Lomustine (Gleostine): Uses, How It Works, and Side Effects

Lomustine (Gleostine) is an oral chemotherapy medication used to treat certain brain tumors as well as Hodgkin’s lymphoma. Unlike many other chemotherapy medications that are given by an intravenous (IV) infusion, lomustine is taken by mouth as a single dose every 6 weeks because its effects on the bone marrow can last for several weeks. Read on to learn how lomustine works, its approved uses, recommended dosage, possible side effects, and cost. 

What Is Lomustine? 

Lomustine is a type of chemotherapy medication. It belongs to a drug class called alkylating agents. This medication is FDA-approved to treat:

• Brain tumors (both primary and metastatic) in people who’ve previously received surgery or radiation
• Hodgkin’s Lymphoma (a type of cancer that affects white blood cells called B lymphocytes) that has progressed in people who’ve received chemotherapy

Lomustine is available as oral capsules in the following strengths in the United States: 

• 10 mg (white cap and body)
• 40 mg (white cap and a moss green body)
• 100 mg (moss green cap and body)

Lomustine Mechanism of Action

Lomustine is an alkylating agent. It works by damaging the DNA of cancer cells by forming abnormal chemical bonds. This prevents cancer cells from growing and dividing normally, ultimately causing them to die. 

Lomustine can also cross the blood-brain barrier, allowing it to reach brain tumors more effectively than many other chemotherapy drugs. This makes it especially useful for treating certain cancers of the brain. 

Lomustine Dosing

The recommended starting dose for adults and pediatric patients is 130 mg/m² taken by mouth once every 6 weeks. Your healthcare provider will calculate your dose based on your body surface area and may adjust it depending on your blood cell counts, liver or kidney function, and other cancer treatments you are receiving. 

Important Lomustine Warnings

Risk of Bone Marrow Suppression

Bone marrow suppression occurs when your bone marrow doesn’t produce enough blood cells. This can increase your risk of serious infections, anemia, and bleeding. Unlike many chemotherapy drugs, lomustine causes delayed bone marrow suppression, meaning your blood cell counts may not reach their lowest levels until 4 to 6 weeks after treatment. Severe and potentially fatal infections may occur 4 to 6 weeks after you have received lomustine. 

Call your healthcare provider immediately if you experience:

• Fever, sore throat, hoarseness, ongoing cough, chills, or other signs of infection
• Abnormal bleeding or bruising
• Bloody or tarry stools
• Bloody vomit
• Vomiting blood or brown material that looks like coffee grounds

Risk of Overdosage

Overdosing on lomustine can be fatal. Take only one dose of lomustine every 6 weeks. 

Because lomustine can affect your body for prolonged periods, your healthcare provider will order a weekly blood test for at least 6 weeks after each dose. 

Before Taking Lomustine 

Before you receive your first dose of lomustine, inform your provider if you:

• Are allergic to this product or any product component
• Ever had liver, kidney, or lung disease
• Are pregnant or plan to get pregnant 
• Are breastfeeding or plan to breastfeed 

Females who can get pregnant should use birth control during treatment and for at least 14 days after the last dose. Males with female partners who can get pregnant should use birth control during treatment and for at least 14 weeks after the last dose. 

Contact your healthcare provider immediately if you or your partner becomes pregnant during treatment with this medication. 

Avoid breastfeeding during treatment and for at least 14 days after the last dose. 

Lomustine Side Effects

Like most chemotherapy medications, lomustine can cause both common and serious side effects. Your healthcare provider will monitor you closely throughout treatment with regular blood tests and follow-up appointments. 

Common Side Effects

• Nausea
• Vomiting
• Increased risk of infection 
• Mouth sores
• Hair loss

Talk to your healthcare provider or pharmacist if any side effects worsen or persist. 

Severe Side Effects

Call your healthcare provider immediately or seek emergency care if you have:

• Signs of an allergic reaction, such as hives, difficult breathing, and swelling of the face, lips, tongue, or throat
• Jaundice (yellowing of the skin or eyes)
• Easy bruising
• Abnormal bleeding or purple/red pinpoint spots under the skin
• Signs of kidney problems, such as little to no urination, swelling in the feet or ankles, tiredness, and breathing difficulty
• Signs of infection, such as fever, chills, sore throat, blisters in the mouth, red or swollen gums, and difficulty swallowing
• Signs of delayed lung damage, such as new or worsening cough, chest pain, shortness of breath (these symptoms may appear within 6 months or even longer after you take lomustine)
• Sudden change or loss of vision

Proper Use, Handling, and Storage

• Take your doses exactly as directed: a single dose once every 6 weeks. 
• To take your full dose, you may need to take 2 or more capsules of different strengths and colors. 
• If you miss a dose, call your healthcare provider immediately. 
• If you think you have overdosed, seek emergency medical care or call the Poison Help line at 1-800-222-1222. Signs of an overdose can include stomach pain, diarrhea, vomiting, loss of appetite, lethargy, dizziness, cough, and shortness of breath.
• Because lomustine is a chemotherapy medication, wear disposable gloves when handling the capsules whenever possible, especially if someone other than the patient is handling the medication. Never reuse the gloves. Throw them away after single use. 
• Don’t open the capsule or use a broken one. If the medicine from a broken capsule comes in contact with your skin, wash immediately with soap and water. 
• Ask your healthcare provider or pharmacist to learn more about safe handling and disposal of broken capsules. 
• Store lomustine capsules at room temperature (25°C/77°F). Short-term storage between 15°C and 30°C (59°F to 86°F) is permitted. Avoid exposing the medication to temperatures above 40°C (104°F). 

Lomustine Cost

Lomustine is a specialty chemotherapy medication, and its cost can vary significantly depending on your insurance coverage, pharmacy, and whether you receive the brand-name or generic version. Ask your insurance provider whether your plan covers this medication or requires prior authorization. 

According to Drugs.com, 

• A supply of five 10 mg Gleostine capsules costs about $601
• A supply of five 40 mg capsules starts from $2,381
• A supply of five 100 mg capsules starts from $6,559

Note: Prices quoted above apply only when you pay in cash

You may be able to get the generic version of Gleostine at a lower cost. If you’re concerned about the cost of treatment, contact us to learn whether you may qualify for financial assistance or copay assistance for lomustine. 

Conclusion

Lomustine is an oral chemotherapy medication used to treat certain brain tumors and Hodgkin’s lymphoma. Because it can cause delayed but serious side effects, including bone marrow suppression, it should be taken exactly as prescribed and requires regular blood test monitoring. If you have questions about your treatment, side effects, or medication costs, speak with your healthcare provider or pharmacist.