INCLUSION CRITERIA:
1. Patients with histologically proven malignant glioma who have progressive disease following standard treatment will be eligible for this protocol. Malignant glioma include glioblastoma multiforme (GBM), anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), anaplastic mixed oligoastrocytoma (AMO), or malignant glioma NOS (not otherwise specified). Additionally, patients with primitive neuroectodermal tumors (PNETs) of the central nervous system, progressive low-grade gliomas and radiographically diagnosed brain stem gliomas will be eligible.
2. Patients must have unequivocal evidence for tumor progression by MRI or CT scan. This scan should be performed within 14 days prior to registration and on a steroid dosage that has been stable for at least 5 days. If the steroid dose is increased between the date of imaging and registration a new baseline MR/CT is required. The same type of scan, that is., MRI or CT must be used throughout the period of protocol treatment for tumor measurement.
3. Patients having undergone recent resection of recurrent or progressive tumor will be eligible as long as all of the following conditions apply:
A. They have recovered from the effects of surgery.
B. Residual disease following resection of recurrent tumor is not mandated for eligibility into the study. To best assess the extent of residual disease post-operatively, a CT/ MRI should be done:
-no later than 96 hours in the immediate post-operative period or
-at least 4 weeks post-operatively, and
-within 14 days of registration, and
-on a steroid dosage that has been stable for at least 5 days.
If the 96 hour scan is more than 14 days before registration, the scan needs to be repeated. If the steroid dose is increased between the date of imaging and registration, a new baseline MRI/CT is required on a stable steroid dosage for at least 5 days.
4. Patients must have failed prior radiation therapy and must have an interval of greater than or equal to 4 weeks from the completion of radiation therapy to study entry.
5. All patients or their previously designated DPA (if the patient is deemed by the treating physician to be cognitively impaired or questionably impaired in such a way that the ability of the patient to give informed consent is questionable) must sign an informed consent indicating that they are aware of the investigational nature of this study. Patients will be registered prior to starting the study.
6. Patients must be greater than or equal to 18 years old, and with a life expectancy greater than 8 weeks.
7. Patients must have a Karnofsky performance status of greater than or equal to 60.
8. Patients must have recovered from the toxic effects of prior therapy: 2 weeks from any noncytotoxic investigational agent, 4 weeks from prior cytotoxic therapy, two weeks from vincristine, 6 weeks from nitrosoureas, 3 weeks from procarbazine administration, and 1 week for non-cytotoxic agents, for example., interferon, tamoxifen, thalidomide, cis-retinoic acid, etc. (radiosensitizer does not count). Any questions related to the definition of non-cytotoxic agents should be directed to the Study Chair.
9. Patients must have adequate bone marrow function (WBC greater than or equal to 3,000/microl, ANC greater than or equal to 1,500/mm(3), platelet count of greater than or equal to 100,000/mm(3), and hemoglobin greater than or equal to 10 gm/dl), adequate liver function (SGOT and bilirubin less than or equal to 2 times ULN), and adequate renal function (creatinine less than or equal to 1.5 mg/dL and/or creatinine clearance greater than or equal to 60 cc/min) before starting therapy. These tests must be performed within 14 days prior to registration. Eligibility level for hemoglobin may be reached by transfusion.
10. Patients must not have any significant medical illnesses that in the investigator's opinion cannot be adequately controlled with appropriate therapy or would compromise the patient's ability to tolerate this therapy.
11. This study was designed to include women and minorities, but was not designed to measure differences of intervention effects. Males and females will be recruited with no preference to gender. No exclusion to this study will be based on race.
12. Patients must practice adequate contraception.
13. Prior treatment with an enzyme inducing antiepileptic drug must have been discontinued at least 14 days prior to study entry for Group A patients.
EXCLUSION CRITERIA:
1. Patients who, in the view of the treating physician, have significant active cardiac, hepatic, or renal diseases are ineligible.
2. No concurrent use of other standard chemotherapeutics or investigative agents.
3. Prior treatment with platinum-based therapy.
4. Patients known to have an allergic response to mannitol.
5. Patients known to have an active malignancy (except non-melanoma skin cancer or carcinoma in-situ of the cervix).
6. Patients who have an active infection requiring IV antibiotics.
7. Patients who are pregnant or breast feeding.
8. Patients who have any disease that will obscure toxicity or dangerously alter drug metabolism.
9. QTc with Bazett's correction that is unmeasurable, or greater than or equal to 460 msec on screening ECG. If a patient has QTc greater than or equal to 460 msec on screening ECG, a second screen ECG may be repeated at least 24 hours apart. The average QTc from the 2 screening ECGs must be less than 460 msec in order for the patient to be eligible for the study.
10. EKG demonstrating clinically significant arrythmia (multifocal premature ventricular contraction [PVC], bigeminy, trigeminy, ventricular tachycardia, bradycardia) that is symptomatic or requires treatment (CTCAE Grade 3), or asymptomatic sustained ventricular tachycardia.
11. Patients who have baseline EKGs suggestive of past or present cardiac ischemia will not be eligible unless they have an appropriate (as defined by the P.I. of this trial) negative cardiac work up (that is, echocardiogram, stress test).
12. Patients may not be on systemic anti-coagulants (that is, heparin, warfarin, small heparin fragments).
National Institutes of Health Clinical Center
Bethesda, Maryland 20892. Last update: 01/30/2009