Patient case: 84-year-old male with glioblastoma; genetic feature: CDK6

Clinical trial: Busulfan in Treating Children and Adolescents With Refractory CNS Cancer

Summary: RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die.
  PURPOSE: Phase I trial to study the safety of delivering intrathecal busulfan in children and adolescents who have refractory CNS cancer and to estimate the maximum tolerated dose of this treatment regimen.

Detailed description: OBJECTIVES:
  -  Determine the qualitative and quantitative toxicities of intrathecally administered busulfan in children and adolescents with refractory CNS malignancies.
  -  Determine the maximum tolerated dose of this treatment regimen in these patients.
  -  Determine the cerebrospinal fluid and serum pharmacokinetics of this treatment regimen in these patients.
  -  Determine the efficacy of this treatment regimen in these patients.
  OUTLINE: This is a dose-escalation study.
  Patients receive intrathecal busulfan twice a week, at least 3 days apart, for 2 weeks. Patients with complete or partial response or stable disease may continue therapy once a week for 2 weeks, once a week every other week for 2 treatments, and then once a month thereafter in the absence of disease progression or unacceptable toxicity.
  Cohorts of 3-6 patients receive escalating doses of busulfan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 6 patients experience dose limiting toxicities.
  Patients are followed every 3 months for the first year, every 6 months for 4 years, and then annually for 5 years.
  PROJECTED ACCRUAL: Approximately 18-24 patients will be accrued for this study over 18-38 months.

Eligibility: DISEASE CHARACTERISTICS:
  -  Histologically confirmed CNS malignancy, including any of the following:
  -  Primary malignant brain tumor refractory to standard therapy and metastatic to the cerebrospinal fluid (CSF) or leptomeningeal subarachnoid space
  -  Recurrent or persistent leptomeningeal leukemia, lymphoma, or germ cell tumor refractory to conventional therapy
  -  In second or greater relapse
  -  CSF white blood count greater than 5 cells/mm3 with blasts on cytospin OR
  -  Evidence of leptomeningeal tumor by MRI
  -  No concurrent bone marrow disease
  -  No obstruction or compartmentalization of CSF flow on CSF flow study
  PATIENT CHARACTERISTICS:
  Age:
  -  3 to 21
  Performance status:
  -  Lansky 50-100% (under 10 years)
  -  Karnofsky 50-100% (10 to 21 years)
  Life expectancy:
  -  Greater than 8 weeks
  Hematopoietic:
  -  Absolute neutrophil count greater than 1,000/mm^3
  -  Platelet count greater than 75,000/mm^3
  Hepatic:
  -  Bilirubin normal for age
  -  ALT and AST less than 5 times upper limit of normal (ULN)
  -  No hepatic disease
  Renal:
  -  Creatinine no greater than 1.5 times ULN OR
  -  Glomerular filtration rate greater than 70 mL/min
  -  No renal disease
  Cardiovascular:
  -  No cardiac disease
  Pulmonary:
  -  No pulmonary disease
  Other:
  -  No uncontrolled infection
  -  Not pregnant or nursing
  -  Negative pregnancy test
  -  Fertile patients must use effective contraception
  PRIOR CONCURRENT THERAPY:
  Biologic therapy:
  -  Not specified
  Chemotherapy:
  -  At least 3 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosoureas)
  -  At least 1 week since prior intrathecal chemotherapy (2 weeks for cytarabine) and recovered
  -  Evidence of subsequent disease progression
  -  Concurrent systemic chemotherapy allowed for recurrent disease after first course of treatment except for the following:
  -  Chemotherapy targeted at leptomeningeal disease
  -  Other phase I agent
  -  Any agent that significantly penetrates the CSF (e.g., high dose methotrexate greater than 1 g/m2, thiotepa, high dose cytarabine, fluorouracil, IV mercaptopurine, nitrosoureas, or topotecan)
  -  Any agent that causes serious unpredictable CNS side effects
  Endocrine therapy:
  -  Prior dexamethasone allowed with decreasing or stable dose at least one week before study
  -  Concurrent dexamethasone or prednisone with chemotherapy regimen allowed
  Radiotherapy:
  -  At least 1 week since prior focal irradiation to the brain or spine
  -  At least 8 weeks since prior craniospinal irradiation
  -  No concurrent cranial or craniospinal irradiation
  Surgery:
  -  Not specified
  Other:
  -  No other concurrent intrathecal or systemic therapy for leptomeningeal disease

Relevance to patient case: not relevant