Phase II Treatment of Adults With Primary Malignant Glioma With Irinotecan Plus Temozolomide
Objectives of study are to determine activity of combo of Irinotecan + Temozolomide & to
further characterize any toxicity associated w combo of Irinotecan + Temozolomide.
Temozolomide administered orally at 200mg/m2 in fasting state 1hr prior to CPT-11 infusion.
Temozolomide administered on day 1 of treatment cycle & every 24hrs thereafter for 5 days w
treatment cycles repeated every 6wks. Treatment cycles may be repeated up to maxi of 3
cycles until occurrence of either unacceptable toxicity/evidence of disease progression. At
end of 3rd cycle/if cycles are stopped early for toxicity or progression, subject will
undergo radiation therapy. CPT-11 administered intravenously in fasting state over 90min.
CPT-11 will begin 1hr after Temozolomide administration on day 1 of treatment cycle. CPT-11
administered on days 1, 8, 22, & 29 of 6wk treatment cycle. Treatment cycles may be repeated
up to maxi of 3 cycles until occurrence of either unacceptable toxicity/evidence of disease
progression. Dose of CPT-11 will be based on whether pt is receiving CYP3A4-inducing
antiepileptic drugs due to increased drug clearance produced by these agents. For pts
receiving EIAEDs including phenytoin, fosphenytoin, oxcarbazepine, phenobarbital/ primidone,
CPT-11 dose of 325mg/m2 administered. For pts not receiving EIAEDs, CPT-11 dose of125 mg/m2
Subjects have newly diagnosed histologically proven supratentorial glioblastoma multiforme.
Toxicities associated w CPT-11 are anemia, decreased blood counts, diarrhea, constipation,
nausea, vomiting, tiredness, fever, mouth sores, dehydration, rash, itching, changes in skin
color, swelling, numbness, tingling, dizziness, confusion, low blood pressure, sweating, hot
flashes, hair loss, inflammation of liver, flu-like symptoms, decreased urine output,
shortness of breath,& pneumonia. Low white blood cell & platelet counts may be associated w
risk of infection/bleeding, respectively. Irinotecan has also caused birth defects in
animals. Most frequent toxicities in earlier studies have been low white blood cells &
diarrhea, & death has been seen from these & other side effects. Temozolomide has been well
tolerated by both adults & children w most common toxicity being mild myelosuppression.
Other, less likely, potential toxicities include nausea & vomiting, constipation, headache,
alopecia, rash, burning sensation of skin, esophagitis, pain, diarrhea, lethargy,
hepatotoxicity, anorexia, fatigue & hyperglycemia. Hypersensitivity reactions have not yet
been noted w Temozolomide. As in case w many anti-cancer drugs, Temozolomide may be
Allocation: Non-Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Treatment
David A. Reardon, MD
Duke University Health System
United States: Institutional Review Board
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