Pemetrexed Disodium in the Cerebrospinal Fluid of Patients With Leptomeningeal Metastases

Inclusion Criteria

• •DISEASE CHARACTERISTICS:
• •Diagnosis of systemic malignancy (solid tumor or hematologic malignancy) or primary CNS lymphoma with leptomeningeal metastases (LM) as documented by MRI, cerebrospinal fluid, or both
• •Patients may have brain metastases in addition to LM
• •Patients with clinically significant interstitial fluid with effusion controlled by drainage are eligible
• •PATIENT CHARACTERISTICS:
• •Karnofsky performance status 60-100%
• •Life expectancy \> 2 months
• •Creatinine clearance ≥ 45 mL/min
• •Bilirubin \< 1.5 times upper limit of normal (ULN)
• •Transaminases \< 3.0 times ULN (5 times ULN for hepatic metastasis)
• •WBC \> 3,000/mm³
• •Neutrophil count \> 1,500/mm³
• •Platelet count \> 100,000/mm³
• •Hemoglobin \> 10 g/dL
• •Not pregnant or nursing
• •Negative pregnancy test
• •Fertile patients must use effective contraception during and for 3 months after completion of study treatment
• •Able to undergo lumbar puncture (i.e., no noncommunicating hydrocephalus or spinal block) or has an Ommaya reservoir in place
• •Able to take steroids, cyanocobalamin (vitamin B12), and folic acid
• •No other active cancer except nonmelanoma skin cancer or carcinoma in situ of the cervix
• •Patients with prior malignancies who are in complete remission and are off all therapy for that malignancy for ≥ 3 years are eligible
• •No significant medical or psychiatric illness that would interfere with study compliance
• •PRIOR CONCURRENT THERAPY:
• •More than 2 weeks since prior radiotherapy and recovered
• •No concurrent radiotherapy
• •No nonsteroidal anti-inflammatory drugs (NSAIDs) or acetylsalicylic acid within 2 days before or after study treatment (5 days for long-acting NSAIDs)
• •No other concurrent cytotoxic chemotherapy
• •Concurrent hormonal or biological therapy allowed