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Care During Chemotherapy and Beyond

Carmustine Wafer

(kar-MUS-teen)

Trade Name: Gliadel® wafer

Other Name: Prolifeprospan 20 with Carmustine implant

Camustine wafer is the generic name for the trade name drug Gliadel® wafer. Prolifeprospan 20 with carmustine implant is another name for carmustine wafer. In some cases, health care professionals may use the trade name gliadel wafer or other names prolifeprospan 20 with carmustine implant when referring to the generic drug name carmustine wafer.

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 carmustine wafer works" section below).

What Carmustine Wafer Is Used For:

  • Used to treat a certain type of brain tumor, glioblastoma multiforme (GBM).

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 be helpful.

How Carmustine Wafer Is Given:

  • Gliadel® wafer is a form of the medication carmustine 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.
  • The amount of carmustine that you will receive depends on the size of the cavity, and how many wafers can be put into place. Your surgeon will determine your dose.

Side Effects of Carmustine Wafer:

  • Most people will not experience all of the carmustine wafer side effects listed.
  • Carmustine wafer side effects are often predictable in terms of their onset and duration.
  • Carmustine wafer side effects will improve after therapy is complete.
  • Carmustine wafer side effects may be quite manageable. 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 carmustine wafer.

Note: These side effects may occur after brain surgery alone, however, they may occur more frequently when carmustine wafer is used.

The following side effects are common (occurring in greater than 30%) for patients taking Carmustine:

  • Seizures - these do not occur more often than with surgery alone but may occur sooner after surgery.

These are less common side effects (occurring in 10-29%) for patients receiving carmustine:

Not all side effects are listed above. Side effects that are very rare -- occurring in less than about 10 percent of patients -- are not listed here. But 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) of higher, chills (possible signs of infection).
  • Drainage from surgery site.
  • Weakness on 1 side of the body, trouble speaking or thinking, change in balance, or blurred eyesight.
  • Chest pain.
  • Neck stiffness
  • Having thoughts or feeling like you may want to harm yourself or others.
  • Shortness of breath, wheezing, difficulty breathing, closing up of the throat, swelling of facial features, hives (possible allergic reaction).

The following symptoms require medical attention, but are not an emergency. Contact your health care provider within 24 hours of noticing any of the following:

  • 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
  • Blood in the urine
  • Pain or burning with urination
  • Extreme fatigue (unable to carry on self-care activities).
  • Mouth sores (painful redness, swelling or ulcers).
  • Constipation unrelieved by laxative use.
  • Swelling, redness and/or pain in one leg or arm and not the other.
  • Signs of infection such as redness or swelling, pain on swallowing, coughing up mucous, or painful urination.
  • Unable to eat or drink for 24 hours or have signs of dehydration: tiredness, thirst, dry mouth, dark and decrease amount of urine, or dizziness.
  • Depressed (interfering with your ability to carry on your regular activities).

Always inform your health care provider if you experience any unusual symptoms.

Precautions:

  • Before receiving treatment with carmustine wafer, make sure you tell your doctor about any other medications you are taking (including prescription, over-the-counter, vitamins, herbal remedies, etc.).
  • The effects of carmustine wafer on the developing fetus are unknown. Implantation of carmustine wafer can cause fetal harm when administered to a pregnant woman. If you are pregnant or suspect your may be pregnant let your doctor know. 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).
  • Discontinue breast feeding after receiving this medication.
  • Do not receive any kind of immunization or vaccination without your doctor's approval while taking the carmustine wafer.

Self-Care Tips:

  • 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.
  • If you should experience nausea, take anti-nausea medications as prescribed by your doctor, and eat small frequent meals. Sucking on lozenges and chewing gum may also help.
  • Avoid sun exposure. Wear SPF 30 (or higher) sunblock and protective clothing.
  • 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.
  • Remain active as you are able.
  • 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 During Carmustine Wafer Treatment:

You will be checked regularly by your doctor after receiving carmustine wafer, to monitor side effects and check your response to therapy.

How Carmustine Wafer Works:

Chemotherapy (anti-neoplastic drugs)

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.

The formulation of the carmustine wafer allows the drugs to be delivered directly to the site of the brain tumor. After a surgeon operates to remove the cancerous tissue in the brain, he or she implants up to eight dime-sized wafers in the space where the tumor once was. Over the following 2 to 3 weeks, the wafers slowly dissolve, bathing the surrounding cells with the medication. The goal of this method of treatment is to kill tumor cells left behind after surgery.

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.

Carmustine Lexicomp Online®. [May 19th 2016] Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc.; June 29th 2016.

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