Carmustine

Carmustine, sold under the brand name BiCNU among others, is a medication used mainly for chemotherapy. It is a nitrogen mustard β-chloro-nitrosourea compound used as an alkylating agent.^[7]

Carmustine

Names
IUPAC name 1,3-Bis(2-chloroethyl)-1-nitrosourea[1]
Other names N,N'-Bis(2-chloroethyl)-N-nitrosourea, bis-chloroethylnitrosourea, BCNU
Identifiers
CAS Number	154-93-8 Y
3D model (JSmol)	Interactive image
ChEBI	CHEBI:3423 Y
ChEMBL	ChEMBL513 Y
ChemSpider	2480 Y
DrugBank	DB00262 Y
ECHA InfoCard	100.005.309
EC Number	205-838-2
KEGG	D00254 Y
MeSH	Carmustine
PubChem CID	2578
RTECS number	YS2625000
UNII	U68WG3173Y Y
UN number	2811
CompTox Dashboard (EPA)	DTXSID8022743
InChI InChI=1S/C5H9Cl2N3O2/c6-1-3-8-5(11)10(9-12)4-2-7/h1-4H2,(H,8,11) Y Key: DLGOEMSEDOSKAD-UHFFFAOYSA-N Y
SMILES C(CCl)NC(=O)N(CCCl)N=O
Properties
Chemical formula	C5H9Cl2N3O2
Molar mass	214.05 g·mol−1
Appearance	Orange crystals
Odor	Odourless
Melting point	30 °C (86 °F; 303 K)
log P	1.375
Acidity (pKa)	10.194
Basicity (pKb)	3.803
Pharmacology
ATC code	L01AD01 (WHO)
Pregnancy category	AU: D
License data	EU EMA: by INN
Legal status	AU: S4 (Prescription only) UK: POM (Prescription only)[2][3] US: ℞-only[4][5] EU: Rx-only
Hazards
GHS labelling:
Pictograms
Signal word	Danger
Hazard statements	H300, H350, H360
Precautionary statements	P301+P310, P308+P313
Lethal dose or concentration (LD, LC):
LD50 (median dose)	20 mg kg−1 (oral, rat)
Related compounds
Related ureas	Dimethylurea
Related compounds	Noxytiolin 1,1,3,3-Tetramethylguanidine Metformin Allantoic acid Buformin
Except where otherwise noted, data are given for materials in their standard state (at 25 °C [77 °F], 100 kPa). N verify (what is YN ?) Infobox references

Carmustine

Clinical data
Trade names	BiCNU, Gliadel
AHFS/Drugs.com	Monograph
MedlinePlus	a682060
License data	US DailyMed: Carmustine
Drug class	Antineoplastic agents
Legal status
Legal status	US: WARNING[6]
Identifiers
CompTox Dashboard (EPA)	DTXSID8022743
ECHA InfoCard	100.005.309

Description

Carmustine is an orange-yellow solid medication used mainly for chemotherapy. It is a nitrogen mustard β-chloro-nitrosourea compound.^[8]

Mechanism of action

As an alkylating agent, carmustine can form interstrand crosslinks in DNA, which prevents DNA replication and DNA transcription.^[9]

Uses

Carmustine is used as an alkylating agent to treat several types of brain cancer including glioma, glioblastoma multiforme, medulloblastoma and astrocytoma, multiple myeloma, and lymphoma (Hodgkin's and non-Hodgkin).

Carmustine is sometimes used in conjunction with alkyl guanine transferase (AGT) inhibitors, such as O⁶-benzylguanine. The AGT-inhibitors increase the efficacy of carmustine by inhibiting the direct reversal pathway of DNA repair, which will prevent formation of the interstrand crosslink between the N¹ of guanine and the N³ of cytosine.

It is also used as part of a chemotherapeutic protocol in preparation for hematological stem cell transplantation, a type of bone marrow transplant, in order to reduce the white blood cell count in the recipient.^[10] Use under this protocol, usually with fludarabine and melphalan, was developed by oncologists at the University of Texas MD Anderson Cancer Center.^{[citation needed]}

Implants

In the treatment of brain tumours, the U.S. Food and Drug Administration (FDA) approved biodegradable discs infused with carmustine (Gliadel).^[11] They are implanted under the skull during a surgery called a craniotomy. The disc allows for controlled release of carmustine in the extracellular fluid of the brain, thus eliminating the need for the encapsulated drug to cross the blood-brain barrier.^[12]

Production

Carmustine for injection was marketed under the name BiCNU by Bristol-Myers Squibb^[13] and now^[when?] by Emcure Pharmaceuticals.^[14] In India it is sold under various brand names, including Consium.^{[citation needed]}. The product is available as a generic version with other manufacturers offering the product licensed in the US and EU markets.^{[citation needed]}

See also

• Bendamustine
• Lomustine
• Semustine

References

1. CID 2578 from PubChem
2. "Carmustine 100mg Powder and solvent for Solution for Infusion - Summary of Product Characteristics (SmPC)". (emc). 24 March 2020.
3. "Gliadel 7.7mg Implant - Summary of Product Characteristics (SmPC)". (emc). 15 June 2020.
4. "Bicnu- carmustine kit". DailyMed. Retrieved 27 February 2021.
5. "Gliadel- carmustine wafer". DailyMed. Retrieved 27 February 2021.
6. "FDA-sourced list of all drugs with black box warnings (Use Download Full Results and View Query links.)". nctr-crs.fda.gov. FDA. Retrieved 22 Oct 2023.
7. Silverman RB, Holladay MW (January 2014). "Chapter 6 - DNA-Interactive Agents". In Silverman RB, Holladay MW (eds.). The Organic Chemistry of Drug Design and Drug Action (Third ed.). Boston: Academic Press. pp. 275–331. doi:10.1016/b978-0-12-382030-3.00006-4. ISBN 978-0-12-382030-3.
8. Rider BJ (January 2007). "Carmustine". In Enna SJ, Bylund DB (eds.). xPharm: The Comprehensive Pharmacology Reference. New York: Elsevier. pp. 1–4. doi:10.1016/b978-008055232-3.61389-3. ISBN 978-0-08-055232-3.
9. "NLM PubChem CID Index", Vitamin D Handbook, Hoboken, NJ, USA: John Wiley & Sons, Inc., pp. 239–244, 2007, doi:10.1002/9780470238165.indsp1, ISBN 9780470238165
10. Damaj G, Cornillon J, Bouabdallah K, Gressin R, Vigouroux S, Gastinne T, et al. (July 2017). "Carmustine replacement in intensive chemotherapy preceding reinjection of autologous HSCs in Hodgkin and non-Hodgkin lymphoma: a review". Bone Marrow Transplantation. 52 (7): 941–949. doi:10.1038/bmt.2016.340. PMID 28112752.
11. Ewend MG, Brem S, Gilbert M, Goodkin R, Penar PL, Varia M, et al. (June 2007). "Treatment of single brain metastasis with resection, intracavity carmustine polymer wafers, and radiation therapy is safe and provides excellent local control". Clinical Cancer Research. 13 (12): 3637–3641. doi:10.1158/1078-0432.CCR-06-2095. PMID 17575228. S2CID 14016432.
12. "Hopkins Medicine Magazine - In Spite of All Odds". Archived from the original on 2014-11-20. Retrieved 2014-07-08.
13. "Company Statement on BiCNU® (carmustine for injection)". Bristol-Myers Squibb Company. Archived from the original on 2014-07-11. Retrieved 2015-01-31.
14. "Emcure Press release" (PDF). Archived from the original (PDF) on 2014-07-02. Retrieved 2015-01-31.

External links

• "Carmustine Implant". MedlinePlus.