Safety Study of Tarceva in Children With Refractory and Relapsed Malignant Brain Tumors and Newly Diagnosed Brain Stem Glioma

Prognosis in relapsing malignant brain tumors is poor. Those in brain stem gliomas is dismal; median survival of these children does not exceed 9 months. Radiation therapy may result in early and transient amelioration of symptoms, but have not contributed to increase or prolong survival. Moreover, chemotherapy has not increased this outcome to date.Prados et al. reported encouraging results from a phase I study of TarcevaTM/OSI-774 alone or with temozolomide (TMZ) in patients with malignant gliomas. Of 25 evaluated patients, 6 experienced PR: 4 GBM (glioblastoma multiforme) and 1 grade 3 astrocytoma treated with TarcevaTM alone, 1 GBM treated with TarcevaTM/TMZ; 2 had minor responses, and 3 stable diseases. These results in malignant glioma and the lack of efficacy in brain stem glioma with current treatment suggests the evaluation of this new therapeutic agent in children with relapsed brain tumors and upfront at diagnosis in brain stem glioma in combination with radiation therapy.

Inclusion criteria

• Histologically or cytologically confirmed malignant brain tumor
• Disease must be considered refractory to first line or relapsing after conventional therapy and for which no effective conventional treatment exists.·
• Newly diagnosed, histologically proven brain stem glioma, except pilocytic astrocytomas.
• Age: 1 to ≤ 21 years of age at study entry
• Life expectancy: at least 8 weeks
• ECOG Performance status ≤ 1 or Lansky-Play Scale>= 70%, and including children with motor paresis due to disease
• Measurable or evaluable disease
• No other serious concomitant illness
• No organ toxicity > grade 2 NCI-CTC AE v3.0, except alopecia and neurological symptoms due to disease

Exclusion criteria

• Patients with spontaneous intratumoral hemorrhage will not be included in the study, in exception of small post-biopsy hemorrhage due to biopsy procedure
• Pregnant and breast feeding woman
• Uncontrolled intercurrent illness or active infection
• Chemotherapy within 4 weeks prior to study medication (within 6 weeks, if the regimen contained a nitrosourea)
• Radiation therapy within 6 weeks prior to study medication
• Any clinical or non-clinical evidence of pulmonary dysfunction or pre-existing lung disease
• Severe cardiac pathology; history of myocardial infarction within the year prior to inclusion
• Any significant ophthalmologic abnormality, especially severe dry eye syndrome, keratoconjunctivitis sicca, Sjögren syndrome, severe exposure keratitis or any other disorder likely to increase the risk of corneal epithelial lesions
• Treatment with Coumarin (warfarin)