weight, your general health or other health problems, and the type
of cancer or condition being treated. Your doctor will determine your dose
Important things to remember about the side effects of carmustine:
- Most people do not experience all of the side effects listed.
- Side effects are often predictable in terms of their onset and duration.
- Side effects are almost always reversible and will go away after treatment is complete.
- There are many options to help minimize or prevent side effects.
- There is no relationship between the presence or severity of side effects and the
effectiveness of the medication.
- The side effects of carmustine and their severity depend on how much of the drug
is given. In other words, high doses may produce more severe side effects.
The following side effects are common (occurring in greater than 30%) for
patients taking carmustine:
- Nausea and vomiting, usually within 2-4 hours of infusion, lasting for about 4-6
hours. Anti-nausea nausea medication is given prior to infusion to prevent
or decrease this side effect.
- Facial flushing (see skin problems).
- Pain and burning at the injection site. (Can be relieved by diluting the drug, let
your health care provider know if you are experiencing pain during the infusion).
- Low blood counts. Your white blood cells and platelets may temporarily decrease. This
can put you at increased risk for infection, and/or bleeding. This effect is
usually delayed, onset 2 weeks after dose with nadir 5-6 weeks later.
Nadir: Meaning low point, nadir is the point in time between chemotherapy
cycles in which you experience low blood counts.
Onset: 7-14 days
Nadir: 3-5 weeks
Recovery: 42-56 days
The following side effects are less common (occurring in 10-29%) for patients
- Increases in blood tests measuring liver function, these return to normal once treatment
is stopped. (see liver problems).
- Low red blood cell count (anemia).
- Low blood pressure (hypotension) with high dose therapy.
- Dizziness, loss of coordination.
- Eye problems: (temporary redness and/or blurring), retinal bleeding.
- Pulmonary toxicity (damage to the lungs) is uncommon in low doses of carmustine.
However it is more common with cumulative or high doses. This toxicity may
be delayed up to 3 years after treatment. A history of lung disease may increase
the risk of this reaction, or use of other lung-toxic drugs. Your doctor will
check your lung function prior to the start carmustine and will order periodic checks
(pulmonary function tests), particularly if you are receiving high doses of carmustine.
- There is a slight risk of developing a blood cancer such as leukemia after taking
carmustine. Talk to your doctor about this risk.
Not all side effects are listed above, some that are rare (occurring in less than
10% of patients) are not listed here. However, you should always inform your
health care provider if you experience any unusual symptoms.
When to contact your doctor:
Contact your health care provider immediately, day or night, if you should
experience any of the following symptoms:
- Fever of 100.4°F (38° C) or higher, chills (possible signs of infection).
The following symptoms require medical attention, but are not an emergency.
Contact your health care provider within 24 hours of noticing any of the
- Nausea (interferes with ability to eat and unrelieved with prescribed medication).
- Vomiting (vomiting more than 4-5 times in a 24 hour period).
- Unusual bleeding or bruising.
- Black or tarry stools, or blood in your stools or urine.
- Extreme fatigue (unable to carry on self-care activities).
- Yellowing of eyes or skin, change in color of stools or urine.
Always inform your health care provider if you experience any unusual symptoms.
- Before starting carmustine treatment, make sure you tell your doctor about any other
medications you are taking (including prescription, over-the-counter, vitamins,
herbal remedies, etc.). Do not take aspirin, products containing aspirin unless
your doctor specifically permits this.
- Do not receive any kind of immunization or vaccination without your doctor's approval
while taking carmustine.
- Inform your health care professional if you are pregnant or may be pregnant prior
to starting this treatment. Pregnancy category D (carmustine may be hazardous to
the fetus. Women who are pregnant or become pregnant must be advised of the
potential hazard to the fetus).
- For both men and women: Do not conceive a child (get pregnant) while taking carmustine.
Barrier methods of contraception, such as condoms, are recommended. Discuss with
your doctor when you may safely become pregnant or conceive a child after therapy.
- Do not breast feed while taking this medication.
- Apply warm compress if you have any pain, redness or swelling at the IV site, and
notify your doctor.
- You may be at risk of infection so try to avoid crowds or people with colds, and
report fever or any other signs of infection immediately to your health care provider.
- Wash your hands often.
- To help treat/prevent mouth sores, use a soft toothbrush, and rinse three times
a day with 1/2 to 1 teaspoon of baking soda and/or salt mixed with 8 ounces of water.
- Use an electric razor and a soft toothbrush to minimize bleeding.
- Avoid contact sports or activities that could cause injury.
- To reduce nausea, take anti-nausea medications as prescribed by your doctor, and
eat small, frequent meals.
- Avoid sun exposure. Wear SPF 15 (or higher) sunblock and protective clothing.
- Drink at least two to three quarts of fluid every 24 hours, unless you are instructed
- Avoid driving and tasks that require being alert until your response to this drug
is well understood.
- In general, drinking alcoholic beverages should be kept to a minimum or avoided
completely. You should discuss this with your doctor.
- Get plenty of rest.
- Maintain good nutrition.
- If you experience symptoms or side effects, be sure to discuss them with your health
care team. They can prescribe medications and/or offer other suggestions that
are effective in managing such problems.
Monitoring and testing:
You will be checked regularly by your doctor while you are taking carmustine, to
monitor side effects and check your response to therapy. Periodic blood work
to monitor your complete blood count (CBC) as well as the function of other organs
(such as your kidneys and liver) will also be ordered by your doctor.
Pulmonary function tests to check your lung function may be performed prior to treatment
and periodically to monitor your lung function during and after treatment with carmustine.
How this drug works:
Cancerous tumors are characterized by cell division, which is no longer controlled
as it is in normal tissue. "Normal" cells stop dividing when they come
into contact with like cells, a mechanism known as contact inhibition. Cancerous
cells lose this ability. Cancer cells no longer have the normal checks and
balances in place that control and limit cell division. The process of cell
division, whether normal or cancerous cells, is through the cell cycle. The
cell cycle goes from the resting phase, through active growing phases, and then
to mitosis (division).
The ability of chemotherapy to kill cancer cells depends on its ability to halt
cell division. Usually, the drugs work by damaging the RNA or DNA that tells
the cell how to copy itself in division. If the cells are unable to divide,
they die. The faster the cells are dividing, the more likely it is that chemotherapy
will kill the cells, causing the tumor to shrink. They also induce cell suicide
(self-death or apoptosis).
Chemotherapy drugs that affect cells only when they are dividing are called cell-cycle
specific. Chemotherapy drugs that affect cells when they are at rest are called
cell-cycle non-specific. The scheduling of chemotherapy is set based on the
type of cells, rate at which they divide, and the time at which a given drug is
likely to be effective. This is why chemotherapy is typically given in cycles.
Chemotherapy is most effective at killing cells that are rapidly dividing.
Unfortunately, chemotherapy does not know the difference between the cancerous cells
and the normal cells. The "normal" cells will grow back and be healthy but in the
meantime, side effects occur. The "normal" cells most commonly affected by
chemotherapy are the blood cells, the cells in the mouth, stomach and bowel, and
the hair follicles; resulting in low blood counts, mouth sores, nausea, diarrhea,
and/or hair loss. Different drugs may affect different parts of the body.
Carmustine is classified as an alkylating agent. Alkylating agents are most
active in the resting phase of the cell. These drugs are cell cycle non-specific.
There are several types of alkylating agents.
- Mustard gas derivatives: Mechlorethamine, Cyclophosphamide,
Chlorambucil, Melphalan, and Ifosfamide.
- Ethylenimines: Thiotepa and Hexamethylmelamine.
- Alkylsulfonates: Busulfan.
- Hydrazines and Triazines: Altretamine, Procarbazine, Dacarbazine
- Nitrosureas: Carmustine, Lomustine and Streptozocin.
Nitrosureas are unique because, unlike most chemotherapy, they can cross the blood-brain
barrier. They can be useful in treating brain tumors.
- Metal salts: Carboplatin, Cisplatin, and Oxaliplatin.
Note: We strongly encourage you to talk with your health care professional
about your specific medical condition and treatments. The information contained
in this website is meant to be helpful and educational, but is not a substitute
for medical advice.
Chemocare.com is designed to provide the latest information about chemotherapy to patients and their families, caregivers and friends. For information about the 4th Angel Mentoring Program visit www.4thangel.org