CeeNU®

Posted on April 28th, 2009 by

Class: Chemotherapy

Generic Name: Lomustine (loh-MUS-teen), CCNU
Trade Name: CeeNU®

How is this drug used? Lomustine is FDA approved for the treatment of brain tumors, either those that have originated in the brain or have spread to the brain from a different site in the body, in patients who have already received appropriate surgery or radiation therapy.  Lomustine, in combination with other agents, is also approved for the treatment of Hodgkin’s disease that has recurred or has never responded to previous therapy. It is important for patients to remember that physicians have the ability to prescribe medication for conditions other than those for which the drug has been approved by the FDA. Patients who have received a prescription of this drug for a condition other than which it is approved may wish to discuss this issue with their physician.

What is the mechanism of action? Lomustine belongs to a class of drugs called alkylating agents.  Alkylating agents produce their anti-cancer effects by causing a chemical reaction that damages the DNA and RNA in a cell.  The DNA damage caused by lomustine results in cell death.

How is lomustine given (administered)? Lomustine is given by mouth in capsule form and the dose depends on several factors, including the condition being treated, the size of the patient, the particular regimen being used and the overall health of the patient.

How are patients monitored? Patients will usually have scheduled meetings with their healthcare provider while they are being treated with lomustine.  Typically, blood will be drawn to check levels of blood cells and to monitor functions of some organ systems, such as the kidneys or liver.  Patients may also undergo physical examinations, scans or other measures to assess side effects and response to therapy.  In addition, patients will have their lung function monitored, as serious lung complications may occur, although this is rare. Patients will also have their kidney function monitored, including swelling of the ankles or feet.

What are the common (occur in 30% or more of patients) side effects of treatment with lomustine?

• Low white blood cell levels – increases the risk of infection
• Low red blood cell levels – increases the risk of anemia
• Low platelet levels – increases the risk of bleeding
• Nausea and vomiting

What are the less common (occur in 10% to 29% of patients) side effects of treatment with lomustine?

• Loss of appetite
• Mouth sores
• Infertility

This is not a complete list of side effects. Some patients may experience other side effects that are not listed here. Patients may wish to discuss with their physician the other less common side effects of this drug, some of which may be serious.

Some side effects may require medical attention. Other side effects do not require medical attention and may go away during treatment. Patients should check with their physician about any side effects that continue or are bothersome.

What are the possible late side effects of treatment with lomustine?
Lung complications are a rare but serious side effect that may occur years following treatment with lomustine. In addition, late side effects may occur to the kidneys. Patients will be monitored for these side effects, which tend to occur with accumulated doses of lomustine. However, should patients experience difficulty breathing, cough, swelling of the ankles, feet or hands, and/or sudden weight gain, they should contact their healthcare provider. Patients are also at a slightly increased risk of developing a secondary malignancy associated with treatment with lomustine. A secondary malignancy is a new and unrelated cancer that occurs in an individual as a result of previous treatment with radiation or chemotherapy.  Patients should ask their physician about the possibility of developing a secondary malignancy as a result of their treatment.

What can patients do to help alleviate or prevent discomfort and side effects?

• Lomustine should be taken on an empty stomach, unless the patient is instructed otherwise.
• Pay careful attention to the physician’s instructions and inform the physician of any side effects.
• Maintain adequate rest and nutrition.
• Wear sunscreen and protective clothing and try to minimize sun exposure.
• Drink plenty of fluids. (Patients should ask their physician about the amount of liquid to consume during a day.)
• If possible, avoid large crowds or people who are sick or not feeling well, as this drug may leave some patients susceptible to infection.
• Wash hands often to reduce the risk of infection.
• Eat small meals frequently to help alleviate nausea.
• If patients have been prescribed an anti-nausea medication, they should be sure to take the prescribed doses.
• Avoid activities that may cause injury or bruising.
• Use a soft toothbrush and an electric razor to prevent cuts on the mouth or skin.
• For mouth sores, patients should rinse their mouth three times a day with a salt and soda solution (8 ounces of water mixed with ½ to 1 tsp baking soda and/or ½ to 1 tsp salt) and brush their teeth with a soft toothbrush to help prevent the development of mouth sores.

Are there any special precautions patients should be aware of before starting treatment?

• Patients should inform their physician if they are pregnant, breastfeeding or planning a family in the near future. This drug may cause birth defects. It is important to use some kind of birth control while undergoing treatment. Also, patients may want to talk to their physician if they are considering having children in the future, since some drugs may cause fertility problems.
• It is important that patients inform their physician of any pre-existing conditions (chicken pox, heart disease, kidney disease, liver disease, lung disease, etc.) as they may worsen with this drug.
• Patients should inform their physician of any other medication they are taking (whether prescription or over-the-counter, including vitamins, herbs, etc.) as they may interfere with treatment.
• Patients should check with their physician before starting any new drug or nutritional supplement.
• Patients should inform their physician of any known drug or food allergies or any reactions to medications they have experienced in the past.
• Patients should use caution when driving or completing tasks that require mental alertness until effects of the drug are known

When should patients notify their physician?

• Difficulty breathing, wheezing, cough
• Swelling of the feet, hands and/or ankles
• Sudden weight gain
• Low or no urine output
• Flu or cold-like symptoms – fever, sore throat, cough, chills
• Signs of infection – redness, swelling, pus, tenderness, painful urination
• Persistent or severe fatigue
• Skin rash, hives or itching
• Yellowng of eyes or skin
• Mouth sores
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)
• Vision changes
• Mental confusion
• Severe or prolonged nausea or vomiting
• Diarrhea
• Unexplained or excessive bleeding (nosebleeds, bruising, black tarry stools, blood in the urine, etc.)

What is a package insert?
A package insert is required by the FDA and contains a summary of the essential scientific information needed for the safe and effective use of the drug for healthcare providers and consumers.  A package insert typically includes information regarding specific indications, administration schedules, dosing, side effects, contraindications, results from some clinical trials, chemical structure, pharmacokinetics and metabolism of the specific drug. Click here to view the package insert

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Tags: C, Chemotherapy

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