Carmustine

(kar-MUS-teen)

Trade name: BiCNU®

Other name: BCNU, Gliadel® wafer

Carmustine is the generic name for the trade name drug BiCNU®. In some cases, health care professionals may use the trade name BiCNU® when referring to the generic drug name carmustine.

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 Carmustine 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, and may be used on the skin (topically) for cutaneous T-cell lymphoma.

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 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 this formulation).
• 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 and schedule.

Side Effects:

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 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 does with nadir 5-6 weeks later.

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

• 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.

Delayed effects:

• 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 of 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 following:

• Signs of an allergic reaction such as hives, rash, skin changes, difficulty breathing or talking, or swelling of the mouth, face, lips, tongue, or throat.
• Nausea (interferes with ability to eat and unrelieved with prescribed medication).
• Vomiting (vomiting more than 4-5 times in a 24 hour period or any vomit that contains blood or resembles coffee grounds).
• Chest pain or fast heartbeat
• 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.
• Significant dizziness or passing out.
• Changes in eyesight.

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

Precautions:

• 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.

Self-Care Tips:

• Apply a 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 otherwise.
• 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 While Taking Carmustine:

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 Carmustine 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.

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.