A chemotherapy for brain tumours and some blood cancers
Carmustine
A chemotherapy used for brain tumours and some blood cancers, sometimes given as a wafer placed in the brain.
What is Carmustine?
Carmustine is a chemotherapy medicine from the nitrosourea group, used to treat brain tumours and some blood cancers such as certain lymphomas and myeloma. It can be given by drip into a vein or, in some brain tumours, placed during surgery as a wafer directly into the brain. It works by damaging the DNA of cancer cells so they cannot keep dividing. Its most important risk is delayed and prolonged bone-marrow suppression — a fall in blood cells that can come weeks after treatment and last a long time, raising the risk of infection, bleeding and anaemia. It can also cause lung scarring (fibrosis). It is given only by cancer specialists.
Education and reference only. This is a plain-language guide to Carmustine — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Carmustine is a chemotherapy medicine belonging to a group called nitrosoureas. It is used to treat certain brain tumours and some blood cancers, such as particular lymphomas and myeloma. It can be given as a drip into a vein, and in some brain tumours it is also available as a wafer that the surgeon places directly into the area where a tumour has been removed, so it releases the medicine close to where it is needed. It is a powerful treatment given only by specialist cancer teams, who plan and monitor it carefully.
How it works
Carmustine works by damaging the DNA inside cancer cells, the instructions cells need to grow and divide. By cross-linking and disrupting this DNA, it stops cancer cells from multiplying and causes them to die. A particular feature of carmustine is that it can cross into the brain, which is why it is useful for brain tumours and can also be placed there as a wafer. Because it acts on dividing cells generally, it also affects fast-dividing healthy cells, especially in the bone marrow, which is the source of its main delayed side effect of low blood counts.
Company & origin
Originated / developed by: Specialist manufacturer.
A chemotherapy medicine used for brain tumours and some blood cancers, sometimes also placed as a wafer into the brain during surgery.
Practical use
How to take Carmustine
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- It is given by a specialist cancer team, either as a drip into a vein or as a wafer placed in the brain during surgery; it is not taken at home.
- Attend all your blood tests, as the fall in blood cells can be delayed and prolonged and the timing of treatment depends on recovery.
- Report any signs of infection, such as fever, or any unusual bruising or bleeding, straight away.
- Tell your team about any new cough or breathlessness, as carmustine can affect the lungs.
- Keep all your monitoring appointments, including breathing, liver and kidney checks, over the long term.
Weighing it up
Advantages & disadvantages of Carmustine
Advantages
- An effective chemotherapy for certain brain tumours and some blood cancers.
- Able to reach the brain, and available as a wafer placed directly where a brain tumour has been removed.
- Given and managed by specialist cancer teams as part of a planned treatment programme.
Disadvantages
- Causes delayed and prolonged bone-marrow suppression, lowering blood cells for a long time.
- Can cause lung scarring (fibrosis), sometimes appearing late.
- Can affect the liver and kidneys and cause nausea, and must be given by specialists.
Practical use
Good to know
The most important thing to understand about carmustine is its effect on the bone marrow, where blood cells are made. It causes bone-marrow suppression that is characteristically delayed and prolonged — the fall in blood cells often comes some weeks after a dose and can last a long time. This lowers white cells (raising the risk of infection), platelets (raising the risk of bleeding and bruising) and red cells (causing anaemia and tiredness), so blood counts are watched closely and the timing of further treatment is spaced to allow recovery. Another serious risk is lung scarring (pulmonary fibrosis), which can occur and may appear even years later, so breathing is monitored and any new cough or breathlessness should be reported. It can also affect the liver and kidneys and cause nausea. It is always given by specialist cancer teams who manage these risks.
Who should not take it / use with caution
- People who have had a serious allergic reaction to carmustine should not be given it.
- It is not used when the bone marrow is already severely suppressed with very low blood counts.
- It is used with great caution in people with existing lung, liver or kidney problems, under specialist supervision.
- It is avoided in pregnancy because of the risk of harm to the baby, and effective contraception is advised.
Monitoring
- Regular blood counts, watching for the delayed and prolonged fall in blood cells.
- Breathing tests and watching for any cough or breathlessness, as the lungs can be affected.
- Checking liver and kidney function over the course of treatment.
Side effects
- Delayed and prolonged low blood counts, raising the risk of infection, bleeding and anaemia.
- Nausea and vomiting, often managed with anti-sickness medicines.
- Lung scarring (fibrosis), which can appear late and needs monitoring.
- Effects on the liver and kidneys, and irritation at the drip site.
Key interactions
- Other medicines that lower blood counts add to the risk of bone-marrow suppression.
- Some medicines may add to the strain on the liver, kidneys or lungs, so the team reviews everything you take.
- Live vaccines are generally avoided during treatment, as the immune system is weakened.
Available as: A solution given by drip into a vein, and a wafer placed in the brain during surgery.
Answers
Carmustine: frequently asked questions
What is carmustine used for?
It is a chemotherapy used for certain brain tumours and some blood cancers such as particular lymphomas and myeloma; it can be given by drip or placed as a wafer in the brain.
Why are my blood counts checked so carefully?
Carmustine causes a delayed and prolonged fall in blood cells that often comes weeks after a dose, so counts are watched closely and treatment is spaced to allow recovery.
Can it affect my lungs?
Yes, it can cause lung scarring (fibrosis), sometimes appearing late, so your breathing is monitored and any new cough or breathlessness should be reported.
What is the wafer form?
In some brain tumours, the surgeon places a wafer of carmustine directly into the area where the tumour was removed, so it releases the medicine close to where it is needed.
Who gives carmustine?
It is given only by specialist cancer teams, who plan the treatment, manage the side effects and monitor your blood, lungs, liver and kidneys.
The wider class
About Nitrosourea chemotherapy
Carmustine belongs to the nitrosourea chemotherapy class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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