Phase II Study of Intraventricular Methotrexate in Children With Recurrent or Progressive Malignant Brain Tumors

The purpose of this research study is to test an experimental treatment method for recurrent
or progressive brain tumors in children aged from 0-22 years. The use of methotrexate and
chemotherapy (topotecan and cyclophosphamide) is experimental in this study. This means that
their use by themselves or together has not been approved by the U.S. Food and Drug
Administration for this usage. This study will attempt to determine via serial MRI scans if
methotrexate administration into the lateral or fourth ventricle in combination with systemic
intravenous topotecan and cyclophosphamide is effective in reducing tumor burden in the brain
and spine for patients with recurrent or progressive brain tumors, including medulloblastoma,
ependymoma, PNET (Primitive Neuroectodermal Tumor), atypical teratoid/rhabdoid tumor (AT/RT),
and other malignant embryonal tumors. In addition, the study will evaluate the toxicity of
the above mentioned experimental treatment during a two-year progression-free survival and
survival of children with recurrent malignant brain tumors.

Inclusion Criteria:

- Recurrent or progressive supratentorial or posterior fossa tumors with measurable
disease on imaging studies of the brain and spine or CSF cytology.

- Tumor histology, including: Medulloblastoma , PNET, or other embryonal tumor, Atypical
teratoid/rhaboid tumor (AT/RT), and Ependymoma.

- Leptomeningeal dissemination of a previously diagnosed CNS tumor.

- Diagnosis of tumor pathology will be based upon pathology diagnosis from previous
surgeries for patients with recurrent tumors.

- Patients must have received prior radiation before current recurrence, unless the
patient is less than 36 months old at diagnosis and has progressed after at least one
upfront chemotherapy regimen in which case no prior radiation is required.

- Patients must have a life expectancy of at least 12 weeks as indicated by the
patient's oncologist and/or neurosurgeon.

- Lansky or Karnofsky Performance status of at least 50.

- Negative pregnancy test.

- Specific organ function requirements for: Central Nervous System, Bone Marrow, renal
and liver.

Exclusion Criteria:

- Patients that do not meet the inclusion criteria above.

- Pregnant or lactating female patients.

- Patients currently enrolled in another experimental treatment protocol.

- Patients with documented allergies to any of the chemotherapy agents used in this
study.

- Patient/Parent refuses study participation.

- Patient is severely somnolent or comatose.

- Unable or unwilling to commit to return or to follow-up visits.