A Phase II Study of Dose-Dense Temozolomide and Lapatinib for Recurrent Low-Grade and Anaplastic Supratentorial, Infratentorial and Spinal Cord Ependymoma

Inclusion Criteria:

1. Histologically proven ependymoma or anaplastic ependymoma. There must be pathologic
or imaging confirmation of tumor progression or regrowth. The patients histologic
diagnosis must be confirmed on Central Pathology Review prior to registration Step 2.

2. History and physical examination, including neurologic examination, within 2 weeks
prior to registration.

3. Patients must be able to undergo brain or spine MRI scans with intravenous
gadolinium, based on tumor location(s) within 14 days prior to registration.

4. Patients must be on a steroid dose that has been stable or decreasing for at least 5
days. If the steroid dose is increased between the date of imaging and registration,
a new baseline MRI is required.

5. Karnofsky performance status >/= 70

6. Age >/= 18

7. CBC/differential obtained within 14 days prior to registration, with adequate bone
marrow function defined as follows: 1) Absolute neutrophil count (ANC) >/=
1,500/mm^3. 2) Platelets >/= 100,000 cells/mm^3. 3) Hemoglobin >/= 10.0 gm/dL (Note:
The use of transfusion or other intervention to achieve Hgb >/= 10.0 is acceptable).
4) White blood cell count (WBC) >/= 3,000/mcL.

8. Adequate liver function within 14 days prior to registration, defined as follows:
SGPT [ALT] < 2.5 times the upper limit of normal, Bilirubin
9. Adequate renal function within 14 days prior to registration, defined as follows:
Creatinine < 1.7 mg/dL

10. Patients must have recovered from the toxic effects of prior therapy, and there must
be a minimum time of: 1) 28 days from the administration of any investigational
agent. 2) 28 days from administration of prior cytotoxic therapy with the following
exceptions: (a) 14 days from administration of vincristine. (b) 42 days from
administration of nitrosoureas. (c) 21 days from administration of procarbazine.

11. ( 11. continued) 3) 7 days from administration of non-cytotoxic agents [e.g.,
interferon, tamoxifen, thalidomide, cis-retinoic acid, etc. (radiosensitizer does not
count)]. 4) 28 days from prior radiation therapy.

12. Patients must have recovered from the effects of surgery and a minimum of 14 days
must have elapsed from the day of surgery to the day of registration. For core or
needle biopsy, a minimum of 7 days must have elapsed prior to registration.

13. Residual disease following resection of recurrent tumor is not mandated for
eligibility into the study. To best assess the extent of residual disease
post-operatively, an MRI should be done no later than 96 hours in the immediate
postoperative period or at least 4 weeks postoperatively, within 14 days prior to
registration. If the " within 96-hour of surgery " scan is more than 14 days before
registration, the scan needs to be repeated.

14. Patients must sign study-specific informed consent and authorization for the release
of their protected health information prior to registration. Patients must be
registered in the MDACC OMCR database prior to treatment with study drug.

15. Women of childbearing potential must have a negative beta-HCG pregnancy test
documented within 14 days prior to registration.

16. Women of childbearing potential and male participants must practice adequate
contraception

17. All patients must have an LVEF measurement of at least 50% by Echo or MUGA (if
clinically indicated) within 14 days prior to registration. The method used for LVEF
assessment in an individual subject must be the same throughout the trial.

Exclusion Criteria:

1. Prior invasive malignancy that is not the ependymoma (except non-melanomatous skin
cancer or carcinoma in situ of the cervix) unless the patient has been disease free
and off therapy for that disease for a minimum of 3 years

2. Transmural myocardial infarction or unstable angina within 3 months prior to study
registration

3. Evidence of recent myocardial infarction or ischemia by the findings of S-T
elevations of >/= 2 mm using the analysis of an EKG performed within 14 days prior to
registration

4. New York Heart Association grade II or greater congestive heart failure requiring
hospitalization within 12 months prior to registration

5. History of stroke or transient ischemic attack within 3 months prior to registration.

6. Inadequately controlled hypertension (systolic blood pressure > 140 mm Hg and/or
diastolic blood pressure > 90 mm Hg despite antihypertensive medication)

7. History of cerebral vascular accident (CVA) within 3 months prior to registration

8. Serious and inadequately controlled cardiac arrhythmia

9. Significant vascular disease (e.g., aortic aneurysm, history of aortic dissection)

10. Acute bacterial or fungal infection requiring intravenous antibiotics at the time of
registration

11. Acquired immune deficiency syndrome (AIDS) based upon current CDC definition; note,
however, that HIV testing is not required for entry into this protocol. The need to
exclude patients with AIDS from this protocol is necessary because the treatments
involved in this protocol may be significantly immunosuppressive.

12. Pregnant or nursing women because of concern of fetal/infant exposure to these agents

13. Any condition that impairs ability to swallow pills (e.g., gastrointestinal tract
disease resulting in an inability to take oral medication or a requirement for IV
alimentation, prior surgical procedures affecting absorption, active peptic ulcer
disease).

14. Patients cannot be receiving EIAEDs nor any other CYP3A4 inducers such as rifampin or
St. John's wort beginning at least 14 days prior to registration Step 2.

15. Patients cannot be receiving CYP3A4 inhibitors beginning at least 7 days prior to
registration Step 2.

16. Patients must not have current active hepatic or biliary disease (with exception of
patients with Gilbert's syndrome, asymptomatic gallstones, or stable chronic liver
disease per investigator assessment).

17. Patients cannot be receiving HAART (Highly Active Anti-Retroviral Therapy) therapy.