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A - Regimen Name

LOMU Regimen
Lomustine


Disease Site
Central Nervous System

(Recurrent malignant glioma)


Intent
Palliative

Regimen Category
Evidence-Informed :

Regimen is considered appropriate as part of the standard care of patients; meaningfully improves outcomes (survival, quality of life), tolerability or costs compared to alternatives (recommended by the Disease Site Team and national consensus body e.g. pan-Canadian Oncology Drug Review, pCODR).  Recommendation is based on an appropriately conducted phase III clinical trial relevant to the Canadian context OR (where phase III trials are not feasible) an appropriately sized phase II trial. Regimens where one or more drugs are not approved by Health Canada for any indication will be identified under Rationale and Use.


Supplementary Public Funding

lomustine
ODB - General Benefit (lomustine)

 
B - Drug Regimen

lomustine
130 mg /m² PO Day 1
(Outpatient prescription in multiples of 10, 40 & 100mg capsules)
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C - Cycle Frequency

REPEAT EVERY 42 DAYS

For a Usual Total of 6 to 7 Cycles

 
D - Premedication and Supportive Measures

Antiemetic Regimen:

Moderate – Consider prophylaxis daily

Other Supportive Care:

Also refer to CCO Antiemetic Recommendations.

 
E - Dose Modifications

Doses should be modified according to the protocol by which the patient is being treated. The following recommendations are in use at some centres.

Dosage with toxicity

Hematologic Toxicities:  See Appendix 6 for general recommendations. 
Do not retreat until leukocytes > 4 x 109/L and platelets > 100 x 109/L. Reduce dose next cycle according to nadir counts as follows:
Nadir after prior dose
 
Leukocytes (x 109/L)
Platelets (x 109/L)
Lomustine (% previous dose)
 
> 4
> 100
100 %
3 - 4
75 – 100
100 %
2 - <3
25 – 74.99
70 %
<2
< 25
50 %



Hepatic Impairment

No specific recommendations found. Although the metabolites are mainly excreted by the kidney, the liver is involved in lomustine metabolism. Monitor closely in patients with hepatic impairment and adjust dose based on hematologic toxicity.


Renal Impairment

Dose reduction required.  The following is suggested:

Creatinine clearance (mL/min)
Lomustine (% previous dose)
 
> 50
100 %
10 – 50
75 %
< 10
50 %

 
F - Adverse Effects
Refer to lomustine drug monograph(s) for additional details of adverse effects
 
G - Interactions
Refer to lomustine drug monograph(s) for additional details
 
H - Drug Administration and Special Precautions
Refer to lomustine drug monograph(s) for additional details
 
I - Recommended Clinical Monitoring

Recommended Clinical Monitoring

  • Periodic clinical exam, for pulmonary toxicity, infection, and bleeding. 
  • Baseline renal and liver function tests
  • Baseline and regular CBC 
  • Baseline lung function in at risk patients: extreme caution in patients with FVC or DLCO < 70%
  • Baseline and regular function tests with prolonged (> 6month) therapy or cumulative doses > than 1,100 mg/m2
  • Grade toxicity using the current NCI-CTCAE (Common Terminology Criteria for Adverse Events) version

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J - Administrative Information

Outpatient prescription for home administration


 
K - References
Garrett MJ, Hughs HJ, Ryall RDH. CCNU in brain tumor. Clin radiol 1974; 25:183.
 
Wasserman TH. Slavik M, Carter SK. Review of CCNU in clinical cancer therapy. Cancer Treatment Rev 1974; 1: 131-51.

June 2019 Updated emetic risk category


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M - Disclaimer

Regimen Abstracts
A Regimen Abstract is an abbreviated version of a Regimen Monograph and contains only top level information on usage, dosing, schedule, cycle length and special notes (if available). It is intended for healthcare providers and is to be used for informational purposes only. It is not intended to constitute or be a substitute for medical advice, and all uses of the Regimen Abstract are subject to clinical judgment. Such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability, and Cancer Care Ontario disclaims all liability for the use of this information, and for any claims, actions, demands or suits that arise from such use.
Information in regimen abstracts is accurate to the extent of the ST-QBP regimen master listings, and has not undergone the full review process of a regimen monograph.  Full regimen monographs will be published for each ST-QBP regimen as they are developed.
Regimen Monographs
Refer to the New Drug Funding Program or Ontario Public Drug Programs websites for the most up-to-date public funding information.
The information set out in the drug monographs, regimen monographs, appendices and symptom management information (for health professionals) contained in the Drug Formulary (the "Formulary") is intended for healthcare providers and is to be used for informational purposes only. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects of a particular drug, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for a given condition. The information in the Formulary is not intended to constitute or be a substitute for medical advice and should not be relied upon in any such regard. All uses of the Formulary are subject to clinical judgment and actual prescribing patterns may not follow the information provided in the Formulary.
The format and content of the drug monographs, regimen monographs, appendices and symptom management information contained in the Formulary will change as they are reviewed and revised on a periodic basis. The date of last revision will be visible on each page of the monograph and regimen. Since standards of usage are constantly evolving, it is advised that the Formulary not be used as the sole source of information. It is strongly recommended that original references or product monograph be consulted prior to using a chemotherapy regimen for the first time.
Some Formulary documents, such as the medication information sheets, regimen information sheets and symptom management information (for patients), are intended for patients. Patients should always consult with their healthcare provider if they have questions regarding any information set out in the Formulary documents.
While care has been taken in the preparation of the information contained in the Formulary, such information is provided on an “as-is” basis, without any representation, warranty, or condition, whether express, or implied, statutory or otherwise, as to the information’s quality, accuracy, currency, completeness, or reliability.
CCO and the Formulary’s content providers shall have no liability, whether direct, indirect, consequential, contingent, special, or incidental, related to or arising from the information in the Formulary or its use thereof, whether based on breach of contract or tort (including negligence), and even if advised of the possibility thereof. Anyone using the information in the Formulary does so at his or her own risk, and by using such information, agrees to indemnify CCO and its content providers from any and all liability, loss, damages, costs and expenses (including legal fees and expenses) arising from such person’s use of the information in the Formulary.