Safety Study of High Dose Temozolomide to Treat Relapsed/Refractory Central Nervous System (CNS) Malignancy

Study Overview
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Brief Summary
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The goal of this study is to find the maximum dose of a drug, temozolomide, that can safely be given to subjects with brain tumors. Past studies showed that the maximum dose of temozolomide was limited by low blood counts. The investigators will use blood stem cells collected from bone marrow to help subjects recover their blood counts, a procedure called autologous stem cell transplant or stem cell rescue. This way, the investigators expect to be able to safely deliver very high doses of temozolomide. This study is only available at Tufts Medical Center.

Detailed Description
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High dose chemotherapy and autologous stem cell transplant is an accepted treatment alternative for patients with brain tumors. Temozolomide has been approved for use by the United States Food and Drug Administration (FDA) for certain tumors of the brain. The doses of temozolomide given in this study will be higher than approved by the FDA and higher than those given in any prior studies. Over 25 subjects will be enrolled on this study over a period of 5 years. This study will only be available at Tufts Medical Center.

Official Title
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Phase I Dose Escalation Study of Temozolomide With Autologous Stem Cell Rescue for Patients With Relapsed/Refractory CNS Malignancy Including Isolated Metastatic Disease

Conditions
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Central Nervous System Neoplasms, Neoplasm Metastasis

Intervention / Treatment
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* Drug: Temozolomide


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients or their health care proxies must be able to provide consent to participate in this trial. Patients must have one of the following diagnoses which has not responded or recurred following at least one prior chemotherapy regimen or radiation therapy: anaplastic astrocytoma, glioblastoma multiforme or oligodendroglioma primary CNS lymphoma malignant disease metastatic to the CNS Patients must be candidates for high dose chemotherapy and autologous stem cell transplant according to the following criteria: Patients must be between the ages of 18 and 70 years (inclusive) Patients must have a left ventricular ejection fraction greater than or equal to 45% by MUGA or echocardiogram Patients must have adequate pulmonary function with FEV1, FVC and DLCO greater than or equal to 50% of predicted Patients must have serum direct bilirubin less than or equal to 2.0 mg/dl and transaminases less than or equal to 3x institutional upper limit of normal Patients must have serum creatinine less than or equal to 2 mg/dl with creatinine clearance greater than or equal to 60 ml/min (either calculated or measured) Patients must have an ECOG performance status between 0 and 2 Patients must be at least 4 weeks from last cytoreductive chemotherapy. Expected survival of at least 3 months Exclusion Criteria: Patients with uncontrolled metastatic disease outside of the CNS which would itself, in the investigator's opinion, limit survival to less than 6 months Patients with uncontrolled seizures are ineligible. Patients with a history of myocardial infarction within the preceding 6 months, significant arrhythmia within the preceding 3 months, or uncontrolled hypertension or congestive heart failure are ineligible. Patients with unstable angina are ineligible. Pregnant or lactating women are ineligible. Male and female patients who do not agree to practice approved methods of birth control for the duration of the study are ineligible. Patients with uncontrolled, active infection are ineligible. Patients infected with HIV are ineligible.

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 70 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: 1<br> | Drug: Temozolomide<br>* Before taking part in this study, subjects will have stem cells collected in a procedure called apheresis. Once on this study, subjects will be admitted to the hospital and receive daily doses of temozolomide by mouth for 5 days. Stem cells will be given back to subjects who will remain in the hospital until blood counts have recovered. Doses of temozolomide will range from 350 mg to 1500 mg/m(squared) daily for 5 days (total dose 1750 to 7500 mg/m(squared).<br>* Other names: Temodar;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Determine the maximum tolerated dose of temozolomide with hematopoietic stem cell rescue in patients with recurrent CNS malignancy |  | 5 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Estimate the response rate, response duration and survival according to established response definitions |  | 5 years | 
| Determine the pharmacokinetics of high daily dosing of temozolomide in the transplant setting |  | 5 years | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Lung Neoplasm, Breast Neoplasm, Melanoma, Central Nervous System Neoplasms, Neoplasm Metastasis, Neoplasm Second Primary, Peripheral Blood Stem Cell Transplantation