The drug is indicated as the palliative therapy as a single agent or in established combination therapy with the several other approved chemotherapeutic agents as follows:
Brain tumor: as an alkylating agent in order to treat several types of brain cancer including glioma, glioblastoma multiforme, medulloblastoma, and astrocytoma.
Multiple Myeloma: carmustine is used in multiple myeloma in combination with prednisone.
Hodgkin’s Disease: as the secondary therapy together with the other approved medications in patients with the relapse taking treatment with the primary therapy, or who fail in order to respond to the primary therapy.
Non-Hodgkin’s lymphomas: as the secondary therapy together with other approved medications for patients who relapse while being treated with the primary therapy or who fail in order to respond to the primary therapy.
Malignant melanoma: In combination with vincristine sulfate, it has been shown to give response rates up to 45% in malignant melanoma.
Stem cell transplantation: It is also used as part of a chemotherapeutic protocol in preparation for hematological stem cell transplantation, a type of bone marrow transplant, in order to reduce the WBC count in the recipient.
Contraindications: Carmustine 100 mg injection should not be given to individuals who have demonstrated a previous hypersensitivity to it.
This multiple myeloma medication should be avoided in individuals with decreased circulating platelets, leucocytes, or erythrocytes either from previous chemotherapy or other causes.
Dosage: Carmustine should be administered by slow intravenous infusion. It should not be recommended as a rapid intravenous injection. Recommended BiCNU dose as the single agent in those patients who are previously untreated is carmustine 200 mg/m2, should be given intravenously every 6 weeks. This can be recommended as a single dose or separated into daily injections such as 100 mg/m2 on successive days. When this drug (BiCNU) is used together with the other myelosuppressive medications or in those patients in whom bone marrow reserve is depleted, the drug doses must be adjusted accordingly.
Carmustine Side Effects:
Most common adverse reactions have been reported vomiting, nausea, renal toxicity, pneumonitis, myelosuppression, pneumonitis, interstitial lung disease, burning sensation, swelling, hyperpigmentation, pain, erythema, skin necrosis, alopecia, and allergic reaction.
How does Carmustine work: Carmustine is alkylate DNA and RNA has been specified in order to inhibit the several enzymes by the carbamoylation of the amino acids in proteins. This drug is not cross resistant with the other alkylators.
It is believed that the antineoplastic and toxic activities of carmustine can be due to the metabolites.
How should it be supplied: Each and every package includes a vial contained carmustine 100mg and an ampule contains 3 mL sterile diluent.
Precautions while/before administering carmustine:
Carmustine 100 mg must be administered by individuals experienced in antineoplastic therapy.
Liver and renal function tests are recommended and must be monitored.
Patients who are with pre-existing lung disease are at a higher risk of developing carmustine-associated with pulmonary toxicity. Thoracic irradiation and other medication affecting the pulmonary function have also been implicated as predisposing in order to development of the pulmonary toxicity during the treatment with the carmustine.
Studies of baseline pulmonary function must be conducted along with the frequent pulmonary function tests during the treatment. Patients with a baseline below 70 % of the predicted Forced Vital Capacity (FVC) or Carbon Monoxide Diffusing Capacity (Dlco) are at risk.
Delayed toxicity of bone marrow is the major toxicity, complete blood counts must be monitored frequently for at least 42 days after the dose. Consecutive doses of carmustine injection must not be recommended more frequently than every 42 days.
The toxicity of bone marrow of carmustine injection is cumulative, and thus the adjustment of the dosage should be considered on the behalf of the blood counts before a dose.
How should carmustine be stored:
Unopened vials of the dry powder should be shipped and stored under refrigeration (20°C-80°C). Do not freeze.
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Prescribing information: To know more please see PI. Prior to initiating any treatment consult a physician.