Carmustine(BCNU) is one of the nitrosoureas indicated as palliative therapy as a single agent or in established combination therapy with other approved chemotherapeutic agents in treatment of brain tumors, multiple myeloma, Hodgkin's disease, and non-Hodgkin's lymphomas. It by itself would be an appropriate drug.
Clinical trials of thalidomide as a single agent in malignant gliomas that have recurred following radiation therapy have shown evidence of that this drug is active and can produce responses. Thalidomide is currently being tested in combination with a chemotheraputic agent active in malignant gliomas (carboplatin), and single-agent clinical trials are being initiated in the treatment of recurrent brain metastases and in the treatment of recurrent atypical or malignant meningiomas.
There was one study of the combination. This study involved 40 patients with high-grade gliomas, all of whom had failed radiation therapy and 50% had failed chemotherapy, including carmustine in 4 instances. The dose of carmustine was 200 mg/m2 given every 6 weeks and the dose of thalidomide was 800 mg/day with escalation to 1200 mg/day. The response rate was 24%. There was one complete response. Disease was stable in 24% of patients. The median time to progression in patients who had a response was 239 days. The main side effects were hematologic and increased sedation. This regimen is under study for a variety of solid tumors. It is also under study for gioloblatoma: Temozolomide vs. Temozolomide and Thalidomide Treatment in Recurrent Glioblastoma, NCT0052148.