O6-benzylguanine and Carmustine in Treating Children With Refractory CNS Tumors
Brain and Central Nervous System Tumors
About this trial
This is an interventional treatment trial for Brain and Central Nervous System Tumors focused on measuring childhood craniopharyngioma, childhood central nervous system germ cell tumor, childhood oligodendroglioma, childhood choroid plexus tumor, recurrent childhood brain stem glioma, recurrent childhood supratentorial primitive neuroectodermal tumor, recurrent childhood visual pathway glioma, recurrent childhood cerebellar astrocytoma, recurrent childhood cerebral astrocytoma, recurrent childhood medulloblastoma, recurrent childhood ependymoma
Eligibility Criteria
DISEASE CHARACTERISTICS: Histologically or cytologically proven CNS tumor that is refractory to conventional therapy or for which no effective therapy is known Histological requirement may be waived for brainstem and optic gliomas Stratum 2: No bone marrow involvement PATIENT CHARACTERISTICS: Age: 21 and under Performance status: Karnofsky 50-100% OR Lansky 50-100% Life expectancy: At least 8 weeks Absolute neutrophil count at least 1500/mm3 Platelet count at least 100,000/mm3 (stratum 2: at least 125,000/mm3) Hemoglobin at least 8 g/dL Bilirubin less than 1.5 mg/dL SGOT/SGPT no greater than 2.5 times normal Creatinine or GFR normal for age If required, DLCO must be 80% of normal and patient old enough to cooperate for DLCO test Neurologic deficits must be stable for at least 2 weeks prior to study Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception during and for 6 months after study PRIOR CONCURRENT THERAPY: At least 7 days since prior biologic therapy or immunotherapy and recovered At least 6 months since prior bone marrow transplant (stratum 1 only) At least 7 days since prior growth factors No concurrent filgrastim (G-CSF) prophylaxis Stratum 2: No prior bone marrow transplantation At least 2 weeks since prior myelosuppressive chemotherapy (6 weeks for nitrosourea) and recovered Stratum 2: No greater than 2 prior chemotherapy regimens No prior nitrosourea therapy If receiving dexamethasone, must be on stable or decreasing dose for at least 2 weeks prior to study At least 2 weeks since prior local palliative radiotherapy (small port) At least 6 months since prior substantial bone marrow radiation, total body irradiation, hemipelvic radiotherapy, or total abdominal/pelvic/chest or mantle/Y ports radiotherapy Recovered from prior radiotherapy Stratum 2: No prior central axis radiation No other concurrent anticancer or investigational agents
Sites / Locations
- University of Arkansas for Medical Sciences
- University of California San Diego Cancer Center
- Children's Hospital Los Angeles
- Jonsson Comprehensive Cancer Center, UCLA
- City of Hope National Medical Center
- Children's Hospital of Orange County
- UCSF Cancer Center and Cancer Research Institute
- Stanford University Medical Center
- Children's National Medical Center
- University of Florida Health Science Center
- Emory University Hospital - Atlanta
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University
- Children's Memorial Hospital, Chicago
- Indiana University Cancer Center
- University of Kansas Medical Center
- Johns Hopkins Oncology Center
- Boston Floating Hospital Infants and Children
- Dana-Farber Cancer Institute
- University of Michigan Comprehensive Cancer Center
- Children's Hospital of Michigan
- University of Minnesota Cancer Center
- Mayo Clinic Cancer Center
- University of Mississippi Medical Center
- Children's Mercy Hospital
- Cardinal Glennon Children's Hospital
- Washington University School of Medicine
- Hackensack University Medical Center
- Cancer Institute of New Jersey
- Roswell Park Cancer Institute
- NYU School of Medicine's Kaplan Comprehensive Cancer Center
- Memorial Sloan-Kettering Cancer Center
- Columbia Presbyterian Hospital
- State University of New York - Upstate Medical University
- Graham Children's Health Center
- Duke Comprehensive Cancer Center
- Children's Hospital Medical Center - Cincinnati
- Children's Hospital of Columbus
- University of Oklahoma Health Sciences Center
- Children's Hospital of Philadelphia
- Children's Hospital of Pittsburgh
- Medical University of South Carolina
- Vanderbilt Cancer Center
- Simmons Cancer Center - Dallas
- Cook Children's Medical Center - Fort Worth
- Texas Children's Cancer Center
- University of Texas - MD Anderson Cancer Center
- University of Texas Health Science Center at San Antonio
- Primary Children's Medical Center
- Children's Hospital and Regional Medical Center - Seattle
- University of Wisconsin Comprehensive Cancer Center
- Midwest Children's Cancer Center
- Royal Children's Hospital
- Princess Margaret Hospital for Children
- Hospital for Sick Children
- Montreal Children's Hospital
- Hopital Sainte Justine
Arms of the Study
Arm 1
Experimental
Arm I
Patients receive O6-benzylguanine IV over 1 hour, then, 1 hour later, carmustine IV is administered over 1 hour. Treatment is repeated every 6 weeks for up to 1 year in the absence of disease progression or unacceptable toxicity. Cohorts of 3-6 patients each receive escalating doses of carmustine until the maximum tolerated dose (MTD) is reached. The MTD is defined as the dose level at which fewer than 2 of 6 patients experience dose limiting toxicity (DLT). If myelosuppression is the DLT, stratum 1 is closed and patients are accrued to stratum 2. If neutropenia is the DLT in stratum 2, patients receive filgrastim (G-CSF) subcutaneously beginning on day 2 and continuing until blood counts recover.