Trial record 2 of 12 for:    chemotherapy and ependymoma | Open Studies

Risk-Adapted Therapy for Young Children With Embryonal Brain Tumors, Choroid Plexus Carcinoma, High Grade Glioma or Ependymoma

This study is currently recruiting participants. (see Contacts and Locations)
Verified July 2014 by St. Jude Children's Research Hospital
Sponsor:
Collaborators:
University of Florida
Information provided by (Responsible Party):
St. Jude Children's Research Hospital
ClinicalTrials.gov Identifier:
NCT00602667
First received: January 10, 2008
Last updated: July 2, 2014
Last verified: July 2014
  Purpose

RATIONALE: In this study a combination of anti-cancer drugs (chemotherapy) is used to treat brain tumors in young children. Using chemotherapy gives the brain more time to develop before radiation is given. The chemotherapy in this study includes the drug methotrexate. This drug was an important part of the two clinical trials which resulted in the best survival results for children less than 3 years of age with medulloblastoma. Most patients treated on this trial will also receive radiation which is carefully targeted to the area of the tumor. This type of radiation (focal conformal or proton beam radiotherapy) may result in fewer problems with thinking and learning than radiation to the whole brain and spinal cord.

PURPOSE: This clinical trial is studying how well giving combination chemotherapy together with radiation therapy works in treating young patients with newly diagnosed central nervous system tumors.


Condition Intervention
Brain and Central Nervous System Tumors
Drug: Induction Chemotherapy
Drug: Low-Risk Therapy
Drug: High-Risk Therapy
Drug: Intermediate-Risk Therapy

Study Type: Interventional
Study Design: Allocation: Non-Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Open Label
Primary Purpose: Treatment
Official Title: Risk-Adapted Therapy for Young Children With Embryonal Brain Tumors, Choroid Plexus Carcinoma, High Grade Glioma or Ependymoma

Resource links provided by NLM:


Further study details as provided by St. Jude Children's Research Hospital:

Primary Outcome Measures:
  • Progression-free survival [ Time Frame: 1 year after treatment initiation of the last patient ] [ Designated as safety issue: No ]
    Defined as the time interval from date on treatment until the date of first progression, medulloblastoma-related death or date of last contact for patients who have not experienced an event. All eligible patients who receive any methotrexate will be included in the analysis.

  • DNA methylation in peripheral blood or tissue [ Time Frame: 1 year after treatment initiation date of the last patient enrolled ] [ Designated as safety issue: No ]
    Sample and array processing of tumor tissue samples from all participants will be completed at one time following the collection of the sample from the last subject enrolled. Design and analysis will utilize the latest sample and array processing methodologies available at that time. Statistical methodology will also utilize the latest approach at the time of analysis.

  • Event-free survival [ Time Frame: 1 year after treatment initiation date of the last patient enrolled ] [ Designated as safety issue: No ]
    Defined as the time interval from date on treatment until the date of first progression, second malignancy or death due to any cause; or date of last contact for patients who have not experienced an event. All eligible patients who receive any methotrexate will be included in the analysis.


Secondary Outcome Measures:
  • Chromosomal abnormalities [ Time Frame: After the treatment initiation date of the last patient enrolled on the study ] [ Designated as safety issue: No ]
    For patients from whom fresh frozen tumor is available at the time of surgery microarray analysis will be performed on the tumor sample obtained at initial or repeat surgery prior to treatment. The association between clinicopathological variables (e.g., M-stage, desmoplasia, age etc.) and presence of mutations as well as gene expression profiles will be explored.

  • Gene expression patterns [ Time Frame: After the treatment initiation date of the last patient enrolled on the study ] [ Designated as safety issue: No ]
  • Molecular abnormalities by tumor type [ Time Frame: After the treatment initiation date of the last patient enrolled on the study ] [ Designated as safety issue: No ]
  • Number of successful collections for frozen and fixed tumor samples [ Time Frame: After the treatment initiation date of the last patient enrolled on the study ] [ Designated as safety issue: No ]
    Successful collections will be defined as the number of patients who have frozen tissue available and the number of available frozen tumor tissue which will be suitable for high-quality RNA extraction, high-quality protein, and high-quality DNA.

  • Event free survival compared to historical controls [ Time Frame: 1 year after the treatment initiation date of the last patient enrolled ] [ Designated as safety issue: No ]
    We will estimate event-free survival (EFS) using the method of Kaplan and Meier for all eligible patients who received at least one dose of methotrexate. EFS will be measured from the date of initial treatment to the earliest date of disease progression, second malignancy or death for patients who fail; and to the date of last contact for patients who remain at risk for failure. EFS will be compared to a St. Jude historical cohort.

  • Overall survival compared to historical controls [ Time Frame: 1 year after the treatment initiation date of the last patient enrolled ] [ Designated as safety issue: No ]
    We will estimate survival using the method of Kaplan and Meier for all eligible patients who received at least one dose of methotrexate. Survival will be compared to a St. Jude historical cohort.

  • Rate of disease progression [ Time Frame: 1 year after completion of radiation therapy for last patient ] [ Designated as safety issue: No ]
    We will estimate the rate of local and distant disease progression in patients treated in the intermediate risk stratum (M0 non-desmoplastic medulloblastoma and other eligible tumors) after focal irradiation of the post-operative tumor bed using a 5 mm clinical target volume margin. This analysis will be done once all patients in this stratum have been followed for at least 1 year from the end of their radiation treatment.

  • Objective response rate [ Time Frame: From on-study date to 2 months after completion of induction chemotherapy (up to 4 months after on-study date) ] [ Designated as safety issue: No ]
    For patients treated in the intermediate and high risk strata with residual or metastatic disease we will estimate the stratum-specific objective response rate (CR or PR). All patients who receive at least 1-dose of methotrexate are evaluable for response. Objective responses must be sustained for at least eight weeks.

  • Number of participants who successfully complete induction therapy [ Time Frame: From on-study date up to 4 months after on-study date ] [ Designated as safety issue: No ]
    During induction, the proportion of courses during which subsequent chemotherapy administration was delayed for more than 7 days due to toxicity will be calculated.

  • Number of participants who successfully complete consolidation therapy [ Time Frame: At completion of consolidation therapy (up to 6 months after on-study date) ] [ Designated as safety issue: No ]
    During consolidation, we will estimate the proportion of courses during which subsequent chemotherapy administration was delayed for more than 7 days due to toxicity.

  • Sustained objective response rate [ Time Frame: 8 weeks after completion of consolidation therapy (up to 8 months after on-study date) ] [ Designated as safety issue: No ]
    Objective responses must be sustained for at least eight weeks.

  • Percent of total scheduled doses received during oral maintenance therapy [ Time Frame: From start of oral maintenance therapy (approximately 6 months after on-study date) to completion of oral maintenance therapy (up to 1 year after on-study date) ] [ Designated as safety issue: No ]
    These data are based on patient diaries. If the average number of doses successfully administered per course is less than 75% of the scheduled number of doses due to toxicity or patient refusal to take the agent, then the feasibility of administering oral maintenance therapy may be in question.

  • Change in neurostructure, especially white matter volume and integrity [ Time Frame: From baseline to 60 months off therapy ] [ Designated as safety issue: No ]
    Quantitative MRI measures of change in neurostructure (especially white matter volume and integrity) over time will be assessed using a random effects model incorporating various covariates. Covariates to be considered include age at diagnosis, time since diagnosis and risk-arm. Differences in quantitative MRI measures of neurostructure volume and integrity between patient groups will be evaluated as a metric of structural neurotoxicity of therapy.

  • Percent of PET scans with loss of signal intensity [ Time Frame: Up to 3 times during RT consolidation ] [ Designated as safety issue: No ]
    Measures will be analyzed for intermediate risk participants who receive proton beam therapy (PBT) and who consent. This objective aims to assess the feasibility of using post-proton beam therapy (PBT) positron emission tomography (PET) as an in-vivo dosimetric and distal edge verification system in this patient population. To this end we will estimate the percentage of PET scans where loss of signal intensity or resolution were observed. In addition the differences observed between the measured and simulated parameters such as positron activation locations and intensities will be estimated.

  • Pharmacokinetic variables of methotrexate [ Time Frame: During induction therapy, approximately 4 months after participant enrollment. ] [ Designated as safety issue: No ]
    Individual pharmacokinetic parameters estimated will include volume of the central compartment (Vd), elimination rate constant (Ke), and half-life (t1/2). The methotrexate clearance will be calculated using the log-linear trapezoidal method. population parameters and both the inter- and intra-subject variability. After the population parameters and corresponding covariance matrix are estimated, individual estimates can be obtained using post hoc analysis. Thereafter the influence of patient specific covariates such as age, body-surface area, and sex on methotrexate pharmacokinetic parameters will be evaluated.

  • Pharmacokinetic variables of intravenous and oral cyclophosphamide and its metabolites by age, gender, race, and weight [ Time Frame: In consenting patients, at the end of consolidation therapy (approximately 6 months after participant enrollment) and at the end of maintenance therapy (approximately 1 year after the start of therapy) ] [ Designated as safety issue: No ]
    Population pharmacokinetic parameters for cyclophosphamide and metabolites will be estimated, including population parameters and inter-subject variability. After the population parameters and corresponding covariance matrix are estimated, individual estimates can be obtained using post hoc analysis. Using such a method, the influence of patient specific covariates such as age, BSA, and sex on cyclophosphamide/4-HCY pharmacokinetic parameters will be tested to optimize dosing in children with medulloblastoma.

  • Number of participants who successfully achieve target systemic exposure of intravenous topotecan [ Time Frame: During consolidation therapy, approximately 6 months after participant enrollment. ] [ Designated as safety issue: No ]

    Pharmacokinetic (PK) studies will be performed on day 1 of IV topotecan (TPT). If the systemic exposure (AUC) of TPT lactone is not within the target range (140±20 ng/ml*hr) on day 1, the TPT dosage will be adjusted and another PK study will be performed. If PK studies are performed 3 times in 1 course and the AUC is not in target, a dosage adjustment without further PK studies will be made during that course. The final dosage from course 1 will be used for the initial day 1, course 2 dosage. The same PK studies will be performed during course 2 to achieve the target AUC.

    For analysis of our target success rate, we'll consider AUC values from an empiric dosage (course 1 day 1) as a "dose success" or "dose failure" while AUC values from a PK-guided dosage adjustment will be defined as a "PK targeting success" or "PK targeting failure". The initial topotecan dosage of course 1 will not count towards this feasibility objective, since this dosage is predetermined.


  • Pharmacokinetic variables of intravenous and oral topotecan by age, gender, race and weight [ Time Frame: At the end of consolidation therapy (approximately 6 months after participant enrollment); and at the end of maintenance therapy for consenting participants (approximately 1 year after the start of therapy) ] [ Designated as safety issue: No ]
    The population parameters and the inter-subject variability will be estimated. Once the population parameters and corresponding covariance matrix are estimated, individual estimates can be obtained using post hoc analysis. Using such a method, the influence of patient specific covariates such as age, BSA, concomitant drugs, pharmacogenetic factors, and sex on topotecan pharmacokinetic parameters will be tested to optimize dosing in very young children with brain tumors.

  • Pharmacokinetic variables of oral erlotinib by age, gender, race and weight [ Time Frame: At the end of maintenance therapy for consenting participants (approximately 1 year after the start of therapy) ] [ Designated as safety issue: No ]
    The population parameters and the inter-subject variability will be estimated. Once the population parameters and corresponding covariance matrix are estimated, individual estimates can be obtained using post hoc analysis. Using such a method, the influence of patient specific covariates such as age, BSA, concomitant drugs, pharmacogenetic factors, and sex on erlotinib pharmacokinetic parameters will be tested to optimize dosing in very young children with brain tumors.

  • Change in concentration of cerebrospinal fluid (CSF) neurotransmitters [ Time Frame: Baseline, at the completion of therapy, and every 12 months up to 36 months after off therapy date ] [ Designated as safety issue: No ]
  • Change in neurocognitive performance [ Time Frame: Baseline, at the completion of therapy, and every 12 months up to 60 months off therapy ] [ Designated as safety issue: No ]
    Age standardized performance on measures of global cognitive functioning, attention, processing speed and executive functions.

  • Number and type of genetic polymorphisms [ Time Frame: At study enrollment (Day 0) ] [ Designated as safety issue: No ]
  • Pharmacogenetic variation on CNS transmitters [ Time Frame: At study enrollment (Day 0) ] [ Designated as safety issue: No ]
  • Change in neuropsychological performance [ Time Frame: Baseline, 6- and 12-months from treatment initiation, and yearly after the first year (up to 5 years) ] [ Designated as safety issue: No ]
    The primary interest is in global cognitive functioning. This is measured using the SB-V Routing subtests.

  • Change in quantitative magnetic resonance (MR) measures in the frontal lobe [ Time Frame: Baseline and up to 60 months after completion of therapy. ] [ Designated as safety issue: No ]
  • Change in neurocognitive performance in attention, working memory, and fluency [ Time Frame: Baseline and prior to cycle A1 (~6 months) and at end of therapy and at 12, 24, 36, 48 and 60 months after completion of therapy. ] [ Designated as safety issue: No ]
    Neurocognitive performance is assessed using a comprehensive battery of standard tests. Sustained attention is measured using the TOVA; selective auditory attention is measured using the WJIII; nonverbal attention span is measured using the SB-V Block Span subset. Working memory is measured using the WJIII. Fluency is measured using is also measured using the WJIII.

  • Change in quantitative MR measures in the right frontal-parietal regions [ Time Frame: Baseline and up to 5 years after completion of therapy ] [ Designated as safety issue: No ]
  • Change in neurocognitive performance in visual-spatial reasoning and processing speed [ Time Frame: Baseline and up to 5 years after completion of therapy. ] [ Designated as safety issue: No ]
    Processing speed will be measured using the WJIII. Visual perception and visual-motor integration will be measured using the Beery VMI.

  • Number of participants with endocrinopathy [ Time Frame: Baseline, end of therapy, and at 6- and 24-months after completion of therapy ] [ Designated as safety issue: No ]
    Serial GH testing (at baseline, the end of therapy, and at 6 and 24 months after completion of therapy) will be performed on consenting patients in order to estimate longitudinal change in GH secretion as measured by mean peak GH values, with the intent to explore associations with radiation dose to the hypothalamus. Since determination of proton- or photon-based radiotherapy is not based on randomization, it will not be possible to compare the endocrine outcome between the patients with and without PBT. However, the differences between these two clinical cohorts with respect to clinical and demographic variables of interest will be summarized via descriptive statistics.

  • Longitudinal change in growth hormone secretion [ Time Frame: Baseline, end of therapy, and at 6- and 24-months after completion of therapy ] [ Designated as safety issue: No ]
    The intent of this objective is to estimate the longitudinal change in abnormal GH secretion as measured by mean peak GH values via a mixed effects model for the patients who receive PBT.


Estimated Enrollment: 315
Study Start Date: November 2007
Estimated Study Completion Date: December 2023
Estimated Primary Completion Date: December 2018 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Low-Risk Patients
Patients with GTR/M0 medulloblastoma, nodular desmoplastic or high grade glioma histology will receive induction chemotherapy and low-risk therapy.
Drug: Induction Chemotherapy
All patients will receive 4 identical cycles of induction chemotherapy including highdose (5 g/m2 or 2.5g/m2 for patients less than or equal to 31 days of age at enrollment) intravenous methotrexate and standard dose vincristine, cisplatin, and cyclophosphamide.
Other Names:
  • MTX (methotrexate)
  • Oncovin(R) (vincristine)
  • Platinol-AQ(R) (cisplatin)
  • Cytoxan(R) (cyclophosphamide)
Drug: Low-Risk Therapy
Induction will be followed by further conventional chemotherapy with carboplatin, cyclophosphamide, and etoposide. After consolidation, patients will receive 6 cycles of oral maintenance chemotherapy with cyclophosphamide, topotecan, and depending on the diagnosis, either erlotinib or etoposide (VP-16).
Other Names:
  • Cytoxan(R) (cyclophosphamide)
  • Paraplatin(R) (carboplatin)
  • Vepesid(R), VP-16 (etoposide)
  • Hycamptin(R) (topotecan)
  • Tarceva(TM) (erlotinib)
Experimental: High-Risk Patients
Patients with CNS metastatic disease will receive induction chemotherapy and high-risk therapy.
Drug: Induction Chemotherapy
All patients will receive 4 identical cycles of induction chemotherapy including highdose (5 g/m2 or 2.5g/m2 for patients less than or equal to 31 days of age at enrollment) intravenous methotrexate and standard dose vincristine, cisplatin, and cyclophosphamide.
Other Names:
  • MTX (methotrexate)
  • Oncovin(R) (vincristine)
  • Platinol-AQ(R) (cisplatin)
  • Cytoxan(R) (cyclophosphamide)
Drug: High-Risk Therapy
High risk patients will also receive vinblastine with each course of induction chemotherapy. Induction will be followed by either chemotherapy with targeted intravenous topotecan and cyclophosphamide or optional craniospinal irradiation (CSI). CSI will be offered only to patients who reach 3 years of age by the end of induction only. After consolidation, all patients will receive 6 cycles of oral maintenance chemotherapy with cyclophosphamide, topotecan, and depending on the diagnosis, either erlotinib or etoposide (VP-16).
Other Names:
  • Velban(R) (vinblastine)
  • Cytoxan(R) (cyclophosphamide)
  • Hycamptin(R) (topotecan)
  • Tarceva(TM) (erlotinib)
  • Vepesid(R), VP-16 (etoposide)
Experimental: Intermediate-Risk Therapy
Patients with M0 medulloblastoma or nodular desmoplastic histology with less than a GTR, other histologic diagnoses with no metastatic disease, will receive induction chemotherapy and intermediate-risk therapy.
Drug: Induction Chemotherapy
All patients will receive 4 identical cycles of induction chemotherapy including highdose (5 g/m2 or 2.5g/m2 for patients less than or equal to 31 days of age at enrollment) intravenous methotrexate and standard dose vincristine, cisplatin, and cyclophosphamide.
Other Names:
  • MTX (methotrexate)
  • Oncovin(R) (vincristine)
  • Platinol-AQ(R) (cisplatin)
  • Cytoxan(R) (cyclophosphamide)
Drug: Intermediate-Risk Therapy
Induction will be followed by consolidation focal radiotherapy (RT) to the tumor bed. Patients less than 12 months old upon completion of induction will receive low risk chemotherapy to delay RT until the age of 12 months. After consolidation, patients will receive 6 cycles of oral maintenance chemotherapy with cyclophosphamide, topotecan, and depending on the diagnosis, either erlotinib or etoposide (VP-16).
Other Names:
  • Cytoxan(R) (cyclophosphamide)
  • Hycamptin(R) (topotecan)
  • Tarceva(TM) (erlotinib)
  • Vepesid(R), VP-16 (etoposide)

  Show Detailed Description

  Eligibility

Ages Eligible for Study:   up to 5 Years
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Histologically confirmed newly diagnosed CNS tumors of any of the following :

  • Medulloblastoma (all histologic subtypes, including medullomyoblastoma and melanotic medulloblastoma)
  • Supratentorial primitive neuroectodermal tumor (PNET) (including CNS neuroblastoma or ganglioneuroblastoma, medulloepithelioma, and ependymoblastoma)
  • Pineoblastoma
  • Atypical teratoid rhabdoid tumor (ATRT)
  • Choroid plexus carcinoma
  • High grade glioma (including anaplastic astrocytoma, anaplastic oligodendroglioma, anaplastic ganglioglioma, pleomorphic xanthoastrocytoma with anaplastic features, high-grade astroblastoma , anaplastic pilocytic astrocytoma, malignant glioneuronal tumor, glioblastoma multiforme), or gliosarcoma,
  • Ependymoma (including all ependymoma histological variants)
  • Age < 3 years at time of diagnosis for all histological diagnosis. Medulloblastoma patients ≥ 3 and < 5years old at diagnosis who have non-metastatic disease with no more than 1cm2 of residual tumor are also eligible.

    • Meets criteria for 1 of the following risk groups:
  • Low-risk group:

    • Histologically confirmed nodular desmoplastic medulloblastoma, including medulloblastoma with extensive nodularity

      • Focal areas of anaplasia or other atypical features suggesting more aggressive phenotype in a tumor otherwise considered nodular desmoplastic should be treated on the intermediate-risk group, with final risk stratification at the discretion of principal investigator and study pathologist
    • No evidence of CNS metastasis 7 to 28 days after surgery by MRI and cytologic examination of lumbar cerebrospinal fluid (CSF)

      • Ventricular CSF from a shunt or Ommaya reservoir may be used to rule out M1 disease when lumbar puncture is medically contraindicated
      • Intermediate-risk group assignment when there is no other evidence of metastasis and CSF sampling is not possible
    • Gross total resection, defined as residual tumor or imaging abnormality (not definitive for residual tumor) with a size of < 1 cm2 confirmed on postoperative CT scan or MRI
    • Brain stem invasion by the tumor in the absence of imaging evidence of residual tumor (tumor size < 1 cm2) and otherwise meets criteria for the low-risk group, the patient will be classified as low-risk
    • Desmoplastic medulloblastoma patients who are ≥3 -<5 years of age will NOT be eligible for the low risk arm of the protocol.
  • Intermediate-risk group:

    • Histologically confirmed nodular desmoplastic medulloblastoma with less than gross total resection and no evidence of metastasis
    • Any eligible histologic diagnosis other than desmoplastic medulloblastoma with no evidence of CNS metastasis
    • Medulloblastoma patients who are ≥3 and < 5 yrs of age irrespective of histology and with no evidence of CNS metastasis
  • High-risk group:

    • Any eligible histologic diagnosis with evidence of CNS metastasis
    • Patients with extraneural metastasis are eligible for treatment on the high-risk group

PATIENT CHARACTERISTICS:

  • Lansky performance status ≥ 30 (except for posterior fossa syndrome)
  • WBC > 2,000/mm3
  • Platelets > 50,000/mm3 (without support)
  • Hemoglobin > 8 g/dL (with or without support)
  • ANC > 500/mm3
  • Serum creatinine < 3 times upper limit of normal (ULN)
  • ALT < 5 times ULN
  • Total bilirubin < 3 times ULN

PRIOR CONCURRENT THERAPY:

  • See Disease Characteristics
  • No more than 31 days since prior definitive surgery
  • No prior radiotherapy or chemotherapy other than corticosteroid therapy
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT00602667

Contacts
Contact: Amar Gajjar, MD 1-866-278-5833 info@stjude.org

Locations
United States, California
Lucile Packard Children's Hospital at Stanford University Medical Center Recruiting
Palo Alto, California, United States, 94304
Contact: Paul G. Fisher, MD, MHS    650-497-8953    pfisher@stanford.edu   
Rady Children's Hospital Recruiting
San Diego, California, United States, 92123
Contact: John Crawford, MD, MS    858-576-1700      
United States, Minnesota
Children's Hospitals and Clinics of Minnesota - St. Paul Recruiting
St. Paul, Minnesota, United States, 55102
Contact: Anne E. Bendel, MD    651-220-6732      
United States, Tennessee
St. Jude Children's Research Hospital Recruiting
Memphis, Tennessee, United States, 38105
Contact: Amar Gajjar, MD    901-495-5007    amar.gajjar@stjude.org   
United States, Texas
University of Texas Southwestern Medical Center at Dallas Recruiting
Dallas, Texas, United States, 75390
Contact: Daniel C. Bowers, MD    214-456-6139      
Australia, Queensland
Royal Children's Hospital Recruiting
Brisbane, Queensland, Australia, 4029
Contact: Tim Hassall, MBBS, FRACP    61-7-3636-9115    tim_hassall@health.qld.gov.au   
Sponsors and Collaborators
St. Jude Children's Research Hospital
University of Florida
Investigators
Study Chair: Amar Gajjar, MD St. Jude Children's Research Hospital
  More Information

Additional Information:
No publications provided

Responsible Party: St. Jude Children's Research Hospital
ClinicalTrials.gov Identifier: NCT00602667     History of Changes
Other Study ID Numbers: SJYC07, R01CA154619
Study First Received: January 10, 2008
Last Updated: July 2, 2014
Health Authority: United States: Food and Drug Administration

Keywords provided by St. Jude Children's Research Hospital:
untreated childhood medulloblastoma
untreated childhood supratentorial primitive neuroectodermal tumor
untreated childhood pineoblastoma
childhood atypical teratoid/rhabdoid tumor
childhood choroid plexus tumor
childhood high grade glioma
newly diagnosed childhood ependymoma

Additional relevant MeSH terms:
Ependymoma
Nervous System Neoplasms
Central Nervous System Neoplasms
Neoplasms
Carcinoma
Choroid Plexus Neoplasms
Glioma
Neoplasms, Neuroepithelial
Neuroectodermal Tumors
Neoplasms, Germ Cell and Embryonal
Neoplasms by Histologic Type
Neoplasms, Glandular and Epithelial
Neoplasms, Nerve Tissue
Neoplasms by Site
Nervous System Diseases
Cerebral Ventricle Neoplasms
Brain Neoplasms
Brain Diseases
Central Nervous System Diseases
Cyclophosphamide
Methotrexate
Etoposide phosphate
Etoposide
Topotecan
Erlotinib
Immunosuppressive Agents
Immunologic Factors
Physiological Effects of Drugs
Pharmacologic Actions
Antirheumatic Agents

ClinicalTrials.gov processed this record on September 16, 2014