This phase I trial studies the side effects and best dose of ropidoxuridine when given together with whole brain radiation therapy in treating patients with cancer that has spread to the brain (brain metastases). Ropidoxuridine may help whole brain radiation therapy work better by making cancer cells more sensitive to the radiation therapy.
PRIMARY OBJECTIVE: I. To conduct a phase 1 dose escalation trial in patients with brain metastases to determine the recommended phase -2 dose of ropidoxuridine (5-iodo-2-pyrimidinone-2'-deoxyribose \[IPdR\]) when administered alone orally once daily for 7 consecutive days and then concurrently with conventionally fractionated whole brain radiation therapy (WBRT) for additional 21 days. SECONDARY OBJECTIVES: I. To observe and record anti-tumor activity to IPdR-mediated radiosensitization. II. To estimate 6 month intracranial progression-free survival (PFS) in brain metastasis cancer patients who receive daily oral IPdR x 28 days and WBRT. III. To establish the pharmacokinetics of daily oral dosing of IPdR times 8 days. IV. To evaluate safety and tolerability of oral IPdR x 28 days and WBRT. V. To estimate the incidence of delayed neurological toxicity at 2, 4, and 6 months (+/-1 week) post-completion of WBRT (for patients without intracranial progression) including: Va. Delayed-recall through Hopkins Verbal Learning Test Revised (HVLT-R). Vb. Quality of life as measured by the Functional Assessment of Cancer Therapy-Brain (FACT-BR). CORRELATIVE OBJECTIVES: I. To assess for biochemical evidence of IPdR effect in normal tissues (circulating granulocytes) by measuring %IUdR-deoxyribonucleic acid (DNA) cellular incorporation by flow cytometry and high-pressure liquid chromatography (HPLC) analyses as an exploratory biomarker for the following: Ia. %IUdR-DNA tumor cell incorporation from day 8 extracranial tumor biopsies in brain metastasis cancer patients receiving RP2D doses of IPdR as an exploratory biomarker of tumor radiosensitization using Response Evaluation Criteria in Solid Tumors (RECIST) criteria. Ib. %IUdR-DNA cellular incorporation in patients' circulating granulocytes taken weekly during the 28-day IPdR RP2D dose, on day 29, and week 8 as an exploratory biomarker of IPdR systemic toxicities to bone marrow as measured by serial complete blood count (CBC)/differential values. OUTLINE: This is a dose escalation study of ropidoxuridine. Patients receive ropidoxuridine orally (PO) once daily (QD) on days 1-28 and undergo WBRT daily for not more than 5 days per week beginning on day 8 for a total of 15 fractions in the absence of disease progression or unacceptable toxicity. After completion of study treatment, patients are followed up every 2 months for 6 months, every 3-4 months for 6 months, and every 6 months for 1 year.
Correlative studies
Correlative studies
Ancillary studies
UC San Diego Moores Cancer Center
La Jolla, California, United States
University of California Davis Comprehensive Cancer Center
Sacramento, California, United States
Number of Participants Experiencing a Dose Limiting Toxicity
Dose limiting toxicities are protocol-defined, treatment-related adverse events.
Time frame: Up to week 8
Number of Participants With Complete Response, Partial Response, Stable Disease or Progressive Disease.
To observe and record anti-tumor activity as assessed by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. Complete response is no remaining tumor. Partial response is a 30% or greater decrease in overall tumor burden. Progressive disease is a 20% or greater increase in tumor burden. Stable disease is between 20% increase and 30% decrease.
Time frame: Up to 2 years
Intracranial Disease Status
Intracranial disease status assessed at month 6.
Time frame: At 6 months
Pharmacokinetics of Oral IPdR
To establish the pharmacokinetics of daily oral dosing of IPdR for 8 days.
Time frame: At Day 8
Number of Participants Experience Grade 3, 4, or 5 Adverse Events
To establish safety and tolerability of oral IPdR for 28 days with whole brain radiation treatment.
Time frame: 28 days
Number of Participants With Delayed Neurological Toxicity
To estimate the incidence of delayed neurological toxicity at 2, 4, and 6 months after whole blood radiation treatment.
Time frame: At 6 months
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Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
11
Given PO
Undergo WBRT
University of Iowa/Holden Comprehensive Cancer Center
Iowa City, Iowa, United States
University of Maryland/Greenebaum Cancer Center
Baltimore, Maryland, United States
University of Michigan Rogel Cancer Center
Ann Arbor, Michigan, United States
Wayne State University/Karmanos Cancer Institute
Detroit, Michigan, United States
Weisberg Cancer Treatment Center
Farmington Hills, Michigan, United States
University of Nebraska Medical Center
Omaha, Nebraska, United States
NYP/Columbia University Medical Center/Herbert Irving Comprehensive Cancer Center
New York, New York, United States
Fox Chase Cancer Center
Philadelphia, Pennsylvania, United States
...and 4 more locations