Lomustine (CCNU)

General information

Class/mechanism: Nitrosourea, alkylates DNA and RNA and may inhibit certain key enzymatic reactions by carbamoylation of amino acids in proteins.
Route: PO
Extravasation: n/a

For conciseness and simplicity, HemOnc.org currently will focus on treatment regimens and not list information such as: renal/hepatic dose adjustments, metabolism (including CYP450), excretion, monitoring parameters (although this will be considered for checklists), or manufacturer. Instead, for the most current information, please refer to your preferred pharmacopeias such as Micromedex, Lexicomp, UpToDate (courtesy of Lexicomp), or the prescribing information.

Diseases for which it is used

• Acute myeloid leukemia
• Anaplastic glioma
• CNS lymphoma
• Glioblastoma
• High-grade glioma, pediatric
• Low-grade glioma
• Medulloblastoma

Diseases for which it was used

• Hodgkin lymphoma
• Non-small cell lung cancer
• Ovarian cancer
• Small cell lung cancer

Patient drug information

• Lomustine (Ceenu) package insert
• Lomustine (Ceenu) patient drug information (Chemocare)
• Lomustine (Ceenu) patient drug information (UpToDate)

History of changes in FDA indication

• 1976-08-04: Initial approval
• 2009-04-30: (oldest available label) has been shown to be useful as a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in brain tumors - both primary and metastatic, in patients who have already received appropriate surgical and/or radiotherapeutic procedures. (No supporting studies are cited)
• 2009-04-30: (oldest available label) has been shown to be useful as a single agent in addition to other treatment modalities, or in established combination therapy with other approved chemotherapeutic agents in 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. (No supporting studies are cited)

History of changes in EMA indication

• 1976-01-26: EURD

Also known as

• Generic names: CCNU
• Brand names: CeeNu, Gleostine
  • In 10/2013, Bristol-Myers Squibb discontinued production of their Lomustine brand name, CeeNu. Lomustine is currently supplied as Gleostine by NextSource Biotechnology LLC.

COG ACNS0331 Lomustine Dosing Nomogram

Available Capsule Sizes

• 10 mg
• 40 mg
• 100 mg

Body Surface Area (m2)	Ideal Dose (75 mg/m2/day once daily)	Actual Dose to be Given
2.0	150 mg,	150 mg
1.9	143	140
1.8	135	130
1.7	128	130
1.6	120	120
1.5	112	110
1.4	105	100
1.3	98	100
1.2	90	90
1.1	82	80
1.0	75	80
0.95	71	70
0.9	68	70
0.85	64	60
0.8	60	60
0.75	56	60
0.7	53	50
0.65	49	50
0.6	45	40
0.55	41	40
0.5	38	40
0.45	34	30
0.4	30	30
0.35	26	30
0.3	23	20