Carmustine - BCNU
Braintumor Website

Carmustine is the generic name for BCNU® (aka BICNU). It is a chemotherapy medication that works by preventing DNA replication of tumor cells in the brain, which prevents cell division, which in turn prevents tumor growth. It was approved by the FDA in 1977.

It is usually administered by being injected into a vein. Side effects include nausea and vomiting. Anti-nausea medication is commonly given prior to infusion to ameliorate these side effects. There is no pill form of this medication (#2)

Damage to the lungs is an important possible side effect after high doses, or as an effect of cumulative use. Lung function should be checked before starting this drug, and periodically during treatment. Delayed pulmonary toxicity can occur years after treatment, particularly in patients treated in childhood (#3).

Delayed bone marrow suppression is another important possible side effect (#6).

A Phase II study in 2004 (#7) concluded that BCNU worked about as well as Temozolomide, but had high toxicity and slow recovery.

Results of an important study at Johns Hopkins were published in December of 2016. This study tested mice who had been administered Carmustine in a variety of ways (#10). The researchers concluded that the evidence showed that "systemic chemotherapy alters the immune system in such a way that it never fully recovers." This would seem to suggest that delivering chemotherapeutic drugs directly into the brain instead of injecting them into the blood may produce better patient outcomes.

"..while BCNU has played a significant role for more than 30 years in standard chemotherapy for glioblastoma multiforme, it has significant toxicity concerns and more effective, less toxic agents have since been discovered. However, the use of biodegradable polymer wafers impregnated with BCNU (which limits its systemic toxicity) has demonstrated a statistical benefit and should be investigated more thoroughly (#4)."

For more information about the use of biodegradable wafers (Gliadel) read "Gliadel Overview" (#5), on this website.

George Bigham
April 5, 2018

Sources for this article include:
  1. Carmustine
  2. Carmustine
  3. BICNU® (carmustine) For Injection
  4. BCNU (Carmustine) For Brain Tumors
  5. Gliadel Overview
  6. BiCNU (carmustine for injection)
  7. How effective is BCNU in recurrent glioblastoma in the modern era? A phase II trial (2004).
  8. Carmustine Completed Phase 1 Trials for Brain and Central Nervous System Tumors / Neuroblastomas Treatment This website lists eight completed Phase 1 Carmustine trials and provides links to the web page for each one. The earliest one was completed in 1999, and the latest one in 2010.
  9. Bicnu (Carmustine) - Summary This is an excellent description and summary of information about Bicnu. The section on Side Effects and Adverse Reactions may be of particular interest; and also the section on Warnings and Precautions.
  10. Direct-to-brain chemo better than systemic drugs when immunotherapy is to follow (2016)

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This page was created on 04/05/2018 and last updated on 04/05/2018

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