Intrathecal Busulfan in Treating Patients With Recurrent, Refractory, or Metastatic Leptomeningeal Tumors

Study Overview
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Brief Summary
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RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die. Giving drugs into the thin space between the lining of the spinal cord and brain may kill more tumor cells. PURPOSE: Phase I trial to study the effectiveness of intrathecal busulfan in treating patients with recurrent, refractory, or metastatic leptomeningeal tumors.

Detailed Description
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OBJECTIVES: Determine the maximum tolerated dose of intrathecal busulfan by a limited escalation dosage schedule in patients with recurrent or refractory leptomeningeal tumors. Determine the cerebrospinal fluid and serum pharmacokinetics of busulfan administered via intralumbar or intraventricular routes in these patients. OUTLINE: This is dose-escalation study. Patients receive intrathecal busulfan via intralumbar or intraventricular routes twice a week for 2 weeks (4 treatments). Any patient with objective or significant clinical response may continue treatment by receiving the same dose once a week for 2 consecutive weeks, once a week every other week for 3 weeks (2 treatments), and then once a month thereafter until disease progression or unacceptable toxicity. Cohorts of 3-6 patients receive escalating doses of intrathecal busulfan until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which 2 of 3 or 2 of 6 patients experience dose-limiting toxicity. Patients are followed every 12 weeks for 1 year or until disease progression. PROJECTED ACCRUAL: A total of 5-20 patients will be accrued for this study within 1-2 years.

Official Title
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Phase I Study of Intrathecal Spartaject-Busulfan in Patients With Neoplastic Meningitis

Conditions
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Brain and Central Nervous System Tumors

Intervention / Treatment
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* Drug: busulfan


Participation Criteria
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Eligibility Criteria
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DISEASE CHARACTERISTICS: Histologically confirmed neoplasm that is metastatic in the cerebrospinal fluid or leptomeningeal/subarachnoid space Cytologic diagnosis of malignancy in the cerebrospinal fluid or neuroimaging evidence of leptomeningeal tumor by MRI Must have a recurrent or refractory leptomeningeal tumor Leptomeningeal tumors of leukemia, lymphoma, and all germ cell tumors must have also failed initial treatment or be recurrent No evidence of obstructive hydrocephalus or complete block of the spinal cerebrospinal fluid pathways on prestudy technetium Tc 99m albumin or indium In 111 DTPA flow study PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 60-100% Life expectancy: At least 8 weeks Hematopoietic: Absolute neutrophil count greater than 1,500/mm^3 Platelet count greater than 100,000/mm^3 Hepatic: Bilirubin less than 2.5 mg/dL SGOT or SGPT less than 1.5 times normal Renal: BUN less than 30 mg/dL Creatinine less than 1.5 mg/dL Calcium within normal limits Neurological: Neurological examination stable No rapidly progressing or deteriorating neurological deficits Other: No active infectious process Magnesium, phosphorus, potassium, chloride, and bicarbonate normal Not pregnant or nursing Fertile patients must use effective contraception PRIOR CONCURRENT THERAPY: Biologic therapy: At least 4 weeks since prior immunotherapy Chemotherapy: At least 6 weeks since prior nitrosoureas or mitomycin At least 4 weeks since any other prior chemotherapy At least 3 weeks since prior intrathecal chemotherapy No other concurrent intrathecal chemotherapy Endocrine therapy: For patients on corticosteroids: Must be on a stable dose of corticosteroids for at least 1 week Radiotherapy: At least 3 weeks since prior radiotherapy to the CNS At least 4 weeks since any other prior radiotherapy No concurrent radiotherapy to the CNS Surgery: At least 3 weeks since prior surgery Other: No concurrent medication that may interfere with study results (e.g., immunosuppressive agents other than corticosteroids)

Ages Eligible for Study
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Minimum Age: 18 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


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: busulfan|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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leptomeningeal metastases