Irinotecan in Treating Patients With Progressive or Recurrent Malignant Glioma

OBJECTIVES: I. Determine the maximum tolerated dose and the dose limiting toxicities of
irinotecan in patients with progressive or recurrent malignant glioma. II. Define the safety
profile of every 3 week dosing of irinotecan in these patients. III. Characterize the
pharmacokinetic profile of this regimen in these patients. IV. Assess evidence of antitumor
activity in these patients. V. Determine the efficacy of irinotecan in these patients as
measured by 6 month progression-free survival and objective tumor response. VI. Evaluate
further the safety profile of irinotecan in these patients during phase II study.

OUTLINE: This is a dose escalation study. Patients are stratified according to concurrent
enzyme-inducing antiepileptic drugs (EIAEDs)(yes vs no). Group A (without EIAEDs): Patients
receive irinotecan IV over 90 minutes on day 1, followed by up to 3 weeks of rest. Group B
(with EIAEDs): Patients receive the same treatment but dose escalation is performed in
cohorts of 3 patients. The maximum tolerated dose (MTD) is defined as the dose below that at
which 2 of 6 patients experience dose limiting toxicities. The Phase I MTD is the starting
dose recommended for use in the Phase II portion of the study. Treatment continues every 3
weeks for up to 12 months in the absence of disease progression or unacceptable toxicity.
Patients are followed every 2 months for 1 year, every 3 months for 1 year, every 4 months
for 1 year, then every 6 months until disease progression. Patients are then followed every 4
months for survival.

PROJECTED ACCRUAL: Up to 30 patients will be accrued for phase I within 10 months. A total of
48 patients will be accrued for phase II within 6-8 months.

DISEASE CHARACTERISTICS: Histologically proven progressive or recurrent primary malignant
glioma Phase I (excluding group A patients): No more than 2 prior chemotherapy regimens,
including 1 prior adjuvant therapy and 1 prior regimen for recurrent or progressive tumor,
or 2 prior regimens for progressive tumor Phase II and/or group A patients: No more than 1
prior chemotherapy regimen, either as adjuvant or for recurrent disease Measurable disease
by MRI or CT scan

PATIENT CHARACTERISTICS: Age: 18 and over Performance status: Karnofsky 60-100% Life
expectancy: Not specified Hematopoietic: Neutrophil count at least 1,500/mm3 Platelet count
at least 100,000/mm3 Hepatic: Bilirubin no greater than 1.5 mg/dL SGOT no greater than 3
times upper limit of normal Renal: Creatinine no greater than 1.5 mg/dL Cardiovascular: No
uncontrolled hypertension No unstable angina No symptomatic congestive heart failure No
myocardial infarction within 6 months No serious uncontrolled cardiac arrhythmia Other: Not
pregnant or nursing Negative pregnancy test Fertile patients must use effective
contraception No severe nonmalignant systemic disease or active infection No concurrent
alcoholism or drug abuse No psychosis HIV negative

PRIOR CONCURRENT THERAPY: Biologic therapy: No concurrent immunotherapy No concurrent
sargramostim (GM-CSF) Chemotherapy: See Disease Characteristics At least 4 weeks since
prior chemotherapy (6 weeks for nitrosoureas, mitomycin, or suramin) No prior irinotecan,
topotecan, or other topotecan 1 inhibitors No other concurrent chemotherapy Endocrine
therapy: Stable or decreasing dosage of corticosteroids within 72 hours of study entry
(phase II only) No other concurrent immunosuppressive agents No concurrent hormonal therapy
Radiotherapy: At least 4 weeks since prior radiotherapy Patients with prior interstitial
brachytherapy or stereotactic radiosurgery must have confirmation of progressive disease No
concurrent radiotherapy Surgery: At least 3 weeks since prior resection Other: Acute toxic
effects (excluding neurotoxicity or alopecia) of any prior therapy must be resolved No
concurrent valproic acid as a single agent Concurrent enzyme-inducing antiepileptic drugs
(EIAED) with or without steroids are allowed No concurrent investigational drugs