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.
OBJECTIVE
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.


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.


CONCLUSIONS
(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.
Mehta
Minesh P
MP
Department of Human Oncology, Medical School, University of Wisconsin-Madison, K4/334 Clinical Science Center, 600 Highland Avenue, Madison, WI 53792, USA. mehta@mail.humonc.wisc.edu
Shapiro
William R
WR
Glantz
Michael J
MJ
Patchell
Roy A
RA
Weitzner
Michael A
MA
Meyers
Christina A
CA
Schultz
Christopher J
CJ
Roa
Wilson H
WH
Leibenhaut
Mark
M
Ford
Judith
J
Curran
Walter
W
Phan
See
S
Smith
Jennifer A
JA
Miller
Richard A
RA
Renschler
Markus F
MF
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000556:secondary* / Q000628:therapy*; D003071:Cognition / Q000187:drug effects; D016371:Cranial Irradiation; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008665:Metalloporphyrins / Q000627:therapeutic use*; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011446:Prospective Studies; D015996:Survival Rate
D000970:Antineoplastic Agents; D008665:Metalloporphyrins; C437683:motexafin gadolinium