Lomustine (CEENU)

Brain cancer, adjuvant or recurrent

Brain cancer, adjuvant or recurrent

• Oral: 110 mg/m² or 130 mg/m² on day 1 every 6 weeks (duration depends on cycle length of protocol)
• Given as monotherapy or in combination with other chemotherapy agents

Available as 10 mg, 40 mg and 100 mg capsules. Capsules should NOT be opened. Protect from light. Store at room temperature.

Alkylating Agent (Nitrosourea)

Take on an empty stomach, 1 hour before or 2 hours after food

If a dose is missed, patients should be instructed to seek guidance from their healthcare team on how to proceed.

Common: Nausea, Vomiting, Anorexia, Myelosuppression.

Less Common: Pulmonary toxicity, Hepatotoxicity.

The adverse effects listed above are not exhaustive. Please refer to the relevant product monograph for full details.

Baseline before treatment: CBC & differential, platelets, creatinine, serum glucose (for patients on dexamethasone), ALT, bilirubin, neuroimaging,  pulmonary function tests (in at risk patients).

During treatment: CBC & differential, ALT, bilirubin, creatinine.

Day 28 of each cycle: CBC & differential, platelets.

If clinically indicated: Clinical pulmonary exam, pulmonary toxicity ratings, neuroimaging.

• This drug can impact or be impacted by metabolic enzymes for absorption and excretion. Many drugs can also affect or be affected by these enzymes, so please consult with pharmacy to assess for interactions.
• Current drug interaction databases should be consulted for more information.

• Avoid in pregnancy and lactation.
• Myelosuppression is delayed, dose-related, and cumulative, and can be serious.
• Health care professionals should emphasize to the patient that only one dose of lomustine is taken every 6 weeks to minimize risk of dosing errors.

BC Cancer. BC Cancer Drug Manual. Lomustine. Vancouver, British Columbia: BC Cancer Agency. Available at: http://www.bccancer.bc.ca/drug-database-site/Drug%20Index/Lomustine_monograph.pdf.  Updated June 5, 2018. Accessed January 22, 2024.

Lexicomp. Lomustine Monograph. In: Lexi-Drugs. Hudson, Ohio: Lexi-Comp, Inc. Available at: https://online-lexi-com.qe2a-proxy.mun.ca/lco/action/doc/retrieve/docid/patch_f/7191?cesid=67yEozKznUi&searchUrl=%2Flco%2Faction%2Fsearch%3Fq%3Dlomustine%26t%3Dname%26acs%3Dtrue%26acq%3Dlomustine. Updated January 24, 2024. Accessed January 31, 2024.

Cancer Care Ontario. Lomustine Monograph. Drug Formulary. Toronto, Ontario: Cancer Care Ontario. Available at: https://www.cancercareontario.ca/en/drugformulary/drugs/monograph/44171 . Updated June 2019. Accessed January 22, 2024

Bristol Laboratories of Canada. CeeNU® (lomustine) Product Monograph. Montreal, Quebec. Updated February 17, 2016.