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Lead-In Phase to Randomized Trial of Motexafin Gadolinium and Whole-Brain Radiation for Patients With Brain Metastases: Centralized Assessment of Magnetic Resonance Imaging, Neurocognitive, and Neurologic End Points

From the Department of Human Oncology, University of Wisconsin, Madison, and Division of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Barrow Neurologic Institute, Phoenix, AZ; University of Massachusetts, Amherst, MA; University of Kentucky, Lexington, KY; Psychiatry Service, H. Lee Moffitt Cancer Center, Tampa, FL; Department of Neuro-Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX; Division of Radiation Oncology, Cross Cancer Institute, Alberta, Edmonton, Canada; Radiological Associates of Sacramento, Sacramento, Division of Radiation Oncology, UCLA, Los Angeles, and Pharmacyclics, Inc, Sunnyvale, CA; and Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, PA.

Address reprint requests to Minesh Mehta, MD, Department of Human Oncology, University of Wisconsin–Madison Medical School, K4/334 Clinical Science Center, 600 Highland Ave, Madison, WI 53792; email: mehta{at}mail.humonc.wisc.edu

PURPOSE: Motexafin gadolinium is a redox mediator that selectively targets tumor cells, is detectable by magnetic resonance imaging (MRI), and enhances the effect of radiation therapy. This lead-in phase to a randomized trial served to evaluate radiologic, neurocognitive, and neurologic progression end points and to evaluate the safety and radiologic response of motexafin gadolinium administered concurrently with 30 Gy in 10-fraction whole-brain radiation therapy for the treatment of brain metastases.

PATIENTS AND METHODS: Motexafin gadolinium (5.0 mg/kg/d for 10 days) was administered before each radiation treatment in this prospective international trial. Patients were evaluated by MRI, neurologic examinations, and neurocognitive tests. Prospective criteria and centralized review procedures were established for radiologic, neurocognitive, and neurologic progression end points.

RESULTS: Twenty-five patients with brain metastases from lung (52%) and breast (24%) cancer, recursive partitioning analysis class 2 (96%), and an average of 11 brain metastases were enrolled. Neurocognitive function was highly impaired at presentation. Motexafin gadolinium was well tolerated. Freedom from neurologic progression was 77% at 1 year. Median survival was 5.0 months. In 29% of patients, the cause of death was brain metastasis progression. The radiologic response rate was 68%. Motexafin gadolinium’s tumor selectivity was established with MRI.

CONCLUSION: (1) Centralized neurologic progression scoring that incorporated neurocognitive tests was implemented successfully. (2) Motexafin gadolinium was well tolerated. (3) Local control, measured by radiologic response rate, neurologic progression, and death caused by progression of brain metastasis, seemed to be improved compared with historical results. A randomized phase III trial using these methods for evaluation of efficacy has just been completed.

S.P, J.A.S., R.A.M., and M.F.R. are employees and shareholders of Pharmacyclics, Inc.

Presented in part at the Forty-Second Annual Meeting of the American Society for Therapeutic Radiology and Oncology, Boston, MA, October 22-26, 2000.

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