Mafosfamide in Treating Patients With Progressive or Refractory Meningeal Tumors

Phase I Study of Intrathecal Mafosfamide

RATIONALE: Drugs used in chemotherapy use different ways to stop tumor cells from dividing so they stop growing or die.

PURPOSE: Phase I trial to determine the effectiveness of mafosfamide in treating patients who have progressive or refractory meningeal tumors.

Study Overview

• Status: Completed
• Conditions: Brain and Central Nervous System Tumors
• Intervention / Treatment: Drug: mafosfamide

Detailed Description

OBJECTIVES:

• Determine the qualitative and quantitative toxicity of mafosfamide in patients with progressive or refractory meningeal malignancy.
• Determine the maximum tolerated dose of this drug in these patients.
• Determine the cerebrospinal fluid pharmacokinetics of this drug in these patients.

OUTLINE: This is a dose-escalation, multicenter study.

Patients receive intrathecal mafosfamide over 20 minutes twice weekly for 6 weeks (induction therapy). Patients then receive intrathecal mafosfamide once weekly for 4 weeks (consolidation therapy), twice a month for 4 months, and then monthly thereafter (maintenance therapy) in the absence of disease progression or unacceptable toxicity.

Cohorts of 3-6 patients receive escalating doses of mafosfamide until the maximum tolerated dose (MTD) is determined. The MTD is defined as the dose preceding that at which at least 2 of 3 or 2 of 6 patients experience dose-limiting toxicity.

PROJECTED ACCRUAL: A total of 3000 patients will be accrued for this study.

• Study Type: Interventional
• Enrollment (Anticipated): 3000
• Phase: Phase 1

Contacts and Locations

Study Locations

• United States
  • California
    • Los Angeles, California, United States, 90027-0700
      • Children's Hospital Los Angeles
  • District of Columbia
    • Washington, District of Columbia, United States, 20010-2970
      • Children's National Medical Center
  • Maryland
    • Bethesda, Maryland, United States, 20892-1182
      • Warren Grant Magnuson Clinical Center - NCI Clinical Studies Support
  • Michigan
    • Detroit, Michigan, United States, 48202
      • Josephine Ford Cancer Center at Henry Ford Hospital
  • Minnesota
    • Rochester, Minnesota, United States, 55905
      • Mayo Clinic Cancer Center
  • Texas
    • Houston, Texas, United States, 77030-4009
      • University of Texas - MD Anderson Cancer Center
    • Houston, Texas, United States, 77030-2399
      • Texas Children's Cancer Center
  • Vermont
    • Bennington, Vermont, United States, 05201
      • Neurological Research Center, Inc.
  • Washington
    • Seattle, Washington, United States, 98105
      • Children's Hospital and Regional Medical Center - Seattle

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 3 years and older (Child, Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

DISEASE CHARACTERISTICS:

• Diagnosis of leukemia or lymphoma with meningeal involvement defined as cerebrospinal fluid cell count at least 5/mm^3 AND evidence of blast cells on cytospin preparation or by cytology OR
• Diagnosis of other solid tumor with meningeal involvement defined as presence of tumor cells on cytospin preparation or cytology OR presence of measurable meningeal disease on CT or MRI scan

• Meningeal malignancy must be progressive or refractory to conventional therapy

  • Meningeal malignancies secondary to an underlying solid tumor are allowed at initial diagnosis provided there is no conventional therapy
• No concurrent bone marrow relapse in leukemia or lymphoma patients

• No clinical evidence of obstructive hydrocephalus or compartmentalization of the cerebrospinal fluid flow as documented by a radioisotope indium In 111 or technetium Te 99-DTPA flow study

  • Patients demonstrating restored flow after focal radiotherapy are allowed

PATIENT CHARACTERISTICS:

Age:

• Over 3

Performance status:

• ECOG 0-2

Life expectancy:

• At least 8 weeks

Hematopoietic:

• Not specified

Hepatic:

• No clinically significant liver function abnormalities

Renal:

• No clinically significant renal function abnormalities

Other:

• Not pregnant or nursing
• Negative pregnancy test
• Fertile patients must use effective contraception during and for 6 months after study
• No clinically significant metabolic parameter abnormalities (e.g., electrolytes, calcium, and phosphorus)
• No significant systemic illness (e.g., infection)

PRIOR CONCURRENT THERAPY:

Biologic therapy:

• Recovered from prior immunotherapy

Chemotherapy:

• At least 1 week since prior intrathecal chemotherapy (2 weeks for cytarabine (liposomal)) and recovered

• Concurrent systemic chemotherapy to control systemic or bulk CNS disease allowed with the following exceptions:

  • No phase I agent
  • No agent that significantly penetrates the CNS (e.g., high-dose systemic methotrexate (more than 1 g/m^2), high-dose cytarabine (more than 2 g/m^2), IV mercaptopurine, fluorouracil, topotecan, or thiotepa)
  • No agent known to have serious unpredictable CNS side effects

Endocrine therapy:

• Not specified

Radiotherapy:

• See Disease Characteristics
• Recovered from prior radiotherapy
• At least 8 weeks since prior craniospinal irradiation
• Local radiotherapy for symptomatic or bulky CNS disease must be given prior to induction therapy

• No concurrent whole brain or craniospinal irradiation

  • Concurrent partial brain (e.g., base of brain) or limited-field spinal radiotherapy for asymptomatic bulky (radiographically visible) CNS disease allowed
• Total CNS radiotherapy dose must not exceed accepted safe tissue tolerances

Surgery:

• Not specified

Other:

• At least 1 week since any prior CNS therapy
• At least 7 days since prior intrathecal investigational agent
• At least 14 days since prior systemic investigational agent
• No other concurrent intrathecal or systemic investigational agent
• No other concurrent intrathecal or systemic therapy to treat meningeal malignancy
• No other concurrent intrathecal therapy or agent that significantly penetrates the blood-brain barrier
• No concurrent agent known to have serious unpredictable CNS side effects

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment

Collaborators and Investigators

• Sponsor: National Cancer Institute (NCI)
• Investigators: Study Chair: Susan M. Blaney, MD, Texas Children's Cancer Center

Study record dates

Study Major Dates

• Study Start: January 1, 2002

Study Registration Dates

• First Submitted: March 8, 2002
• First Submitted That Met QC Criteria: January 26, 2003
• First Posted (Estimate): January 27, 2003

Study Record Updates

• Last Update Posted (Estimate): April 30, 2015
• Last Update Submitted That Met QC Criteria: April 29, 2015
• Last Verified: November 1, 2003

More Information

Terms related to this study

• Keywords: leptomeningeal metastases
• Additional Relevant MeSH Terms: Nervous System Diseases; Neoplasms; Neoplasms by Site; Nervous System Neoplasms; Central Nervous System Neoplasms; Physiological Effects of Drugs; Antineoplastic Agents; Immunologic Factors; Adjuvants, Immunologic; Mafosfamide
• Other Study ID Numbers: CDR0000069240; NCI-90-C-0095K; BCM-H-3241