PPX, Temozolomide, and Concurrent Radiation for Newly Diagnosed Brain Tumors

To evaluate the safety/tolerability and potential antitumor activity of PPX in combination with temozolomide and radiation for patients with newly diagnosed brain tumors.

Inclusion criteria

• Patients must have histopathologically confirmed, newly diagnosed, glioblastoma multiforme or anaplastic glioma (anaplastic astrocytoma [AA], anaplastic oligodendroglioma, and anaplastic oligoastrocytoma) and have not had a complete surgical resection.
• Patients must be 18 years of age or older.
• Patients must have a Zubrod performance status 0-2.
• Patients must not be on enzyme-inducing anti-epileptic drugs (EIAED). Patients may be on non-enzyme inducing anti-epileptic drugs (NEIAED) or may not be taking any anti-epileptic drugs.
• Patients must not have received prior chemotherapy, radiation or any experimental therapy for their glioblastoma.
• Patients may not be breast-feeding a child.
• Female patients must either be not of child bearing potential or have a negative pregnancy test within 14 days of starting study treatment. Patients are considered not of child bearing potential if they are surgically sterile (they have undergone a hysterectomy, bilateral tubal ligation, or bilateral oophorectomy) or they are postmenopausal. Pregnant or lactating females are not eligible. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.
• Female patients must be using an acceptable method of contraception (oral contraceptives, barrier methods, approved contraceptive implant, long-term injectable contraception, intrauterine device or tubal ligation) OR female patients must be at least 1-year post-menopausal or surgically sterile during their participation in this study (from the time they sign the consent form) to prevent pregnancy. Male patients must be surgically sterile or using an acceptable method of contraception during their participation in this study (from the time they sign the consent form) to prevent pregnancy in a partner
• Patients must have no concurrent malignancy except curatively treated basal or squamous cell carcinoma of the skin or carcinoma in situ of the cervix or breast. Patients with prior malignancies must be disease-free for ≥ 2 years.
• Patients must have normal organ and marrow function as defined below:

• Absolute neutrophil count > 1,500/ul
• Platelets > 100,000/ul
• Hemoglobin > 8 gm/dL
• Total bilirubin < 1.5 x ULN
• Creatinine < 1.5 x ULN
• Patient must have the capacity to understand and the willingness to sign a written informed consent document.
• Patient must be able to tolerate MRIs. CT scans can NOT be substituted for MRI in this study.

Exclusion criteria

• Recurrent malignant gliomas.
• Tumor foci detected below the tentorium or beyond the cranial vault.
• Allergy to gadolinium or contraindication to MRI scan.
• Patients who have received any form of brachytherapy or radiosurgery for their glioblastoma prior to start of standard radiation.
• History of allergic reactions attributed to compounds of similar chemical or biologic composition to PPX.
• Uncontrolled intercurrent illness including, but not limited to, hypertension ongoing or active infection, symptomatic congestive heart failure, unstable angina pectoris, cardiac arrhythmia, or psychiatric illness/social situations that would limit compliance with study requirements.
• Pregnant women are excluded from this study. Because there is an unknown but potential risk for adverse events in nursing infants secondary to treatment of the mother with PPX, breastfeeding should be discontinued if the mother is treated with PPX.