Lomustine

Lomustine also called CCNU or gleostine, is a cancer medicine used to treat certain types of brain tumors in people who have already been treated with surgery or radiation therapy. Lomustine is also used with other cancer medicines to treat Hodgkin’s lymphoma (Hodgkin’s disease) that has not improved or that has worsened after treatment with other medications. Lomustine is in a class of medications called alkylating agents. Lomustine alkylates and crosslinks DNA, thereby inhibiting DNA and RNA synthesis. Lomustine also carbamoylates DNA and proteins, resulting in inhibition of DNA and RNA synthesis and disruption of RNA processing. Lomustine is lipophilic and crosses the blood-brain barrier. Lomustine works by interfering with the growth of cancer cells and slows their spread in your body.

Lomustine comes as a capsule to take by mouth. It is usually taken once every 6 weeks on an empty stomach. Your full dose may contain two or more different types and colors of capsules. You will receive only enough capsules for one dose. Take all of the capsules given to you in the prescription bottle at the same time. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lomustine exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You should wear rubber or latex gloves when you handle the capsules so that your skin does not come into contact with the capsules. If the capsule contents touch your skin, wash the area well with soap and water right away.

Swallow the capsules whole; do not split, chew, or crush them.

Ask your pharmacist or doctor for a copy of the manufacturer’s information for the patient.

What should I avoid while taking lomustine?

Avoid being near people who are sick or have infections. Tell your doctor at once if you develop signs of infection.

Do not receive a “live” vaccine while using lomustine, and avoid coming into contact with anyone who has recently received a live vaccine. There is a chance that the virus could be passed on to you. Live vaccines include measles, mumps, rubella (MMR), rotavirus, typhoid, yellow fever, varicella (chickenpox), zoster (shingles), and nasal flu (influenza) vaccine.

lomustine can pass into body fluids (urine, feces, vomit). Caregivers should wear rubber gloves while cleaning up a patient’s body fluids, handling contaminated trash or laundry or changing diapers. Wash hands before and after removing gloves. Wash soiled clothing and linens separately from other laundry.

Lomustine mechanism of action

Lomustine is a type of nitrosourea alkylating agent. Alkylating agents keep the cell from reproducing (making copies of itself) by damaging its DNA. Alkylating agents work in all phases of the cell cycle and are used to treat many different cancers, including cancers of the lung, breast, and ovary as well as leukemia, lymphoma, Hodgkin disease, multiple myeloma, and sarcoma.

Nitrosoureas are a group of alkylating agents that have a special action. Unlike other alkylating agents that cannot travel into the brain, but nitrosourea alkylating agents are able to do so. They can enter the brain because they are able to cross through the area known as the blood-brain barrier, a special area that keeps most drugs out of the brain. This action makes these drugs useful in treating certain types of brain tumors.

Because these drugs damage DNA, they can affect the cells of the bone marrow which make new blood cells. In rare cases, this can lead to leukemia. The risk of leukemia from alkylating agents is “dose-dependent,” meaning that the risk is small with lower doses, but goes up as the total amount of the drug used gets higher. The risk of leukemia after getting alkylating agents is highest about 5 to 10 years after treatment.

Lomustine uses in cancer

Lomustine is approved to be used alone or with other drugs to treat:

• Brain tumors. It is used in patients who have already had surgery or radiation therapy.
• Hodgkin lymphoma. It is used in patients whose disease has not gotten better with other types of treatment or has recurred (come back).

Lomustine is also being studied in the treatment of other types of cancer.

Lomustine special precautions

Before taking lomustine:

• tell your doctor and pharmacist if you are allergic to lomustine, any other medications, or any of the ingredients in lomustine capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take.
• you should know that lomustine may decrease fertility in men and women. However, you should not assume that you or your partner cannot become pregnant. Tell your doctor if you are pregnant or plan to become pregnant. If you are female, you should use birth control to prevent pregnancy during your treatment with lomustine and for at least 2 weeks after your final dose. If you are male, you and your female partner should use birth control during your treatment with lomustine and continue for 4 months after your final dose. If you or your partner become pregnant while taking lomustine, call your doctor. Lomustine may harm the fetus.
• tell your doctor if you are breast-feeding or plan to breast-feed. You should not breast-feed while taking lomustine and for 2 weeks after your final dose.

It is very important that your doctor check your progress at regular visits to make sure that lomustine is working properly. Blood tests may be needed to check for unwanted effects.

Using lomustine while you are pregnant can harm your unborn baby. Use an effective form of birth control to keep from getting pregnant. If you think you have become pregnant while using the medicine, tell your doctor right away.

Check with your doctor right away if you have any of the following symptoms: fever, chills, dry cough, sore throat, confusion, shortness of breath, swelling of the feet or lower legs, unusual bleeding or bruising, or yellow eyes or skin.

While you are being treated with lomustine, and after you stop treatment with it, do not have any immunizations (vaccinations) without your doctor’s approval. Lomustine may lower your body’s resistance and there is a chance you might get the infection the immunization is meant to prevent. In addition, other persons living in your household should not take oral polio vaccine since there is a chance they could pass the polio virus on to you. Also, avoid persons who have recently taken oral polio vaccine. Do not get close to them, and do not stay in the same room with them for very long. If you cannot take these precautions, you should consider wearing a protective face mask that covers the nose and mouth.

Lomustine can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

• If you can, avoid people with infections. Check with your doctor right away if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
• Check with your doctor immediately if you notice any unusual bleeding or bruising; black, tarry stools; blood in the urine or stools; or pinpoint red spots on your skin.
• Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
• Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
• Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
• Avoid contact sports or other situations where bruising or injury could occur.

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children

Appropriate studies on the relationship of age to the effects of lomustine have not been performed in the pediatric population. However, pediatric-specific problems that would limit the usefulness of this medicine in children are not expected.

Geriatric

No information is available on the relationship of age to the effects of lomustine in geriatric patients. However, elderly patients are more likely to have age-related kidney problems, which may require an adjustment in the dose for patients receiving lomustine.

Breastfeeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Drug Interactions

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lomustine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using lomustine with any of the following medicines is not recommended. Your doctor may decide not to treat you with lomustine or change some of the other medicines you take.

• Measles Virus Vaccine, Live
• Mumps Virus Vaccine, Live
• Rotavirus Vaccine, Live
• Rubella Virus Vaccine, Live
• Varicella Virus Vaccine, Live
• Zoster Vaccine, Live

Using lomustine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

• Adenovirus Vaccine
• Bacillus of Calmette and Guerin Vaccine, Live
• Cholera Vaccine, Live
• Dengue Tetravalent Vaccine, Live
• Influenza Virus Vaccine, Live
• Poliovirus Vaccine, Live
• Smallpox Vaccine
• Typhoid Vaccine
• Yellow Fever Vaccine

Other interactions

• Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems

The presence of other medical problems may affect the use of lomustine. Make sure you tell your doctor if you have any other medical problems, especially:

• Anemia (low red cells in the blood) or
• Bone marrow problems or
• Leukopenia (low white cells in the blood) or
• Lung disease or
• Thrombocytopenia (low platelets in the blood)—May make these conditions worse.
• Chickenpox, including recent exposure, or
• Herpes zoster (shingles) or
• Infection—May decrease the ability to fight an infection.
• Kidney disease—Effects may be increased because of slower removal from the body.

Lomustine dose

Take lomustine only as directed by your doctor. Do not take more or less of it than your doctor ordered. The exact amount of medicine you need has been carefully worked out. Taking too much may increase the chance of side effects, while taking too little may not improve your condition.

In order that you receive the proper dose of lomustine, there may be two or more different types of capsules in the container. This is not an error. It is important that you take all of the capsules in the container at the same time so you receive the right dose of the medicine.

Be careful while handling lomustine. Wear gloves when touching the capsules containing lomustine. Do not break, crush, or open the capsules. If any of lomustine gets on your skin or in your nose or mouth, wash the area with soap and water right away. If the medicine gets in your eyes, wash them with water right away and call your doctor.

This medicine is sometimes given together with other medicines. If you are using a combination of medicines, make sure that you take each one at the right time and do not mix them. Ask your doctor to help you plan a way to remember to take your medicines at the right time.

Nausea and vomiting often occur with lomustine, but usually last less than 24 hours. Loss of appetite may last for several days. This medicine is best taken on an empty stomach at bedtime, so it will cause less stomach upset. Ask your doctor for other ways to lessen these side effects.

If you vomit shortly after taking a dose of lomustine, check with your doctor. You may be told to take the dose again.

Lomustine dosing

The dose of lomustine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of lomustine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For oral dosage form (capsules):
  • For brain tumors or Hodgkin’s disease:
    • Adults and children—Dose is based on body surface area and must be determined by your doctor. The usual dose is 130 milligrams (mg) per square meter (m(2)) of body surface area, given as a single dose every 6 weeks. Your doctor may adjust your dose if needed.

What should I do if I forget a dose?

Take the missed dose as soon as you remember it. Tell your doctor if you take your dose on a different day from what was scheduled.

Lomustine side effects

Lomustine may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• loss of appetite
• sores in the mouth and throat
• unusual tiredness or weakness
• pale skin
• fainting
• hair loss
• unsteady walk
• slurred speech

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, stop taking lomustine and call your doctor immediately or get emergency medical treatment:

• difficulty breathing
• shortness of breath
• dry cough
• chest pain
• wheezing
• decreased urination;
• swelling of the face, arms, hands, feet, ankles, or lower legs.
• yellowing or eyes and skin
• confusion
• sudden change or loss of vision

Lomustine may increase the risk that you will develop other cancers. Talk to your doctor about the risks of taking lomustine.

Symptoms of lomustine overdose may include the following:

• black, tarry stools
• red urine
• unusual bruising or bleeding
• unusual tiredness or weakness
• sore throat, cough, fever, or other signs of infection
• dizziness
• shortness of breath
• diarrhea
• vomiting
• stomach pain
• sores in the mouth and throat

Lomustine may cause other side effects. Call your doctor if you have any unusual problems while taking lomustine.