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
- 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.
- 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
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
PROJECTED ACCRUAL: A total of 90 patients will be accrued for this study within 3 years.
Endpoint Classification: Safety/Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
Survival as measured by clinical and radiographic response at 5 years after study treatment
Edward A. Neuwelt, MD
OHSU Knight Cancer Institute
United States: Federal Government
|Oregon Health & Science University Cancer Institute||Portland, Oregon 97239-3098|