Combination Chemotherapy (Methotrexate, Cyclophosphamide, And Etoposide Phosphate) Delivered In Conjunction With Osmotic Blood-Brain Barrier Disruption (BBBD), With Intraventricular Cytarabine +/- Intra-Ocular Chemotherapy, In Patients With Primary Central Nervous System Lymphoma
16 Years
75 Years
Both
Lymphoma
Trial Information
Combination Chemotherapy (Methotrexate, Cyclophosphamide, And Etoposide Phosphate) Delivered In Conjunction With Osmotic Blood-Brain Barrier Disruption (BBBD), With Intraventricular Cytarabine +/- Intra-Ocular Chemotherapy, In Patients With Primary Central Nervous System Lymphoma
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.
Inclusion 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
- Not specified
Chemotherapy
- More than 4 weeks since prior chemotherapy (6 weeks for nitrosoureas)
- Single-agent methotrexate administered within the past 14 days allowed
Endocrine therapy
- Not specified
Radiotherapy
- No prior cranial or spinal radiotherapy
Surgery
- Prior surgery or biopsy allowed
Type of Study:
Interventional
Study Design:
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Outcome Measure:
Survival as measured by clinical and radiographic response at 5 years after study treatment
Safety Issue:
No
Principal Investigator
Edward A. Neuwelt, MD
Investigator Role:
Principal Investigator
Investigator Affiliation:
OHSU Knight Cancer Institute
Authority:
United States: Federal Government
Study ID:
OHSU-5729-2
NCT ID:
NCT00074178
Start Date:
January 2000
Completion Date:
July 2006
Related Keywords:
- Lymphoma
- primary central nervous system lymphoma
- intraocular lymphoma
- Lymphoma
Name | Location |
|---|---|
| Oregon Health & Science University Cancer Institute | Portland, Oregon 97239-3098 |
