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Oncology
Lomustine overdose in a patient with diffuse glioma: symptoms, management and outcome
  1. Liv Cathrine Heggebø1,2,
  2. Hanne Blakstad1,2,
  3. Marlena Christina Eriksson1 and
  4. Petter Brandal1,3
  1. 1Department of Oncology, Oslo University Hospital, Oslo, Norway
  2. 2Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3Institute for Cancer Genetics and Informatics, Oslo University Hospital, Oslo, Oslo, Norway
  1. Correspondence to Dr Liv Cathrine Heggebø; licahe{at}ous-hf.no

Abstract

A male patient started PCV chemotherapy (a combination of procarbazine, lomustine and vincristine) for a recurrent oligodendroglioma grade 2. Unfortunately, our patient took an unintended overdose of lomustine during the first PCV course: instead of 160 mg absolute dose of lomustine on day 1 only, he consumed 160 mg absolute dose of lomustine for seven consecutive days to a total dose of 1120 mg. Pancytopenia became evident after 24 days, and several months of severe myelosuppression, infections, reduced general condition, and nutrition difficulties followed. Fortunately, our patient with time recovered his bone marrow function. However, the patient’s quality of life was reduced for a long time and several lessons were learnt: oral and written information on chemotherapy is essential, but not always sufficient to ensure the correct dosing of patient-administered chemotherapy. Oral chemotherapeutics should be delivered as a single-dose supply or be administered by experienced health personnel.

  • Safety
  • CNS cancer
  • Chemotherapy

https://doi.org/10.1136/bcr-2024-260450

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    Footnotes

    • LCH and HB are joint first authors.

    • LCH and HB contributed equally.

    • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms and critical revision for important intellectual content: LCH and HB were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms. MCE and PB critical revised the manuscript for important intellectual content. LCH and HB contributed equally to this work and share first authorship. The following authors gave final approval of the manuscript: All authors.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.