CCNU/Gleostine (CeeNu, lomustine)
Lomustine is a chemotherapy drug commonly used in patients experiencing recurrent brain tumors. It is one of the oldest chemotherapy drugs on the market, well known for treatment of malignant tumors.
How is CCNU supplied?
CCNU is supplied in 100 mg, 40 mg and 10 mg capsules.
How should I take CCNU?
- Take nausea medication (e.g., Kytril, Zofran or Anzemet) one hour before taking CCNU in order to mitigate potential side effect of nausea. .
- You can take CCNU any time of the day.
- This medication should only be taken on ONE day every 6 weeks – also explained as day 1 of a 42-day cycle.
What are common side effects of CCNU and how should I manage them?
Take Kytril or Zofran at least once a day prior to taking chemotherapy dose, but more often if needed. There are also other drugs available to help with nausea if needed.
Take a stool softener/stimulant (e.g., MiraLAX) as needed to keep your bowels regular.
- Bone marrow suppression (decrease in WBC, RBC, PLT)
- White Blood Cells (WBC) – infection fighters
Your white blood cells will be affected by CCNU, probably a little more profoundly than with the Temodar. Your WBC count will be at its lowest point starting about four weeks (day 28) after taking the dose. They may stay low for a few weeks. Most people have a normal WBC count again by week 6 (day 42), but some people may take longer to recuperate. This is a normal side effect of the medication. If you get a fever during the time your WBC count is low, you should call your neuro-oncology team.
- Red Blood Cells (RBC) – oxygen carriers
Anemia may worsen over a period of months. Rarely, a patient may need a blood transfusion.
- Platelets (PLT) – blood-clotting cells
Platelets are more affected with CCNU than they are with Temodar. You may need a platelet transfusion if your platelet counts drops too low, or if you experience any bleeding. Notify your neuro-oncology team if you start experiencing bleeding, unusual bruising or small red dots scattered over your body (this is called petechiae). These may be signs that your platelets are low.
Fatigue associated with CCNU is usually manageable for most patients. Fatigue may be worse during the week of chemotherapy, but for some patients the fatigue may linger for a week or even longer after chemotherapy is completed. Talk to your healthcare provider if fatigue is interfering with your daily life.
CCNU is not usually in stock at your local grocery store or CVS pharmacy. Most university hospital pharmacies will keep this drug in stock. If possible, try to get your CCNU/lomustine prescription filled at UCLA Health to avoid a delay that will occur when your local pharmacy has to order the medication for delivery.