Topotecan to Treat Patients with Meningeal Cancers - Article
Clinical Trial: Topotecan to Treat Patients with Meningeal Cancers
This study is currently recruiting patients.
Patients between 1 and 21 years of age with neoplastic meningitis for whom no effective standard treatment is available or effective may be eligible for this study. Candidates will be screened with the following tests, some of which will be repeated at various times throughout the study:
- Complete medical history, physical examination, and neurological examination.
- Lumbar puncture (spinal tap). This procedure is done to examine the cerebrospinal fluid (CSF), which bathes the brain and spinal cord. After a local anesthetic is administered, a needle is inserted in the space between the bones in the lower back where the CSF circulates below the spinal cord. A small amount of fluid is collected through the needle.
- Magnetic resonance imaging (MRI) of the brain and possibly spine. This diagnostic test uses a strong magnetic field and radio waves to show structural and chemical changes in tissues. During the scan, the patient lies on a table within a narrow cylinder containing a magnetic field. He or she can speak with a staff member via an intercom system at all times during the procedure.
- Bone marrow biopsy. This test looks for evidence of cancer cells in the bone marrow. It is done in patients with leukemia or lymphoma and in certain circumstances in patients with solid tumors. The hip area is anesthetized and a special needle is used to draw bone marrow from the hipbone.
- CSF flow study. This nuclear medicine study examines the CSF circulation. It is done in patients with a solid tumor or leukemia or lymphoma that might be blocking the flow of spinal fluid around the brain and spinal cord.
Study participants will be given infusions of topotecan directly into the CSF over a 10-minute period twice a week for 6 weeks. If the disease has not worsened at the end of 6 weeks, therapy will continue once a week for the next 4 weeks, then twice a month for 4 months and then once a month thereafter for a maximum total of 1 year. Topotecan is given by one of the following methods:
- Ommaya reservoir or lumbar reservoir - An Ommaya reservoir is a surgically implanted catheter used to inject medicine or withdraw CSF from the ventricles (fluid chambers) within the brain. A lumbar reservoir is a catheter surgically implanted in the lower back to inject medicine or withdraw CSF. The catheters are attached to a small mushroom-shaped chamber (reservoir) beneath the skin. A needle is inserted through the skin and into the reservoir to sample CSF and to administer the topotecan.
|Condition||Treatment or Intervention||Phase|
|Meningeal Cancer || Drug: Topotecan ||Phase II |
MedlinePlus related topics: Cancer; Cancer Alternative Therapy; Neurologic Diseases
Study Type: Interventional
Study Design: Treatment, Safety/Efficacy
Expected Total Enrollment: 10
Study start: March 23, 2001
Topotecan is a topoisomerase inhibitor with a broad-spectrum of anti-tumor activity. An initial phase I study demonstrated that intrathecal administration of topotecan is well tolerated and is associated with objective anti-tumor response. Furthermore, prolonged intrathecal topotecan administration has not been associated with any unexpected or cumulative toxicities. The purpose of this phase II study is to: 1) determine the therapeutic activity (response rate and time to CNS progression) of intrathecal topotecan in patients with recurrent or refractory neoplastic meningitis; 2) further assess the safety/toxicity of intrathecal topotecan in the treatment of patients with neoplastic meningitis; and 3) evaluate the concentration of matrix metalloproteinases (MMPs) in the CSF of patients with recurrent or refractory neoplastic meningitis.
The administration of intrathecal topotecan may be either intraventricular (Ommaya reservoir injection) or intralumbar (lumbar puncture or indwelling intralumbar catheter) route. During induction therapy, drug will be administered on a twice weekly basis for a total of 6 weeks. Patients may proceed to consolidation therapy if there is no evidence of disease progression. During consolidation, intrathecal topotecan will be administered weekly for a total of 4 doses. The first dose of consolidation will be given 1 week after the last induction dose. Maintenance therapy will be given twice monthly for four months and then monthly thereafter. The first dose of maintenance will be given two weeks after the last consolidation dose. Maximum duration of treatment is one year.
Genders Eligible for Study: Both
Patients must be greater than or equal to 1 and less than or equal to 21.99 years of age at study entry.
Patients must have neoplastic meningitis. Patients with meningeal leukemia/lymphoma must be refractory to conventional therapy (i.e., 2nd or greater relapse). The definition of neoplastic meningitis on this protocol is as follows:
Leukemia/Lymphoma: CSF cell count greater than 5/ul AND evidence of blast cells on cytospin preparation or by cytology;
Solid tumors/Other: Presence of tumor cells on cytospin preparation or cytology OR presence of meningeal disease on MRI scans.
Patients must have a life expectancy of at least 8 weeks.
Patients greater than 10 y.o. should have Karnofsky performance status of greater than or equal to 50% and patients less than or equal to 10 y.o. should have a Lansky performance status of greater than or equal to 50%.
Patients who are unable to walk because of paralysis, but who are up in a wheelchair, will be considered ambulatory for the purposes of the performance score.
Patients must have recovered from the acute toxic effects of all prior chemotherapy, immunotherapy, or radiotherapy, prior to entering this study and must be without significant systemic illness (e.g. infection). Patients must not have received any systemic CNS-directed therapy within 3 weeks (6 weeks if a prior nitrosourea), or craniospinal irradiation within 8 weeks prior to starting treatment on this study. Patients must not have received intrathecal chemotherapy within 1 week (2 weeks if prior DTC101). Patients who have had IT chemotherapy, e.g. in the - 7 to - 14 day period prior to study entry must have evidence of disease progression, e.g. increasing WBC and percentage blasts in patients with leukemia/lymphoma or increased leptomeningeal enhancements in patients with solid tumors.
Patients must have a platelet count greater than 40,000/ul, with transfusions allowed to achieve this platelet count, within 48 hours prior to intrathecal topotecan treatment.
Patients must have adequate liver function, total bilirubin less than 2.0 mg%; SGPT less than 5 times normal; adequate renal function (serum creatinine less than 1.5 mg); and normal metabolic parameters (serum electrolytes, calcium and phosphorus).
All patients or their legal guardians must sign a written informed consent according to institutional guidelines.
Patients receiving other therapy (either intrathecal or systemic) designed specifically to treat their leptomeningeal disease are not eligible for this study. However, patients receiving concomitant chemotherapy to control systemic disease or bulk CNS disease will be eligible, provided the systemic chemotherapy is not a phase I agent, an agent which significantly penetrates the CSF [e.g., high-dose methotrexate (greater than 1 gm/m(2)), thiotepa, high-dose cytarabine, 5-fluorouracil, intravenous 6-mercaptopurine, nitrosoureas, or topotecan], or an agent known to have serious unpredictable CNS side effects. Careful documentation of concurrently administered systemic drugs is required.
Patients with clinical evidence of obstructive hydrocephalus or compartmentalization of the CSF flow as documented by radioisotope Indium(111) or Technitium(99)-DTPA flow study are not eligible for this protocol. If a CSF flow block is demonstrated, focal radiotherapy to the site of block to restore flow and a repeat CSF flow study showing clearing of the blockage is required for the patient to be eligible for the study. [A copy of the institutional CSF flow study report must be submitted to the Primary Study Coordinator, Dr. Susan Blaney, via fax at (832) 824-4039].
Patients with a ventriculoperitoneal (VP) or ventriculoatrial (VA) shunt are not eligible for this study unless they are shunt independent and there is evidence that their shunt is nonfunctional; e.g., a CSF flow study demonstrating normal flow.
Patients with leukemia/lymphoma who have a concomitant bone marrow relapse are not eligible for this study.
Women of childbearing age must not be pregnant or lactating because of potential teratogenic effects (e.g. The anti-proliferative activity of the investigational agent may be harmful to the developing fetus or the nursing infant).
Free of uncontrolled infection except HIV (i.e., AIDS-related lymphomatous meningitis).
Use of any other investigational drug within 7 days prior to study entry. This period should be extended if the patient has received any investigational agent which is known to have delayed toxicities after 7 days or a prolonged half-life.
Patients with impending cord compression, CNS involvement requiring local XRT (e.g. optic nerve), or isolated bulky ventricular or leptomeningeal based lesions are not eligible for this study.
Location and Contact Information
National Cancer Institute (NCI), 9000 Rockville Pike, Bethesda, Maryland, 20892, United States; Recruiting
Detailed Web Page
Berg SL, Balis FM, Zimm S, Murphy RF, Holcenberg J, Sato J, Reaman G, Steinherz P, Gillespie A, Doherty K, et al. Phase I/II trial and pharmacokinetics of intrathecal diaziquone in refractory meningeal malignancies. J Clin Oncol. 1992 Jan;10(1):143-8.
McCully CL, Balis FM, Bacher J, Phillips J, Poplack DG. A rhesus monkey model for continuous infusion of drugs into cerebrospinal fluid. Lab Anim Sci. 1990 Sep;40(5):520-5.
Record last reviewed: March 1, 2005
Last Updated: February 24, 2005
Record first received: March 28, 2001
ClinicalTrials.gov Identifier: NCT00013676
Health Authority: United States: Federal Government
ClinicalTrials.gov processed this record on 2005-04-08
Cache Date: April 9, 2005