A Phase II Study of R115777 (ZARNESTRA) (NSC# 702818, IND# 58359) in Children With Recurrent or Progressive: High Grade Glioma, Medulloblastoma/PNET or Brainstem Glioma
Inclusion Criteria:
- Histologically confirmed brain tumor, including the following:
- Anaplastic astrocytoma
- Glioblastoma multiforme
- Gliosarcoma
- Anaplastic oligodendroglioma
- Medulloblastoma/primitive neuroectodermal tumor (PNET)
- Diffuse intrinsic brain stem glioma*
- Progressive or relapsed disease after prior conventional therapy
- Radiographic evidence of measurable disease
- Performance status - Karnofsky 60-100% (over 16 years of age)
- Performance status - Lansky 60-100% (16 years of age and under)
- Performance status - ECOG 0-2
- At least 8 weeks
- Absolute neutrophil count at least 1,000/mm^3
- Platelet count at least 100,000/mm^3 (transfusion independent)
- Hemoglobin at least 8.0 g/dL (red blood cell transfusions allowed)
- Bilirubin no greater than 1.5 times upper limit of normal (ULN)
- SGPT and SGOT less than 2.5 times ULN
- Creatinine clearance OR radioisotope glomerular filtration rate at least 70 mL/min
- Maximum creatinine based on age as follows:
- 0.8 mg/dL (5 years and under)
- 1.0 mg/dL (6 to 10 years)
- 1.2 mg/dL (11 to 15 years)
- 1.5 mg/dL (over 15 years)
- Shortening fraction at least 27% by echocardiogram
- Ejection fraction at least 50% by MUGA
- No dyspnea at rest
- No exercise intolerance
- Pulse oximetry greater than 94%*
- Not pregnant or nursing
- Negative pregnancy test
- Fertile patients must use effective contraception
- Seizure disorder is allowed provided it is well-controlled on non-enzyme-inducing
anticonvulsants
- No active graft-versus-host disease
- No uncontrolled infection
- No allergy to azoles (e.g., ketoconazole, itraconazole, or fluconazole)
- Recovered from prior immunotherapy
- At least 7 days since prior antineoplastic biologic agents
- At least 1 month since prior autologous stem cell transplantation (SCT)
- At least 6 months since prior allogeneic SCT
- More than 1 week since prior growth factors
- No concurrent immunomodulating agents
- More than 2 weeks since prior myelosuppressive chemotherapy (4-6 weeks for
nitrosoureas or temozolomide) and recovered
- No concurrent anticancer chemotherapy
- Concurrent dexamethasone allowed provided patient is on a stable or decreasing dose
for at least 1 week prior to study entry
- Concurrent corticosteroids allowed only for treatment of increased intracranial
pressure
- Recovered from prior radiotherapy
- At least 2 weeks since prior local palliative radiotherapy (small port)
- At least 3 months since prior craniospinal radiotherapy
- At least 6 weeks since other prior substantial bone marrow radiotherapy
- No concurrent palliative radiotherapy
- No prior initiation of therapy on another phase II study
- No concurrent participation in another therapeutic COG study
- No concurrent enzyme-inducing anticonvulsants
- No other concurrent anticancer or experimental drugs
- No concurrent foods or medications that interfere with CYP3A4, including any of the
following:
- Carbamazepine
- Phenytoin
- Phenobarbital
- Grapefruit juice
- Erythromycin
- Azithromycin
- Clarithromycin
- Rifampin and its analogues
- Fluconazole
- Ketoconazole
- Itraconazole
- Cimetidine
- Cannabinoids (i.e., marijuana or dronabinol)
- Omeprazole
- Hypericum perforatum (St. John's wort)
- Ethosuximide
- Glucocorticoids
- Griseofulvin
- Nafcillin
- Nelfinavir
- Norfloxacin
- Norfluoxetine
- Nevirapine
- Oxcarbazepine
- Phenylbutazone
- Primidone
- Progesterone (all progestins)
- Rifabutin
- Rofecoxib
- Sulfadimidine
- Sulfinpyrazone
- Troglitazone
- Rifapentine
- Modafinil
- Amiodarone
- Anastrozole
- Clotrimazole
- Cyclosporine
- Danazol
- Delavirdine
- Diethyldithiocarbamate
- Diltiazem
- Dirithromycin
- Disulfiram
- Entacapone (high dose)
- Ethinyl estradiol
- Fluoxetine
- Fluvoxamine
- Gestodene
- Indinavir
- Isoniazid
- Metronidazole
- Mibefradil
- Miconazole
- Nefazodone
- Oxiconazole
- Paroxetine
- Propoxyphene
- Roxithromycin
- Quinidine
- Quinine
- Quinupristin and dalfopristin
- Ranitidine
- Ritonavir
- Saquinavir
- Sertindole
- Sertraline
- Troleandomycin
- Valproic acid
- Verapamil
- Voriconazole
- Zafirlukast
- Zileuton