Comprehensive Product Description Guide: Ceenu (Lomustine)

What is Ceenu used for
Ceenu (Lomustine) is a chemotherapy medication used in the treatment of brain tumors, Hodgkin’s lymphoma, and other cancers. It belongs to the nitrosourea class of alkylating agents and works by interfering with cancer cell DNA, preventing replication and causing cell death.

Ceenu 40 mg Capsules (Lomustine)

Lomustine
CCNU

CeeNU

Gleostine (US brand name)

Lomustine (generic)
Therapeutic Class: Antineoplastic (Chemotherapy)

Pharmacologic Class: Alkylating agent – Nitrosoureas

ATC Code: L01AD02

Prescription Classification: Schedule 4 (S4) – Prescription only medicine in Australia
Lomustine is a lipophilic nitrosourea compound that crosses the blood-brain barrier effectively. It works by:

Alkylating DNA and RNA, leading to breaks in strands and abnormal base pairing

Inhibiting DNA and RNA synthesis, which interferes with cancer cell division and induces apoptosis

Exerts delayed myelosuppression, a known class effect

Its lipophilic nature makes it particularly effective in treating brain tumors and malignancies with CNS involvement.
Ceenu is primarily used for:

Primary and metastatic brain tumors (e.g. glioblastoma, astrocytoma, medulloblastoma)

Hodgkin’s lymphoma (in combination with other agents, typically for relapsed/refractory disease)

Malignant gliomas (as adjuvant therapy with radiation)

Off-label: Other cancers such as lung cancer, melanoma, or multiple myeloma under investigational protocols

Dosage must be determined by an oncologist.

130 mg/m² orally every 6 weeks

Dose adjusted based on blood counts and organ function

Dose reduced to 100 mg/m² if used with other myelosuppressive agents

Note: Ceenu is taken as a single oral dose every 6 weeks. This intermittent dosing reduces the risk of severe bone marrow suppression.

Route: Oral

Form: Capsule (typically 40 mg strength)

Administered: On an empty stomach to reduce nausea

Avoid crushing or chewing the capsule

Monitoring: Full blood count (FBC), liver and kidney function tests must be regularly conducted before each dose
Teratogenic: Not to be used during pregnancy unless absolutely necessary

Avoid live vaccines during treatment

Strict contraception required during and after treatment (up to 6 months post-therapy)

Baseline and ongoing blood tests essential to monitor for myelosuppression and organ toxicity

Avoid alcohol and nephrotoxic drugs
Nausea, vomiting (can be prolonged up to 24–72 hours)

Delayed bone marrow suppression (typically seen after 4–6 weeks)

Anorexia and weight loss

Fatigue

Elevated liver enzymes

Pulmonary toxicity (rare)

Serious Adverse Effects:

Thrombocytopenia and neutropenia

Pulmonary fibrosis (especially after prolonged therapy)

Hepatotoxicity

Nephrotoxicity (particularly with long-term use)
Bone marrow suppression is dose-limiting; monitor FBC before every cycle

Use with caution in patients with renal or hepatic impairment

Pulmonary function tests may be required in patients with prolonged use or symptoms

Prolonged therapy increases the risk of secondary malignancies

Avoid use in immunocompromised patients unless essential
Myelosuppressive agents: Additive effect; monitor closely

Live vaccines: Risk of uncontrolled viral replication

Phenytoin and warfarin: Effect may be altered

Nephrotoxic drugs: Increased risk of kidney damage

CYP450 substrates: Limited interaction, but caution advised
Store below 25°C

Protect from moisture and light

Keep out of reach of children

Handle with gloves to avoid skin contact
Stupp R et al. (NEJM, 2005): Lomustine + radiotherapy showed improved survival in glioblastoma when used alongside temozolomide

Batchelor T et al. (JCO, 2007): Lomustine effective as salvage therapy in recurrent high-grade gliomas

Giles FJ et al. (Blood, 1997): Role of lomustine in relapsed Hodgkin’s lymphoma shown to be beneficial in combination regimens

FDA and EMA approvals: Support use in high-grade CNS tumors and lymphomas

Frequently Asked Questions (FAQs)
Q: What is Ceenu used for?
A: Ceenu is used to treat brain tumors and Hodgkin’s lymphoma. It works by damaging the DNA of cancer cells, preventing them from multiplying.

Q: How often is Ceenu taken?
A: Ceenu is usually taken once every 6 weeks as a single oral dose. The frequency may vary based on patient response and blood counts.

Q: Is Ceenu safe in pregnancy?
A: No. Ceenu is contraindicated in pregnancy due to its high risk of fetal harm.

Q: What monitoring is required with Ceenu?
A: Regular blood tests (full blood count), liver, kidney, and lung function tests are essential during treatment.

Q: Can I take Ceenu with food?
A: Ceenu should be taken on an empty stomach to improve absorption and reduce nausea.

Q: Does Ceenu cause hair loss?
A: Hair loss is not common with Ceenu, unlike other chemotherapies. However, fatigue and nausea are frequent.

Q: What happens if I miss a dose?
A: Contact your oncologist immediately. Do not take a missed dose unless instructed by your medical provider.
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