Carmustine (Implantation)

Marketed under the brand name Gliadel, the Carmustine implant is an alkylating agent that works against brain cancer by inhibiting the growth of cancer cells and eventually destroying malignant tumors.

Overview:

The Carmustine implant is intended to treat some of the toughest forms of brain cancer by direct implantation into the area where the tumor was growing. The implant is in the form of a wafer that is coated with a layer of a slowly-dissolving inactive agent that releases the dose of carmustine. This is done directly after the tumor is removed and the carmustine is usually implanted during the same procedure. Time is of the essence as the purpose of the implant is to arrest the growth of cancer cells in the area around an operable brain tumor. It serves the same purpose as when Carmustine is used as an intravenous chemotherapy drug but the purpose of the implant is to avoid some of the more debilitating side effects of that method. However, in the case of fast-growing or aggressive cancers, it is usually part of a combination of different therapies to include chemotherapy, radiation, and surgical procedures.

The most important consideration when deciding whether or not to use Carmustine as part of a treatment plan is the calculation of risk versus the potential benefit. Although intended to minimize exposure of other parts of the body to the Carmustine, Gliadel is not without its harsh side effects. However, the side-effects observed in patients are consistent with the complications and debilitating effects encountered after invasive brain surgery. One concern is that data shows that the implant caused an earlier onset of seizures. There is also some evidence that it has a detrimental effect on healing after the surgery and mildly increases the chance of both brain edema and infections.

Conditions Treated:

  • Brain cancer
  • Malignant glioma
  • Glioblastoma multiforme

Type of Medicine:

  • Alkylating Agent

Side Effects:

Carmustine has some documented side effects that must be considered when they are part of a treatment plan for brain cancers. While these side effects may not occur in all patients, some of them are severe enough to significantly affect the already fragile health of cancer patients. If any of the following symptoms occur while a Carmustine implant is in the brain, inform your medical care provider.

Some of the most common serious side effects of Carmustine include experiencing blurred vision, headaches, or a change in color vision. Patients can become confused or run high fevers, usually accompanied by nausea and vomiting. While seizures may be an expected complication of brain surgery, a common side effect of Carmustine can contribute to this symptom. Patients with the implant have commonly reported difficulty in moving or speaking as well as a slower healing process. Some of the less commonly experienced side effects include general feelings of drowsiness, dizziness, and severe headaches. Some patients may find that they have an unusual pain or stiffness in the neck area or all the way down the back.

Not all of the potential side effects are as serious, and some are routine symptoms that are to be expected as the body is adjusting to the Carmustine implant. These generally will not require special medical attention but some remedies may be available if the conditions are of an unacceptable duration or are worse than expected. Any of the symptoms listed below fall into this category.

Most common of the routine side effects are effects on the gastrointestinal and urinary tract as the body fights to purge a substance that is damaging its cells. Pain in the abdomen, back, and bladder can be accompanied by constipation or painful urination that produces a cloudy or bloody urine flow. Patients have commonly reported that when the implant is first used that they experience feelings of discouragement, sadness, irritability, and loss of interest that is consistent with depression. Other common physical reactions to the medication include a loss of appetite, feeling of weakness, difficulty concentrating, and fatigue. Patients can experience significant periods of insomnia while the implant is in use. Some patients have reported sharp pain in the chest, back, or side while adjusting to the medication.

Dosage:

Carmustine implants are a very potent medication that can have many serious effects. Before receiving the medication a patient should be fully briefed on both the potential risks and the benefits of receiving a Gliadel implant after the removal of a tumor. The surgeon performing the procedure to remove the tumor will typically be the one to place the implant during the same procedure. The implant will consist of one small Gliadel wafer, which will dissolve and gradually release the active medication into the area of the tumor.

Interactions:

As with many medications, there is a risk of adverse reactions when Carmustine is in the system at the same time as incompatible medications. As is the case when aggressively treating cancer, some incompatible medications may need to be used at the same time even though they are known to create a bad reaction. This may also be the case if the patient is struggling with other conditions in addition to their cancer that cannot be treated with any other method. While not a complete list, the following medications are known to have a substantial risk of an adverse reaction when combined with Carmustine.

It is not recommended that you take any of the following live vaccines, but your doctor may make them a part of the treatment plan despite the risk of side effects if the risks of not taking the medication outweigh them.

  • easles Virus Vaccine
  • umps Virus Vaccine
  • otavirus Vaccine
  • ubella Virus Vaccine
  • aricella Virus Vaccine
  • denovirus Vaccine
  • acillus of Calmette and Guerin Vaccine
  • holera Vaccine
  • nfluenza Virus Vaccine
  • oliovirus Vaccine
  • mallpox Vaccine
  • yphoid Vaccine
  • ellow Fever Vaccine

Additionally, it is not recommended to use the drug Cimetidine for the treatment of ulcers while Carmustine is in the system.

Certain medical conditions other than cancer may need to be taken into consideration when deciding whether or not a Carmustine implant is right for the patient. Make sure that the prescribing physician knows if the patient is currently suffering from or has a history of intracranial hypertension or seizure disorders before the procedure as a Giliadel implant may make these worse.

Warnings:

In the days and weeks after receiving a Carmustine implant, a doctor will need to very closely monitor the patient's progress, to include a period of hospitalization. This monitoring will check the progress of the patient in healing and recovery as well as determine if there are any ill effects as a result of the implant. Pregnant women who receive the implant should be advised that it can cause significant harm to an unborn child. Keep your doctor informed of any changes in your pregnancy status. Use of birth control during the period of this procedure and throughout cancer treatment is highly recommended. Some men who have received a Carmustine implant have become infertile and have not been able to have children. If having children is something that you plan to do, consult with your physician regarding this before receiving a Carmustine implant.

There are significant risks of serious conditions developing as a result of receiving a Carmustine implant. There is a chance the medication can cause seizures post-surgery. Report any seizures to your doctor immediately. Carmustine is also known to cause increased pressure in the head that can make the condition of intracranial hypertension significantly worse. Symptoms that indicate that this is happening include blurred vision, nausea, and vomiting, or a severe headache. Vision should be closely monitored after the implant is received as it may be an earlier indicator of serious side effects. Carmustine may contribute to a patient developing a meningitis infection of the brain. Symptoms that indicate that this may be happening include a stiff neck, nausea, confusion, drowsiness, a severe headache, or a general feeling of illness.

Storage:

This medication will be stored and maintained at the hospital by medical professionals in line with the manufacturer's guidelines and hospital policies. In general, this means that the medication will be stored in a refrigerator but must not be allowed to freeze.

Summary:

While there is a significant risk of debilitating and even life-threatening side effects that come with a Carmustine implant, its proven effectiveness as a treatment for the most deadly forms of cancer makes it a potential life-saver. When used responsibly as a part of a diversified treatment plan it is very effective at arresting the progress of very aggressive and fast-growing cancer cells. For some patients, Carmustine can be their last hope of treating a terminal illness with a very poor prognosis. To succeed in this battle and beat the odds, it must be considered an option in the treatment of patients with operable brain tumors.

Resources
Last Reviewed:
December 22, 2017
Last Updated:
April 02, 2018