Drug Detail:Lomustine (Lomustine [ loe-mus-teen ])
Drug Class: Alkylating agents
Usual Adult Dose for Brain/Intracranial Tumor
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
Comments:
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
Uses:
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN'S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Usual Adult Dose for Hodgkin's Disease
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
Comments:
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
Uses:
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN'S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Usual Pediatric Dose for Brain/Intracranial Tumor
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
Comments:
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
Uses:
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN'S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Usual Pediatric Dose for Hodgkin's Disease
As a single agent in previously untreated patients:
- 130 mg/m2 orally as a single dose every 6 weeks
As a single agent in patients with compromised bone marrow function:
- 100 mg/m2 orally as a single dose every 6 weeks
Comments:
- The dose should be adjusted accordingly when this drug is used in combination with other myelosuppressive drugs.
- All doses of this drug should be rounded to the nearest 10 mg by the prescriber.
- Only a single dose of this drug should be dispensed.
Uses:
As a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in the following:
- BRAIN TUMORS: both primary and metastatic tumors; in patients who have already received appropriate surgical and/or radiotherapeutic procedures.
- HODGKIN'S DISEASE: secondary therapy in combination with other approved drugs; in patients who relapse while being treated with primary therapy or who fail to respond to primary therapy.
Renal Dose Adjustments
Dose adjustments may be required; however, no specific guidelines have been provided in the manufacturer product information.
Liver Dose Adjustments
Dose adjustments may be required; however, no specific guidelines have been provided in the manufacturer product information. Caution is recommended in patients with liver dysfunction as this drug is hepatically metabolized.
Dose Adjustments
Doses subsequent to the initial dose should be adjusted according to the hematologic response of the patient to the preceding dose:
NADIR AFTER PRIOR DOSE:
- 4000/mm3 or greater leukocytes; 100,000/mm3 or greater platelets: 100% of prior dose to be given
- 3000 to 3999/mm3 leukocytes; 75,000 to 99,999/mm3 platelets: 100% of prior dose to be given
- 2000 to 2999/mm3 leukocytes; 25,000 to 74,999/mm3 platelets: 70% of prior dose to be given
- Less than 2000/mm3 leukocytes; less than 25,000/mm3 platelets: 50% of prior dose to be given
Comments:
- A repeat course should not be given until circulating blood elements have returned to acceptable levels (leukocytes above 4000/mm3; platelets above 100,000/mm3).
- Repeat courses should not be given before 6 weeks because the hematologic toxicity is delayed and cumulative.
- Adequate number of neutrophils should be present on a peripheral blood smear; blood counts should be monitored weekly.
Precautions
US BOXED WARNING:
- BONE MARROW SUPPRESSION: The most common and severe of the toxic effects is bone marrow suppression/myelosuppression (notably thrombocytopenia and leukopenia) which may contribute to bleeding and overwhelming infections in an already compromised patient. The bone marrow toxicity is cumulative; dosage adjustments must be considered based on nadir blood counts from prior dose. Blood counts should be monitored weekly for at least 6 weeks after a dose. At the recommended dosage, courses of this drug should not be given more frequently than every 6 weeks.
- EXPERIENCED PHYSICIAN: This drug should be administered under the supervision of a qualified physician experienced in the use of cancer chemotherapeutic agents.
Consult WARNINGS section for additional precautions.
Dialysis
Dose adjustments may be required; however, no specific guidelines have been provided in the manufacturer product information.
Other Comments
Administration Advice:
- Administering of this drug on an empty stomach may reduce the incidence of nausea and vomiting.
- Rubber or latex gloves should be worn when handling containers and capsules of this drug.
- Areas that come into contact with broken capsules should be washed immediately and thoroughly with soap and water.
- Handling and disposal of this drug should be performed in a manner consistent with safe procedures for cytotoxic agents.
Storage Requirements:
- Store below 25C/77F; avoid excessive heat (over 40C/104F).
- Store in the original container to protect from light and moisture.
General:
- In order to provide the proper dose of this drug, the prescribed dose may be made up of 2 or more different strengths and colors of capsules; only the appropriate number of drug capsules required for a single dose should be dispensed and different capsule strengths should be dispensed separately.
- Cross resistance with other nitrosoureas is usual (cross resistance between this drug and carmustine has occurred), but cross resistance with conventional alkylating agents is unusual.
- Overdosage: Accidental overdose has been associated with bone marrow suppression, abdominal pain, diarrhea, vomiting, anorexia, lethargy, dizziness, abnormal hepatic function, cough, and shortness of breath. No proven antidotes have been established; treat overdosage immediately with gastric lavage and appropriate supportive measures.
Monitoring:
- Hematological: Blood counts (prior to treatment, then weekly for 6 weeks after a dose)
- Hepatic: Liver function tests (periodically)
- Renal: Kidney function tests (periodically)
- Respiratory: Pulmonary function tests (prior to and frequently during treatment)
