BiCNU (carmustine for injection) should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.
Bone marrow suppression, notably thrombocytopenia and leukopenia, which may contribute to bleeding and overwhelming infections in an already compromised patient, is the most common and severe of the toxic effects of BiCNU (see WARNINGS and ADVERSE REACTIONS).
Since the major toxicity is delayed bone marrow suppression, blood counts should be monitored weekly for at least 6 weeks after a dose (see ADVERSE REACTIONS). At the recommended dosage, courses of BiCNU should not be given more frequently than every 6 weeks.
The bone marrow toxicity of BiCNU is cumulative and therefore dosage adjustment must be considered on the basis of nadir blood counts from prior dose (see “Dosage Adjustment Table” under DOSAGE AND ADMINISTRATION).
Pulmonary toxicity from BiCNU appears to be dose related. Patients receiving greater than 1400 mg/m2 cumulative dose are at significantly higher risk than those receiving less.
Delayed pulmonary toxicity can occur years after treatment, and can result in death, particularly in patients treated in childhood (see ADVERSE REACTIONS and PRECAUTIONS: Pediatric Use).
(carmustine for injection)
BiCNU® (carmustine for injection) is one of the nitrosoureas used in the treatment of certain neoplastic diseases. It is 1,3-bis (2-chloroethyl)-1-nitrosourea.
BiCNU is indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in the following:
- Brain tumors—glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma, and metastatic brain tumors.
- Multiple myeloma—in combination with prednisone.
- Hodgkin’s Disease—as secondary therapy in combination with other approved drugs in patients who relapse while being treated with primary therapy, or who fail to respond to primary therapy.
- Non-Hodgkin’s lymphomas—as secondary therapy in combination with other approved drugs for patients who relapse while being treated with primary therapy, or who fail to respond to primary therapy.
Media Articles Related to Bicnu (Carmustine)
Not Clear: Best Use of Rituximab in Follicular Lymphoma
Source: Medscape Hematology-Oncology Headlines [2014.04.16]
Watching and waiting is the accepted practice for managing patients with asymptomatic, advanced-stage nonbulky follicular lymphoma. But another strategy is being championed.
Medscape Medical News
Lymphoma development and progression may be promoted by inhibition of CDK4
Source: Lymphoma / Leukemia / Myeloma News From Medical News Today [2014.03.24]
Anticancer agents that target a cell-cycle regulatory protein to inhibit tumor growth might actually promote the development and progression of certain B-cell lymphomas, according to a new study led...
Novel Drug Shows Promise in T-Cell Lymphoma
Source: MedPage Today Dermatology [2014.03.24]
DENVER (MedPage Today) -- An investigational drug, resiquimod, successfully healed cutaneous T-cell lymphoma lesions in a small peer-supported trial, researchers reported here.
Early PET negative patients with stage I/II Hodgkin lymphoma show Increased risk of early relapse when radiotherapy is omitted
Source: Lymphoma / Leukemia / Myeloma News From Medical News Today [2014.03.22]
Interim analysis of the intergroup EORTC-LYSA-FIL 20051 H10 trial published in the Journal of Clinical Oncology indicates an increased risk of early relapse when omitting radiotherapy in early PET...
New drug offers potential for chemo-free treatment for leukemia/lymphoma
Source: Lymphoma / Leukemia / Myeloma News From Medical News Today [2014.03.21]
Patients with terminal forms of leukaemia and lymphoma who have run out of treatment options could soon benefit from a new drug, which not only puts an end to chemotherapy and has virtually no side...
Published Studies Related to Bicnu (Carmustine)
The treatment of multiple myeloma using vincristine, carmustine, melphalan, cyclophosphamide, and prednisone (VBMCP) alternating with high-dose cyclophosphamide and alpha(2)beta interferon versus VBMCP: results of a phase III Eastern Cooperative Oncology Group Study E5A93. [2009.05.15]
BACKGROUND: A randomized controlled trial tested the hypothesis that aggressive initial therapy using high-dose cyclophosphamide (HiCy) and alpha(2)beta interferon (IFN) may be superior to standard combination alkylating agent regimens in the treatment of newly diagnosed myeloma... CONCLUSIONS: The study showed no significant benefit with the addition of HiCy and IFN to VBMCP.
Randomized phase II trial of erlotinib versus temozolomide or carmustine in recurrent glioblastoma: EORTC brain tumor group study 26034. [2009.03.10]
PURPOSE: Approximately 50% of glioblastomas (GBMs) are characterized by overexpression of the epidermal growth factor receptor (EGFR) and EGFR gene amplification. In approximately 25% of instances, constitutively activated EGFR mutants are present. These observations make EGFR-inhibiting drugs a logical approach for trials in recurrent GBM... CONCLUSION: Erlotinib has insufficient single-agent activity in unselected GBM. No clear biomarker associated with improved outcome to erlotinib was identified.
Phase III trial of carmustine and cisplatin compared with carmustine alone and standard radiation therapy or accelerated radiation therapy in patients with glioblastoma multiforme: North Central Cancer Treatment Group 93-72-52 and Southwest Oncology Group 9503 Trials. [2006.08.20]
PURPOSE: In patients with newly diagnosed glioblastoma multiforme, to determine whether cisplatin plus carmustine (BCNU) administered before and concurrently with radiation therapy (RT) improves survival compared with BCNU and RT and whether survival using accelerated RT (ART) is equivalent to survival using standard RT (SRT)... CONCLUSION: Cisplatin administered concurrently with BCNU and RT resulted in more toxicity but provided no significant improvement in survival. SRT and ART produced similar toxicity and survival.
Results of a phase I/II trial adding carmustine (300 mg/m2) to melphalan (200 mg/m2) in multiple myeloma patients undergoing autologous stem cell transplantation. [2006.02]
Autologous stem cell transplantation (SCT) with high-dose melphalan (HDM, 200 mg/m2) is the most effective therapy for multiple myeloma. To determine the feasibility of combining carmustine (300 mg/m2) with HDM, we enrolled 49 patients with previously treated Durie-Salmon stage II/III myeloma (32M/17W, median age 53) on a phase I/II trial involving escalating doses of melphalan (160, 180, 200 mg/m2)...
Randomized comparison of stereotactic radiosurgery followed by conventional radiotherapy with carmustine to conventional radiotherapy with carmustine for patients with glioblastoma multiforme: report of Radiation Therapy Oncology Group 93-05 protocol. [2004.11.01]
CONCLUSIONS: Stereotactic radiosurgery followed by EBRT and BCNU does not improve the outcome in patients with GBM nor does it change the general quality of life or cognitive functioning.
Clinical Trials Related to Bicnu (Carmustine)
Gliadel Wafer and Fluorescence-Guided Surgery With 5-ALA Followed by Radiation Therapy And Temozolomide in Treating Patients With Primary Glioblastoma [Recruiting]
RATIONALE: Drugs used in chemotherapy, such as Gliadel wafer and temozolomide, work in
different ways to stop the growth of tumor cells, either by killing the cells or by stopping
them from dividing. Radiation therapy uses high-energy x-rays to kill tumor cells. Giving
radiation therapy and temozolomide after surgery and Gliadel wafer may kill any tumor cells
that remain after surgery.
PURPOSE: This phase II trial is studying the side effects of fluorescence-guided surgery
with 5-ALA given together with Gliadel wafer, followed by radiation therapy and
temozolomide, in treating patients with primary glioblastoma.
Gliadel, XRT, Temodar, Avastin Followed by Avastin, Temodar for Newly Diagnosed Glioblastoma Multiforme (GBM) [Recruiting]
The purpose of this study is to determine the safety and effectiveness of Gliadel wafers at
the time of surgery, followed by the combination of radiation, Temodar, and Avastin, and
then the combination of Avastin and Temodar, after radiation is complete, on malignant brain
About six weeks after surgery, subjects will begin standard radiation therapy, a fixed dose
of Avastin every 2 weeks, and daily Temodar for the six and a half weeks of radiation.
Beginning 2-3 weeks after the last radiation therapy, subjects will be given the same fixed
dose of Avastin intravenously (through the vein) every 14 days. They will also be given a
higher dose of oral Temodar to take daily the first 5 days of each 28-day study cycle.
O6-Benzylguanine and Topical Carmustine in Treating Patients With Early-Stage IA-IIA Cutaneous T-Cell Lymphoma [Recruiting]
This phase I/II trial is studying the side effects of giving O6-benzylguanine together with
topical carmustine and to see how well it works in treating patients with stage IA or stage
IIA cutaneous T-cell lymphoma that has not responded to treatment. Drugs used in
chemotherapy, such as carmustine, work in different ways to stop the growth of cancer cells,
either by killing the cells or by stopping them from dividing. O6-benzylguanine may help
carmustine work better by making cancer cells more sensitive to the drug
Carmustine, Etoposide, Cytarabine, Melphalan, and Antithymocyte Globulin Followed by Peripheral Blood Stem Cell Transplant in Treating Patients With Autoimmune Neurologic Disease That Did Not Respond to Previous Therapy [Recruiting]
This phase II trial studies how well carmustine, etoposide, cytarabine and melphalan
together with antithymocyte globulin before a peripheral blood stem cell transplant works in
treating patients with severe autoimmune neurologic disease that did not respond to previous
therapy. In autoimmune neurological diseases, the patient's own immune system 'attacks' the
nervous system which might include the brain/spinal cord and/or the peripheral nerves.
Giving high-dose chemotherapy, including carmustine, etoposide, cytarabine, melphalan, and
antithymocyte globulin before a peripheral blood stem cell transplant weakens the immune
system and may help stop the immune system from 'attacking' a patient's nervous system. When
the patient's own (autologous) stem cells are infused into the patient they help the bone
marrow make red blood cells, white blood cells, and platelets so the blood counts can
A Study of Gliadel Followed by Avastin + Irinotecan for Glioblastoma Multiforme (GBM) [Recruiting]
The primary objective of the study is to use 24 week survival to assess the efficacy of the
combination of Gliadel followed by Avastin and irinotecan in the treatment of grade IV
malignant glioma patients following surgical resection. The secondary objectives are to
determine the progression-free survival following the combination of Gliadel followed by
Avastin and irinotecan and to describe the toxicity of Gliadel followed by Avastin and
Reports of Suspected Bicnu (Carmustine) Side Effects
Incorrect Storage of Drug (6),
Acute Pulmonary Oedema (4),
Streptococcal Bacteraemia (3),
Myelodysplastic Syndrome (3),
Acute Myeloid Leukaemia (3),
Ejection Fraction Decreased (3),
Necrotising Fasciitis (3), more >>
Page last updated: 2014-04-16