Methotrexate, Cyclophosphamide, and Etoposide Phosphate Given With Osmotic Blood-Brain Barrier Disruption Plus Dexamethasone and Cytarabine in Treating Patients With Primary CNS Lymphoma (Protocol-B)

OHSU Knight Cancer Institute

Status and phase

Completed

Phase 2

Conditions

Lymphoma

Treatments

Biological: filgrastim

Drug: dexamethasone

Drug: methotrexate

Drug: etoposide phosphate

Drug: cytarabine

Drug: cyclophosphamide

Biological: pegfilgrastim

Study type

Interventional

Funder types

Other

NIH

Identifiers

NCT00074178

ONC-99055-L (Other Identifier)

5729-2 (Other Identifier)

935

OHSU-5729-2 (Other Identifier)

IRB00000935

Details and patient eligibility

About

RATIONALE: Drugs used in chemotherapy, such as methotrexate, cyclophosphamide, etoposide phosphate, dexamethasone, and cytarabine, work in different ways to stop cancer cells from dividing so they stop growing or die. Osmotic blood-brain barrier disruption uses certain drugs to open the blood vessels around the brain and allow anticancer substances to be delivered directly to the brain. Giving methotrexate, cyclophosphamide, and etoposide phosphate with osmotic blood-brain barrier disruption plus dexamethasone and cytarabine may kill more cancer cells.

PURPOSE: Phase II trial to study the effectiveness of giving methotrexate, cyclophosphamide, and etoposide phosphate with osmotic blood-brain barrier disruption plus dexamethasone and cytarabine in treating patients who have primary CNS lymphoma.

Full description

OBJECTIVES:

Primary

Determine the toxicity and efficacy of methotrexate, cyclophosphamide, and etoposide phosphate administered in conjunction with osmotic blood-brain barrier disruption and dexamethasone and cytarabine in patients with primary CNS lymphoma.

Secondary

Determine the ability to recruit an adequate number 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 this patient population.
Correlate neuropsychological outcomes with neuroimaging (MRI) outcomes in patients treated with this regimen.

OUTLINE: This is a multicenter study.

Patients receive methotrexate (MTX) intra-arterially over 10 minutes, cyclophosphamide IV over 10 minutes, and etoposide phosphate IV over 10 minutes on days 1 and 2 in conjunction with osmotic blood-brain barrier disruption. Patients also receive oral dexamethasone every 6 hours on days 2-15 (followed by a taper) and intraventricular or intrathecal cytarabine on day 14. Beginning 48 hours after the last dose of MTX, patients receive filgrastim (G-CSF)* subcutaneously once daily for 7-10 days or until blood counts recover. Treatment repeats every 4 weeks for 12 courses in the absence of disease progression or unacceptable toxicity.

NOTE: *Alternatively, patients may receive a single dose of pegfilgrastim, administered 24 hours after the completion of chemotherapy

Patients with intraocular lymphoma also receive MTX intravitreally twice weekly until the vitreous is clear of cells by slit lamp exam and then weekly for 1 month and monthly for 1 year.

Quality of life is assessed at baseline, at 6 months, at the completion of treatment, and then every 6 months for 2 years and 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 90 patients will be accrued for this study within 3 years.

Enrollment

22 patients

Sex

All

Ages

16 to 75 years old

Volunteers

No Healthy Volunteers

Inclusion and exclusion criteria

DISEASE CHARACTERISTICS:

Histologically or cytologically confirmed intermediate- or high-grade primary CNS lymphoma by brain biopsy or cerebrospinal fluid or vitrectomy analysis
No more than 90 days since diagnosis
No systemic lymphoma NOTE: A new classification scheme for adult non-Hodgkin's lymphoma has been adopted by PDQ. The terminology of "indolent" or "aggressive" lymphoma will replace the former terminology of "low", "intermediate", or "high" grade lymphoma. However, this protocol uses the former terminology.

PATIENT CHARACTERISTICS:

Age

16 to 75

Performance status

ECOG 0-3 OR
Karnofsky 40-100%

Life expectancy

Not specified

Hematopoietic

Hematocrit at least 25% (transfusion allowed)
WBC at least 2,500/mm^3
Absolute granulocyte count at least 1,200/mm^3
Platelet count at least 100,000/mm^3 OR at least lower limit of normal (transfusion independent)

Hepatic

Bilirubin no greater than 2.0 times upper limit of normal

Renal

Creatinine clearance at least 30 mL/min

Cardiovascular

Adequate cardiac function to tolerate general anesthesia

Pulmonary

Adequate pulmonary function to tolerate general anesthesia

Other

Not pregnant or nursing
Negative pregnancy test
Fertile patients must use effective contraception for 2 months before and during study participation
No other uncontrolled clinically significant confounding medical condition within the past 30 days
No known allergy to study agents
HIV negative

PRIOR CONCURRENT THERAPY:

Biologic therapy