BCNU chemotherapy is used to treat various types of brain tumors like brainstem glioma, astrocytoma, ependymoma, glioblastoma, medulloblastoma and metastatic brain tumors. BCNU or BiCNU are trade names for the drug Carmustine.

BCNU chemotherapy is also used to treat other cancers like lung and colon cancer, multiple myeloma, Hodgkin’s lymphoma, non-Hodgkin’s lymphoma, melanoma, etc.

BCNU is a drug that comes in the form of white powder. This has to be diluted in an alcohol based solution and then administered intravenously. If this drug is not diluted it can cause severe pain and burning. Pill form of this drug is not available as of now. Apart from intravenous administration, this drug is available in a wafer form that can be implanted in the brain at the tumor site once the tumor is removed surgically. The trade name for the wafer form of this drug is Gliadel. This wafer is left in the cavity of the surgically removed brain tumor. This allows maximum concentration of the drug at the tumor site. This is also called as carmustine wafer.

The dosage of this drug depends on the height, weight, other medical conditions if any and overall health of the patient.

Working of BCNU Chemotherapy

BCNU is categorised as an alkylating agent. Alkylating agents act upon the cancer cells in the resting phase of the cell division process. These are cell cycle non-specific drugs. Chemotherapy drugs that affect cells in the resting phase are cell-cycle non-specific. Hence chemotherapy dose is administered considering the type of cells, the rate at which they divide and at the time the drug would be most effective. These factors can be found out from certain tests done before and after the chemotherapy.

Side Effects of BCNU Chemotherapy

• Nausea and vomiting after infusion that lasts for 4-6 hours. Anti-emetic medication is recommended prior to the infusion to prevent this side effect.
• Pain and burning at the IV site that can be reduced by diluting the drug more during infusion depending on your doctor.
• Low blood counts leading to increased susceptibility to infections, anemia or bruising depending on the type of blood cells that reduce in number like white cells, red cells or platelets.
• Facial flushing or redness

Relatively Rare Side Effects

• Low red blood cell count leading to anemia.

• Low blood pressure or hypotension due to high doses of the drug
• Eye problems like redness of eyes, blurred vision or retinal bleeding.
• Increased numbers in blood tests checking liver function
• Dizziness, loss of coordination or confusion.

Delayed Side Effects of BCNU Chemotherapy

• Pulmonary toxicity or lung damage especially if the drug dose is high. This could occur after 2-3 yrs post treatment. Hence it is essential to get the lung function tests done before and after the chemotherapy as well as periodic tests.

• There is a risk of developing leukemia months or years after undergoing BCNU chemotherapy.

Precautions for BCNU Chemotherapy

• Inform your doctor about any medications including OTC medications, herbs, supplements, alternative therapies, etc that you are taking or have taken in the past.

• Do not take aspirin or aspirin based products without consulting your doctor.
• Do not get yourself vaccinated against a particular disease without your doctor’s approval.
• Inform your doctor in case you or your partner is pregnant, a lactating mother or plan to conceive a baby as this drug could be harmful for a developing fetus.
• Do not breast feed while undergoing BCNU chemotherapy as this drug could enter the breast milk and prove harmful for the baby.

BCNU chemotherapy has been effective in some cases at times when combined with other drugs and surgery. However, due to the possibility of a recurrence, regular follow ups, balanced diet and a healthy lifestyle is essential.