Lung toxicity of lomustine in the treatment of progressive gliomas

Abstract

Background: Pulmonary fibrosis is a rare, but dangerous side effect of CCNU (lomustine). CCNU is a frequently used chemotherapeutic agent in the setting of recurrent or progressive glioblastoma. At present, CCNU is also administered in patients with newly diagnosed gliomas in combination with temozolomide. There is only little evidence if, and how, lung function should be monitored on treatment with CCNU.

Methods: We retrospectively collected data on patient characteristics, lung function analyses, and relevant toxicities among 166 brain tumor patients treated with CCNU at a German University Hospital and National Cancer Center.

Results: The patient collective mainly included patients with recurrent glioblastoma who received a mean number of 2.64 ± 1.57 cycles. There was overall no statistically significant change in parameters of pulmonary restriction among patients treated with CCNU. On an individual patient basis, a >10% decrease in the absolute vital capacity was primarily seen in patients with prior lung diseases and smokers. Other severe toxicities mainly included thrombocytopenia, leukopenia, nausea, and vomiting.

Conclusions: Our findings support to limit lung function analyses on CCNU to patients with gliomas and pulmonary risk factors. However, all patients should be closely followed for clinical symptoms of pulmonary restriction.

Keywords: CCNU; glioma; lung toxicity; recurrent glioblastoma.

Figure 1.

Lung function analysis. Vital capacity (VC) was assessed in liters (a) and %-of normal (b) at baseline, before cycle 3, and before cycle 5. Forced vital capacity (FVC) in liters (c) and %-of normal (d), forced expiratory volume (FEV1) in liters (e) and %-of normal (f), and forced expiratory volume/vital capacity in %-of normal (g) were also analyzed at baseline, before cycle 3, and before cycle 5.