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Phase I Trial of Intrathecal Spartaject Busulfan in Children with Neoplastic Meningitis: a Pediatric Brain Tumor Consortium Study (PBTC-004)

Authors' Affiliations: ¹ The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Durham, North Carolina; ² Mary Babb Randolph Cancer Center, Morgantown, West Virginia; ³ Children's Hospital Boston, Boston, Massachusetts; ⁴ Operations and Biostatistics Center, St. Jude Children's Research Hospital, Memphis, Tennessee; ⁵ Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and ⁶ Texas Children's Hospital/Baylor College of Medicine, Houston, Texas

Requests for reprints: Sridharan Gururangan, The Preston Robert Tisch Brain Tumor Center at Duke, Duke University Medical Center, Box 3624, Durham, NC 27710. Phone: 919-668-6288; Fax: 919-668-2485; E-mail: gurur002{at}mc.duke.edu.

Purpose: A phase I trial of intrathecal Spartaject Busulfan (SuperGen, Inc., San Ramon, CA) was conducted in children with neoplastic meningitis following recurrent primary brain tumors to describe toxicities, estimate the maximum tolerated dose (MTD), and document evidence of responses to this agent.

Experimental Design: The continuous reassessment method was used to assign cohorts of patients to doses of intrathecal Spartaject Busulfan via an Ommaya reservoir and/or lumbar puncture twice weekly for 2 weeks followed by an assessment of toxicity and response. Patients with stable disease or an objective response continued to receive intrathecal Spartaject Busulfan plus systemic chemotherapy at regular intervals. Cerebrospinal fluid and blood were obtained for pharmacokinetic studies in patients with Ommaya reservoirs after the first dose of intrathecal Spartaject Busulfan. Seven evaluable patients were assigned to the starting dose of 5 mg, two patients to 7.5 mg, three patients to 10 mg, seven patients to 13 mg, and four patients to 17 mg.

Results: Between September 2000 and May 2003, 28 patients were enrolled in this study. Twenty-three patients (median age, 8.8 years; range, 2.5-19.5 years) were evaluable for estimating the MTD, and dose-limiting toxicities were observed in three and included grade 3 vomiting (n = 1 at 5 mg), grade 3 headache (n = 1 at 17 mg), and grade 3 arachnoiditis (n = 1 at 17 mg). Pharmacokinetic data showed that post-infusion concentrations of busulfan ranged from 50 to 150 µg/mL and declined to <1 µg/mL within 5 hours.

Conclusions: Intrathecal Spartaject Busulfan was well tolerated in children with neoplastic meningitis from brain tumors, and the recommended dose for future phase II studies is 13 mg.

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