A Safety Study of RTA 744 in Recurrent, Progressive or Refractory Neoplastic Meningitis

A Phase I Safety and Pharmacokinetic Study of Intravenous RTA 744 Injection in Patients With Recurrent, Progressive or Refractory Neoplastic Meningitis

This study assesses the tolerability, safety, efficacy and pharmacokinetics of RTA 744 in recurrent neoplastic meningitis.

Neoplastic meningitis refers to the deposition of malignant cells in the lining (leptomeninges) of the brain and spine. Neoplastic meningitis from solid tumors most often occurs in patients with advanced systemic disease who have failed prior chemotherapy; it is also frequent in patients with CNS parenchymal metastasis. Patient survival remains low, and better treatments are needed to penetrate the blood brain barrier and treat the entire neuraxis.

RTA 744 is a close chemical analogue of the well characterized anti-cancer agent doxorubicin. Unlike doxorubicin, RTA 744 has shown ability to cross the blood brain barrier and to achieve high concentration in CNS tumor tissue in animal models. Dose escalation will continue as pre-determined until first occurrence of a dose-limiting toxicity. Maximum tolerated dose will be determined as defined in protocol.

Inclusion Criteria:

• Histologic confirmation of primary malignancy. All primary tumor types may be enrolled.
• Neoplastic meningitis/leptomeningeal metastasis refractory to conventional therapy with presence of tumor cells on cytology, OR neuroimaging evidence of leptomeningeal tumor by MRI.
• Not eligible for higher priority clinical trial.
• Have recovered from side effects of any surgical resection.
• A stable dose of steroid for at least 7 days prior to the Gd-MRI.
• Karnofsky Performance Status (KPS) of ≥ 60.
• Laboratory Parameters: ANC ≥ 1.5 x 109/L; Hgb ≥ 9 g/dl; Platelets ≥ 100 x 109/L; AST and ALT ≤ 3.0 x ULN; Serum bilirubin ≤ 1.5 x ULN; Serum creatinine ≤ 1.5 x ULN; 24 hour creatinine clearance ≥ 50 ml/min
• Life expectancy of at least 8 weeks.
• Written informed consent obtained.

Exclusion Criteria:

• Concurrent therapy for leptomeningeal disease or other malignancy.
• Clinical evidence of obstructive hydrocephalus or compartmentalization of CSF flow.
• Cumulative doses: doxorubicin > 450 - 550 mg/m2, epirubicin > 800-1000 mg/m2, idarubicin >130-150 mg/m2 and daunorubicin > 400-550 mg/m2.
• Anticonvulsant medications or other types of medications which are known to induce the CYP450 enzymes.
• Pregnancy or breast feeding, or adults (male or female) of reproductive potential not employing an effective method of birth control
• Total 24 hour urinary protein > 500 mg.
• Concurrent severe and/or uncontrolled medical conditions which could compromise participation in the study
• Impaired cardiac function, other significant prior cardiac disease or arrhythmia of any type
• Myocardial infarction ≤ 6 months prior
• History of CHF or arrhythmias
• Therapeutic doses of anticoagulant therapy (prophylactic dosing is allowed)
• Investigational drugs less than 4 weeks prior; intrathecal chemotherapy within 2 weeks prior; systemic cytotoxic chemotherapy within 4 weeks prior (6 weeks for nitrosourea or mitomycin-C or 2 weeks for vincristine); radiation therapy within 2 weeks prior; any medication known to cause QT interval prolongation
• Any surgery <2 weeks prior