Bischlorethyl-Nitrosurea (BCNU)

  • (topical nitrosurea)
  • Alkylating agent
  • Pregnancy Category D

  • Topical

  • 100 mg vials
  • Compound as aqueous solution or with ointment
  • Daily

  • Antimetabolite
  • Irreversibly inhibits thymidylate synthetase preventing DNA synthesis
  • Incorporates in RNA disrupting RNA synthesis

  • Off-label
  • Mycosis fungoides as 2nd / 3rd line treatment (T1 and T2 mainly – see nitrogen mustard section for details)
  • Systemic formulations used in central nervous system (CNS) neoplasms, lymphomas, melanomas

  • Pregnancy & lactation
  • Allergy
  • Children (risk of systemic absorption)

  • Erythema, tenderness, bullae   
  • Telangiectasias (benign)
  • Irritant contact dermatitis/ allergic contact dermatitis
  • Myelosuppression if systemic absorption

* For further reading refer to a pharmacology source

  • Wear gloves during the once daily application
  • Monitoring: complete blood count at baseline then qmonthly
  • Stop treatment if moderate-severe erythema, pruritus, or other symptoms