Methotrexate, Procarbazine, Lomustine, Dexamethasone, and Cytarabine in Treating Patients With Primary CNS Lymphoma
Condition: Lymphoma
MeSH terms: Lymphoma
Study type: Interventional
Phase: Phase 2

Summary: 
      RATIONALE: Drugs used in chemotherapy, such as methotrexate, procarbazine, lomustine,
      dexamethasone, and cytarabine, use different ways to stop cancer cells from dividing so they
      stop growing or die. Combining more than one drug may kill more cancer cells.

      PURPOSE: Phase II trial to study the effectiveness of combination chemotherapy in treating
      patients who have primary CNS lymphoma.
    

Detailed description: 
      OBJECTIVES:

      Primary

        -  Determine the toxicity and efficacy of methotrexate, procarbazine, lomustine,
           dexamethasone, and cytarabine in patients with primary CNS lymphoma.

      Secondary

        -  Determine the ability to recruit adequate numbers of patients for this study.

        -  Compare progression-free and dementia-free survival with standard measures of overall
           survival, progression-free survival, disease-free survival, complete response rate,
           cognitive function, and quality of life of patients treated with this regimen.

        -  Determine the feasibility of conducting a future phase III study of this treatment
           regimen in these patients.

        -  Correlate neuropsychological outcomes with neuroimaging (MRI) outcomes in patients
           treated with this regimen.

      OUTLINE: This is a nonrandomized, multicenter study.

        -  Induction chemotherapy: Patients receive methotrexate IV over 3 hours on days 1, 10, and
           20 and intraventricularly or intrathecally (IT) over 5 minutes on days 1, 5, 10, and 15;
           oral procarbazine on days 1-7; oral lomustine on day 1; oral dexamethasone every 6 hours
           on days 1-14 followed by a taper (as tolerated); and cytarabine intraventricularly or IT
           over 5 minutes on days 1, 5, 10, and 15. Treatment repeats every 42 days for a total of
           3 courses. Patients with intraocular lymphoma also receive methotrexate intravitreally
           twice weekly until the vitreous is clear of cells by slit lamp exam. Patients with
           stable or responding disease proceed to maintenance therapy.

        -  Maintenance chemotherapy: Patients receive methotrexate IV over 3 hours and IT over 5
           minutes on day 1; oral procarbazine on days 1-7; oral lomustine on day 1; oral
           dexamethasone every 6 hours on days 1-14 followed by a taper (as tolerated); and
           cytarabine intraventricularly or IT over 5 minutes on day 1. Treatment repeats every 42
           days for a total of 5 courses.

      Patients with intraocular lymphoma also receive methotrexate intravitreally weekly for 1
      month and then monthly for 1 year.

      Quality of life is assessed at baseline, at 6 months, at the completion of treatment, every 6
      months for 2 years, and then annually thereafter.

      Patients are followed every 3 months for 1 year, every 6 months for 2 years, and then
      annually thereafter.

      PROJECTED ACCRUAL: A total of 180 patients will be accrued for this study within 3 years.
    

Intervention name(s): cytarabine; dexamethasone; lomustine; methotrexate; procarbazine hydrochloride
Intervention type(s): Drug; Drug; Drug; Drug; Drug
Intervention MeSH terms: Cytarabine; Dexamethasone; Methotrexate; Lomustine; Procarbazine
Masking: None (Open Label)
Primary purpose: Treatment
Keywords: intraocular lymphoma; primary central nervous system lymphoma