RATIONALE: Drugs used in chemotherapy, such as carboplatin and topotecan, work in different ways to stop the growth of tumor cells, either by killing the cells or by stopping them from dividing. Tamoxifen may help carboplatin work better by making tumor cells more sensitive to the drug. PURPOSE: This phase II trial is studying the side effects of giving carboplatin and topotecan together with tamoxifen and to see how well it works in treating patients with central nervous system metastases or recurrent brain or spinal cord tumors.
OBJECTIVES: * To evaluate the systemic and CNS response rates and progression-free and overall survival of patients with epithelial cancer and brain metastases treated with tamoxifen citrate, topotecan hydrochloride, and carboplatin. * To evaluate the response rates, progression-free survival, and overall survival of patients with recurrent primary glial tumors treated with this regimen. * To further assess the toxicity of these drugs in these patients. * To further evaluate the pharmacokinetics of topotecan hydrochloride and tamoxifen citrate using paired specimens of cerebrospinal fluid and plasma from these patients. OUTLINE: Patients are stratified by disease type (epithelial CNS metastases vs recurrent glial tumors). Patients receive topotecan IV on days 1-3 (72 hours), carboplatin IV over 30 minutes on day 4, and oral tamoxifen twice daily on days 1-7. Treatment repeats every 28 days in the absence of disease progression or unacceptable toxicity. Patients achieving a complete response (CR) may be treated for 2 additional courses after documentation of CR. Patients undergo blood sample collection at baseline and then periodically after the first dose of topotecan to obtain plasma pharmacokinetic (PK) measurements of topotecan and tamoxifen. Some patients may also undergo cerebrospinal fluid (CSF) collection to assess peak CSF levels of topotecan and tamoxifen during course 1.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
50
CBDCA AUC=3
Tamoxifen 100mg bid
Topotecan 0.75 g/m2/d
Start of tx, hours 24,28 and 72 during Topotecan infusion, and hours 1,2,4 and 6 after end of Topotecan infusion.
City of Hope Comprehensive Cancer Center
Duarte, California, United States
Toxicity profile as assessed by NCI CTC v2.0
Time frame: All patients who complete one course of therapy and are followed a minimum of 3 weeks after completion of first course of therapy
Response rate in patients with recurrent glial tumors as assessed by RECIST criteria
Time frame: All patients who complete at least one cycle of treatment
Response rate in patients with epithelial CNS metastases as assessed by RECIST criteria
Time frame: All patients who complete at least one cycle of treatment
Reason for going off-study
Time frame: Reported for all eligible patients
Progression
Time frame: Reported for all eligible patients
Survival
Time frame: Reported for all eligible patients
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