Nimustine hydrochloride is a hydrochloride obtained by combining nimustine with one equivalent of hydrochloric acid. It is a white to light yellow crystal with the chemical name 1-[(4-amino-2-methyl-5-pyrimidinyl)methyl]-3-(2-chloroethyl)-3-nitrosourea hydrochloride. Nimustine hydrochloride is an antineoplastic drug with a significant effect on malignant brain tumors. The structure is shown in fig. 1.
Fig. 1 Structure of nimustine hydrochloride
Application in the treatment of malignant brain tumors
Introduction of malignant brain tumors
Malignant brain tumors can be divided into primary and secondary malignant brain tumors. Primary malignant brain tumors mean the cancer starts in the brain, while secondary malignant brain tumors mean the cancer starts somewhere else in the body and then metastasizes to the brain. The incidence of the latter is about 10 times that of the former. Meningioma brain tumors usually come with no symptoms, but as they grow gradually, patients may experience the following symptoms:
Seizures
Memory loss
Speech problems
Headache
Loss of smell
Hearing disability
Numbness
Blurred vision
If left untreated, malignant brain tumors can rapidly grow and spread to other areas of the brain and spinal cord. The exact cause of malignant brain tumors remains unknown. However, possible risk factors include family history, skull injury or fracture, obesity, and radiation exposure. Since 1985, the treatment of malignant brain tumors was advanced by a combination of chemotherapy using nimustine hydrochloride and etoposide, which was particularly effective for malignant gliomas[1].
Mechanism of action
Nimustine hydrochloride can alkylate and cross-link DNA, which induces DNA replication blockade and DNA double-strand breaks, leading to the failure of DNA synthesis. In this way, nimustine hydrochloride exerts an anti-tumor effect, especially on malignant brain tumors.
Side effects
Common side effects of nimustine hydrochloride mainly include:
Genitourinary system: Nimustine hydrochloride can cause an increase in blood urea nitrogen.
Blood system: Nimustine hydrochloride can cause delayed and cumulative bone marrow suppression that leads to leukopenia, thrombocytopenia, anemia, etc.
Digestive system: Nimustine hydrochloride can cause loss of appetite, nausea, vomiting, and sometimes diarrhea, stomatitis, and liver damage.
Other side effects of nimustine hydrochloride mainly include:
Nimustine hydrochloride can cause malaise, fever, headache, dizziness, rash, hair loss, cramp and hypoproteinemia.
Nimustine hydrochloride can cause interstitial pneumonia and pulmonary fibrosis in a small number of patients may develop.
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Reference
Tanaka, M., et al. Radiotherapy combined with nimustine hydrochloride and etoposide for malignant gliomas: results of a pilot study. Japanese Journal of Clinical Oncology. 2001, 6(31): 246-250.
