Carmustine

Carmustine is a bicyclohexylnitrosourea (BCNU, Fig. 3) with broad spectrum of antineoplastic activity (e.g., lymphomas, multiple myeloma, sarcomas, brain tumors, gastrointestinal tumors, melanomas). At doses of 80-200 mg/m2 it is given i.v. at 6 week s intervals. 

Carmustine and lomustine can produce remissions that last 3-6 months in 40-50% ofpatients with primary... 

Other subgroups of alkylating agents are the nitrosoureas (examples carmustine, BCNU lomustine, CCNXJ) and the triazenes (example dacarbazine, DTIC). Platinum derivatives (cisplatin, carboplatin, oxaliplatin) have an action that is analogous to that of alkylating agents (formation of crosslinks) and therefore are appended to this class, as well. 

Alkaline phosphatase, an enzyme with a molecular weight of approximately 86,000, has been incorporated into a polyanhydride matrix using compression molded PCPP-SA 9 91. Five percent loaded wafers, 50 mg each, were perpared, and measured 1.4 cm in diameter, with a thickness of 0.5 mm. Release experiments were then conducted using techniques similar to those described for carmustine above. As can be seen in Pig. 13, the alkaline phosphatase was released in a well-controlled manner over a prolonged period of time, just over a month, from this polyanhydride. 

Bleomycin, busulfan, carmustine, cyclophosphamide, methotrexate, mitomycin, and radiation therapy... 

Carmustine, a nitrosurea, cross-links DNA strands to inhibit DNA replication. Carmustine, which is reconstituted with... 

Lomustine is an orally available nitrosurea alkylating agent. Lomustine is converted rapidly to the cis- and frans-4-hydroxy metabolites the range of half-lives of these two metabolites is 2 to 4 hours.25 Lomustine has shown clinical activity in the treatment of Hodgkin s lymphoma and melanoma. Side effects are similar to those of carmustine. Patients should receive only enough drug for one cycle at a time to prevent confusion and accidental overdose. 

BCV (high-dose with autologous stem cell transplant)3 Carmustine 400 mg/m2 IV x 1 day Etoposide 800 mg/m2 IV daily x 3 days Cyclophosphamide 1800 mg/m2 IV daily x 4 days... 

Autologous110 Myeloablative BEAM (carmustine/ etoposide/-cytarabine/melphalan) ... 

Carmustine—maximum total dose is 1440 mg/M2 causes delayed myelosuppression... 

Dexa-BEAM dexamethasone/ carmustine (BCNU)/ etoposide (VP-16)/ cytarabine (Ara-C)/ melphalan Dexamethasone 8 mg PO Q8H days 1 -10 BCNU 60 mg/M2 IV day 2 VP-16 75 mg/M2 IV days 4-7 Ara-C 100 mg/M2 IVQ12H days 4-7 Melphalan 20 mg/M2 IV day 3 REF Pfreundschuh etal. J Clin Oncol 1994 12 580-586 PREMEDICATIONS 1. Kytril 1 mg PO/IV 30 minutes before and 12 hours after chemotherapy on days 2 and 3 2. Compazine 10 mg PO/IV 30 minutes before chemotherapy on days 4-7 OTHER MEDICATIONS 1. Give non-cisplatin delayed emesis prophylaxis Repeat every 28 days Carmustine—maximum total dose is 1440 mg/M2 causes delayed myelosuppression... 

Carmustine (BCNU) -alkylating agent (cell cycle-independent mechanism) -bone marrow suppression—delayed with a nadir of 3-5 weeks -nausea and vomiting—can be severe and prolonged -facial flushing -interstitial lung disease (dose independent)... 

The answer is c. (Hardman, pp 1238-1239.) Remission maintenance can be carried out by combination therapy, which includes cyclophosphamide. Cyclophosphamide causes hemorrhagic cystitis. Doxorubicin and carmustine are useful in the treatment of acute lymphatic leukemia, but neither is known to cause hemorrhagic cystitis. 

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