# Carmustine

Source: https://onco.cc/drugs/carmustine/  
OnCo record `carmustine` (Treatment). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Carmustine is a chemotherapy that reaches the brain. It is given by infusion for brain tumours, lymphoma and myeloma, and as a slow-release wafer left in the cavity after a brain tumour is removed.

## Summary

Intravenous carmustine (BiCNU, approved 1977) is indicated as palliative therapy, alone or in combination, for brain tumours (glioblastoma, brainstem glioma, medulloblastoma, astrocytoma, ependymoma and metastatic brain tumours), multiple myeloma with prednisone, and relapsed or refractory Hodgkin and non-Hodgkin lymphoma; it is also part of the BEAM conditioning regimen before autologous transplant in lymphoma. The Gliadel wafer (approved 1996 for recurrent glioblastoma, 2003 for newly diagnosed high-grade glioma) is a biodegradable polifeprosan 20 implant placed in the resection cavity; the pivotal 240-patient placebo-controlled trial in newly diagnosed high-grade glioma showed a modest survival benefit. Delayed cumulative myelosuppression and dose-related pulmonary fibrosis limit lifetime dosing.

## Fields

- Kind: Treatment
- Status: approved
- Last checked: 2026-09-10
- Also known as: BCNU; Carmustine implant
- Tags: nci-list; generic
- Brand: BiCNU / Gliadel Wafer
- Modality: Alkylating agent (nitrosourea); intravenous and implantable wafer
- Mechanism: Alkylates and cross-links DNA and RNA and carbamoylates proteins; lipophilic, so it crosses the blood-brain barrier. The Gliadel wafer releases carmustine slowly into the resection cavity.
- Approvals: US 1977: Brain tumours, multiple myeloma, relapsed Hodgkin and non-Hodgkin lymphoma (BiCNU); US 1996: Recurrent glioblastoma as an adjunct to surgery (Gliadel Wafer); newly diagnosed high-grade glioma with surgery and radiation added 2003

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Carmustine
- US label (DailyMed): https://dailymed.nlm.nih.gov/dailymed/search.cfm?labeltype=all&query=carmustine
- NCI drug page: https://www.cancer.gov/about-cancer/treatment/drugs/carmustine
- NCI page (carmustine implant): https://www.cancer.gov/about-cancer/treatment/drugs/carmustineimplant

## Connected records

- cancers: [Diffuse large B-cell lymphoma](https://onco.cc/cancers/dlbcl/), [Glioma & glioblastoma](https://onco.cc/cancers/glioblastoma/), [Hodgkin lymphoma](https://onco.cc/cancers/hodgkin-lymphoma/), [Medulloblastoma](https://onco.cc/cancers/medulloblastoma/), [Multiple myeloma](https://onco.cc/cancers/multiple-myeloma/), [Mycosis fungoides](https://onco.cc/cancers/mycosis-fungoides/), [Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma)](https://onco.cc/cancers/peripheral-t-cell-lymphoma/), [Primary CNS lymphoma](https://onco.cc/cancers/primary-cns-lymphoma/), [Relapsed and refractory classical Hodgkin lymphoma](https://onco.cc/cancers/relapsed-refractory-hodgkin-lymphoma/)
- technologies: [Autologous stem cell transplant (high-dose therapy)](https://onco.cc/technologies/autologous-stem-cell-transplant/), [Cytotoxic chemotherapy](https://onco.cc/technologies/cytotoxic-chemotherapy/), [The cumulative dose that decides whether it comes back](https://onco.cc/technologies/rejuv-recovery-cumulative-dose/)
- trials: [A Study of Carmustine With and Without Ethanol in Subjects With Lymphoma](https://onco.cc/trials/nct06915246/), [BMT CTN 0803](https://onco.cc/trials/bmt-ctn-0803/), [Combination Chemotherapy With or Without G-CSF in Treating Older Patients With Acute Myeloid Leukemia](https://onco.cc/trials/nct00002719/), [IELSG32](https://onco.cc/trials/ielsg32/), [MATRix/IELSG43](https://onco.cc/trials/ielsg43/), [Phase II Study of Carmustine, Streptozocin, and Mercaptopurine for Refractory or Recurrent Brain Neoplasms](https://onco.cc/trials/nct00004688/), [Surgery, Radiation Therapy, and Chemotherapy With or Without Photodynamic Therapy in Treating Patients With Newly Diagnosed or Recurrent Malignant Supratentorial Gliomas](https://onco.cc/trials/nct00003788/)
- terms: [Skin-directed therapy in mycosis fungoides: creams, light and small radiotherapy fields](https://onco.cc/terms/lymphoma-tx-skin-directed-therapy/), [Stem cell transplant in lymphoma: what it is still for](https://onco.cc/terms/lymphoma-tx-transplant-role/)
- targets: [Glutathione reductase](https://onco.cc/targets/gsr/)
- key papers: [IELSG32 second randomisation: whole-brain radiotherapy or autologous stem cell transplant as consolidation in primary CNS lymphoma](https://onco.cc/key-papers/paper-ielsg32-wbrt-vs-asct-consolidation-ferreri-lancet-haematol-2017/), [MATRix/IELSG43: high-dose chemotherapy and autologous stem cell transplant versus non-myeloablative consolidation in primary CNS lymphoma](https://onco.cc/key-papers/paper-matrix-ielsg43-asct-consolidation-pcnsl-illerhaus-lancet-2026/)

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