Carmustine Wafer

(kar-MUS-teen)

Trade name: Gliadel^® wafer
Other name: Prolifeprospan 20 with Carmustine implant

Chemocare.com uses generic names in all descriptions of drugs. Gliadel wafer is the trade name for carmustine 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 this drug works" section below).

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

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

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).
• Drainage from surgery site.

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.). Do not take aspirin, products containing aspirin unless your doctor specifically permits this.
• 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 you 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.

Self-care tips:

• 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 after receiving carmustine wafer, to monitor side effects and check your response to therapy.

How this drug 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.  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 and Temozolomide. 
• 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.

The formulation of the carmustine wafer allows the drug 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.