• Percent of patients in each treatment group achieving 50% reduction in dexamethasone usage relative to Baseline by Week 2 without deterioration in neurological function as measured by the 10-Item Neurological Exam and the KPS [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• The proportion of patients in each treatment group who are Responders at Week 2 and who continue to be Responders at Weeks 5 and 8 [ Time Frame: Prospective ] [ Designated as safety issue: No ]
• Change from Baseline in the 10-Item Neurological Examination Score at Weeks 2, 5, 8, 12 (or Early Study Drug Discontinuation), and 16 (or 4-week Follow-up visit). [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Change from Baseline in the Karnofsky Performance Score at Weeks 2, 5, 8, 12 (or Early Study Drug Discontinuation), and 16 (or 4-week Follow-up visit) [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Change from Baseline in the Signal Symptom Score at Weeks 2, 5, 8, 12 (or Early Study Drug Discontinuation), and 16 (or 4-week Follow-up visit) [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Change from Baseline in the FACT-Br quality of life results at Weeks 5, 12 (or Early Study Drug Discontinuation), and 16 [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Change from Baseline in Myopathy assessment results at Week 12 (or Early Study Drug Discontinuation) and Week 16 (or 4-week Follow-up visit) [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Maximum percent reduction in dexamethasone usage relative to Baseline achieved during the study [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]
• Time to discontinuation of blinded study medication prior to the end of Week 5 [ Time Frame: Prospective ] [ Designated as safety issue: Yes ]

The purpose of this study is to compare the safety and efficacy of XERECEPT® to dexamethasone (Decadron) a common treatment for symptoms of brain swelling (edema). This study is specifically aimed at patients who require chronic high doses of dexamethasone to manage symptoms.

XERECEPT® is not a potential treatment for cancer, but may reduce the edema associated with tumors and as a result, decrease neurological symptoms.

• Brain Edema
• Brain Tumor

• Drug: hCRF
• Drug: placebo hCRF

• Experimental: Patients will take hCRF (XERECEPT) 2mg/day and open label-dexamethasone they are currently taking.
• Placebo Comparator: Patient will receive placebo hCRF and any open-label dexamethasone that they are currently taking

Inclusion Criteria:

• Histologically confirmed diagnosis of a primary malignant brain tumor or, if metastatic, documentation and histology (if available) of primary source of cancer.
• Patient must have 1 or more qualifying steroid-associated side effect(s) at Baseline.
• Patient has required administration of dexamethasone to control symptoms of peritumoral edema for at least 30 days.
• Stable dexamethasone dose of 4-24 mg/day for at least 14 days prior to Baseline.
• Need for administration of dexamethasone to treat peritumoral brain edema (referenced above) has been documented by MRI or comparable diagnostic technology within 21 days of Baseline.
• Karnofsky score of > 50 at Screening and Baseline.
• Capable of self-administration of subcutaneous injections twice daily for 12 weeks, or availability of assistance from caregiver.
• Ability to provide written informed consent or, if unable to provide, have a legal guardian or representative provide written informed consent.
• For women of childbearing potential: a negative serum pregnancy test at Screening.
• Must be 18 years of age or older

Exclusion Criteria:

• Ongoing or anticipated need for surgery, radiosurgery or radiation therapy or the introduction of new chemotherapeutic regime within the first 5 weeks of study enrollment. Treatment with pre-study chemotherapy may continue.
• Concurrent enrollment in any other investigational drug or device study, or plan to enroll in such a study during the first 5 weeks of treatment.
• Systemic steroid use for any indication other than peritumoral brain edema.
• Use or intended use of dexamethasone as an anti-emetic during Screening or Study
• Non-compliance with dexamethasone or anticonvulsant therapy.
• Clinical signs and symptoms of cerebral herniation.
• Serious concomitant cardiovascular, pulmonary, renal, gastrointestinal or endocrine metabolic disease which could put the patient at unusual risk for study participation.
• Confounding previous or concurrent neurological disorders that would interfere with adequate clinical evaluation.
• Clinically significant head injury or chronic seizure disorder, if the condition results in functional impairment or is likely to interfere with evaluations. (Maintenance anticonvulsant therapy is allowed.)
• Central nervous system infection.
• Pregnancy, breastfeeding and/or refusal to practice birth control while in study, for women of childbearing potential.
• Any conditions that are considered contraindications for patients to receive niacin, e.g. liver disease (with LFTs > 3 times the upper limit of the norm),active peptic ulcer, arterial hemorrhage, asthma and known hypersensitivity to niacin.