A Phase I Study Of Irinotecan and Bevacizumab With Temozolomide in Children With Recurrent/Refractory Central Nervous System Tumors
- Medulloblastomas, high-grade glioma, low-grade glioma, and ependymoma are eligible.
Other central nervous system tumors may be considered for treatment at discretion of
investigator. Pathology is required unless diffuse intrinsic pontine glioma or optic
- The patient should have failed first line therapy and be considered refractory,
relapsed, or recurrent. Exceptions are high grade gliomas including brain stem
- Age 18 months though age 23 years are eligible for this protocol.
- The patient may have received any of the agents, but not in this combination.
Patients will not be eligible if they have received the combination of bevacizumab
and IV irinotecan as prior therapy. They will not be eligible if they had
progressive disease on any of these agents. Investigator discretion may also be
- Bone marrow should be recovered from prior therapy with ANC >1500 and platelets
- Serum creatinine should be less than institutional upper limit of norm.
- ALT/AST <3 times normal and bilirubin <1.5 times normal.
- Neurologic symptoms should be stable for 1 week with stable or decreasing doses of
- Patients should not be pregnant or breast feeding.
- Patients with bleeding disorders or on anticoagulants.
- Uncontrolled hypertension.
- Other risks of bleeding determined on individual basis.
- Patients receiving enzyme inducing anticonvulsants.
- Patients with significant cardiac or pulmonary dysfunction that would compromise the
patient's ability to tolerate protocol therapy or would likely interfere with the
study procedures or results.
- For patients receiving bevacizumab, those who have had surgical procedures should not
receive bevacizumab within 28 days of a major procedure, 14 days of an intermediate
procedure and 7 days of a minor procedure. Lumbar punctures or placement of PICC
lines are not considered minor procedures and may occur at any time prior to or