Thalidomide and Temozolomide in Relapsed or Progressive CNS Disease or Neuroblastoma

A Phase II Pilot Study Of Thalidomide With Temozolomide In Patients With Relapsed Or Progressive Brain Tumors Or Neuroblastoma

RATIONALE: Thalidomide may stop the growth of tumor cells by stopping blood flow to the tumor. Drugs used in chemotherapy, such as temozolomide, work in different ways to stop tumor cells from dividing so they stop growing or die. Combining thalidomide with temozolomide may kill more tumor cells.

PURPOSE: This phase II trial is studying the effectiveness of combining thalidomide with temozolomide in treating young patients who have relapsed or progressive brain tumors or recurrent neuroblastoma.

OBJECTIVES:

Primary

• Determine the feasibility of thalidomide and temozolomide in pediatric patients with relapsed or progressive poor prognosis brain tumors or recurrent neuroblastomas.

Secondary

• Determine preliminarily evidence of biologic activity of this regimen in these patients.
• Determine the toxic effects of this regimen in these patients.

STATISTICAL DESIGN: The primary data analysis will estimate the percentage of patients who can complete 6 months of therapy in the mixed population. With a target accrual of 20 patients the 90% confidence for the true feasibility rate will be no wider than 40%.

DISEASE CHARACTERISTICS:

• Histologically confirmed* diagnosis of 1 of the following:

  • Poor prognosis brain tumor

    • Relapsed or progressive disease
    • No curative therapy exists

  • Neuroblastoma

    • Recurrent disease NOTE: *Histologic confirmation not required for brain stem glioma; patients with brain stem glioma must have clinical and radiographic evidence of disease

• Patients with brain stem glioma must have symptoms lasting < 3 months comprising cranial nerve deficits (often VI or VII) and/or ataxia and/or long tract signs

PATIENT CHARACTERISTICS:

Age

• 21 and under

Performance status

• Karnofsky 50-100% OR
• Lansky 50-100%

Life expectancy

• More than 2 months

Hematopoietic

• Hemoglobin ≥ 9.0 g/dL
• Platelet count > 75,000/mm^3
• WBC > 2,000/mm^3
• Absolute neutrophil count > 1,000/mm^3

Hepatic

• Bilirubin ≤ 1.5 mg/dL
• SGOT and SGPT ≤ 2 times normal (SGOT ≤ 4 times normal for patients taking Zantac)
• Alkaline phosphatase ≤ 2 times normal
• No active hepatic disease ≥ grade 3

Renal

• Creatinine < 1.5 mg/dL OR
• Creatinine clearance ≥ 70 mL/min
• No active renal disease ≥ grade 3

Cardiovascular

• No active cardiac disease ≥ grade 3

Pulmonary

• No active pulmonary disease ≥ grade 3

Other

• Not pregnant or nursing

• Fertile patients must use effective contraception during and for 4 weeks after study participation

  • Willing and able to participate in the System for Thalidomide Education and Prescription Safety (S.T.E.P.S.^®) program

• No active psychiatric disease ≥ grade 3

PRIOR CONCURRENT THERAPY:

Biologic therapy

• Prior biologic therapy allowed

  • No prior thalidomide

Chemotherapy

• Prior chemotherapy allowed

  • No prior temozolomide

Endocrine therapy

• Concurrent steroids allowed

Radiotherapy

• Prior radiotherapy allowed

Surgery

• Prior surgery allowed

Other

• Concurrent antiseizure medications allowed
• No other concurrent investigational agents