Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Children with definitive confirmatory eligible histologic or cytological diagnosis of eligible CNS tumor within the brain or spinal cord, who have not previously received either irradiation or chemotherapy (except corticosteroids) will be eligible for study entry
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease. Patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered for at least 28 days prior to randomization
Uncontrolled tumor-related pain or impending spinal cord compression.
Patients must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to sub-study registration; patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment and prior to registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to sub-study registration
Patients whose primary tumors arise in the intra-dural soft tissue (eg. brain and spinal cord) are not eligible
Patients with symptomatic uncontrolled brain metastases; a scan to confirm the absence of brain metastases is not required; the patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to enrollment; patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease.
Based on prior radiation records, have had most of the tumor volume (> 50%) previously radiated at doses >= 45 gray (Gy) without exceeding spinal cord tolerance (combining previous and future radiation dose to 1 cc of the spinal cord of =< 60 Gy)
Spinal cord compression or brain metastases unless asymptomatic, treated, stable, and not requiring steroids for at least 4 weeks before first dose of study drug
Spinal cord compression or brain metastases unless asymptomatic treated and stable and not requiring steroids
Prior cranial or spinal radiotherapy
Has spinal cord compression or clinically active central nervous system metastases, defined as untreated and symptomatic, or requiring therapy
Untreated CNS metastatic disease, leptomeningeal disease, or cord compression
Patients with symptomatic uncontrolled brain metastases; a scan to confirm the absence of brain metastases is not required; patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days
Symptomatic or untreated leptomeningeal disease or spinal cord compression
Spinal cord compression or brain metastases unless asymptomatic, treated and stable and not requiring steroids for at least 4 weeks prior to start of study treatment
Subjects with symptomatic brain metastases, carcinomatous meningitis, spinal cord compression, or intractable back pain due to compression of destructive mass
Tumors involving spinal cord or heart
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for at least 2 weeks prior to randomization
Symptomatic or uncontrolled brain metastases requiring concurrent treatments, uncontrolled spinal cord compression, carcinomatous meningitis, or new evidence of brain or leptomeningeal disease; uncontrolled seizures.
Patients with untreated spinal cord metastases are eligible if lesions are asymptomatic
Epidural tumor < 2 mm from spinal cord
Subject with known active CNS metastasis, except primary brain tumors. Subjects with asymptomatic brain metastases or spinal cord compression who have been treated, are considered stable, and have not received steroid doses > 10 mg/day of prednisolone equivalent to treat these conditions prior to consent may be included;
Have known or suspected brain metastases or spinal cord compression, unless the condition has been asymptomatic, has been treated with surgery and / or radiation, and has been stable for at least 4 weeks prior to the first dose of study medication
Tumors that are primarily localized within the brainstem or spinal cord
Active or untreated brain metastases or spinal cord compression\r\n* A scan to confirm the absence of brain metastases is not required\r\n* Patients with treated brain metastases or spinal cord compression are eligible if they have minimal neurologic symptoms and evidence of stable disease (for at least 1 month) or response on follow-up scan; the patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 28 days prior to treatment
Patients with symptomatic central nervous system (CNS) metastases or other tumor location (such as spinal cord compression, other compressive mass, uncontrolled painful lesion, bone fracture, etc.) necessitating an urgent therapeutic intervention, palliative care, surgery or radiation therapy
Subject has clinical signs suggestive of high or imminent risks for pathological fracture, spinal cord compression and/or cauda equina syndrome
Known leptomeningeal carcinomatosis, uncontrolled/unstable spinal cord compression, or brain metastases.
Spinal surgery carried out with the goal of spinal cord decompression and spinal stabilization within 8 weeks
History of leptomeningeal disease or spinal cord compression secondary to metastasis
Extradural tumor in contact with the spinal cord or tumor located where swelling in response to therapy may impinge upon spinal cord
Positive cerebrospinal fluid (CSF) cytology during staging, symptomatic leptomeningeal involvement, or parenchymal involvement of brain or spinal cord
Evidence of spinal cord compression
Patient has spinal cord compression or symptomatic brain metastases.
Presence of tumor cells in the brain or spinal cord which are symptomatic or require treatment
Have symptomatic or uncontrolled brain metastases, spinal cord compression, or leptomeningeal disease requiring concurrent treatment, including but not limited to surgery, radiation, and/or corticosteroids (participants receiving anticonvulsants are eligible).
Metastatic disease impinging on the spinal cord or threatening spinal cord compression; patients that have had previous treatment of disease with impinging on the cord with either surgery or radiotherapy with clinical or radiographic evidence of response or stability are eligible
Metastatic disease impinging on the spinal cord or threatening spinal cord compression
Subjects with known symptomatic or impending spinal cord compression, except if subject has received definitive treatment for this and demonstrates evidence of clinically stable disease
Known central nervous system metastasis; patients with known brain metastases, spinal cord compression, carcinomatous meningitis, or leptomeningeal disease may be enrolled if they have been treated, are no longer taking corticosteroids, and have been stable on imaging for at least 3 weeks
Osseous metastases felt in the opinion of the clinician to be high-risk for impending pathologic fracture or spinal cord compression
Spinal cord compression unless good pain control attained
Radiologic or clinical evidence of spinal cord compression
Patients with primary spinal cord tumors
Evidence of disease in sites or extent that, in the opinion of the investigator, would put the patient at risk from therapy with testosterone (e.g. femoral metastases with concern over fracture risk, severe and extensive spinal metastases with concern over spinal cord compression, extensive liver metastases)
Spinal cord compression or brain metastases unless asymptomatic, stable, and not requiring steroids for at least 4 weeks prior to start of study treatment.
Has a history of untreated brain metastasis or history of leptomeningeal disease or spinal cord compression
Spinal cord compression not definitively treated with surgery and/or radiation
Patients with spinal disease
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; treated brain metastases must have been stable for at least 1 month and require treatment with less than 10 mg/day prednisone equivalent for at least two weeks prior to study drug administration
Patients with radiographic or clinical findings of spinal cord compression or cauda equina syndrome with neurologic deficit thought to be due to malignancy
Spinal cord compression, imminent long bone fracture, or any other condition that, in the opinion of the investigator, is likely to require radiation therapy and/or steroids for pain control during the active phase
Spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for >= 2 weeks prior to randomization
Has imminent or established cord compression based on clinical findings and/or MRI
Patients with symptomatic uncontrolled brain metastases. A scan to confirm the absence of brain metastases is not required. The patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to treatment. Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days
Diffuse Leptomeningeal metastases with radiographic involvement in the brain and/or spinal cord. This does not include local leptomeningeal involvement which is defined as leptomeningeal enhancement within direct contact of targetable metastases
Known spinal cord compression
Presence of extracranial metastatic, significant leptomeningeal disease or tumors primarily localized to the brainstem or spinal cord.
Spinal cord compression that has not definitively treated with surgery and/or radiation
Brain metastases or spinal cord compression unless asymptomatic and not requiring steroids for at least 14 days prior to start of study treatment
No concurrent leptomeningeal disease or cord compression
Patients with symptomatic central nervous system (CNS) metastases or other tumor location (such as spinal cord compression, other compressive mass, uncontrolled painful lesion, bone fracture, etc.) necessitating an urgent therapeutic intervention, palliative care, surgery or radiation therapy
Known symptomatic or impending cord compression
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to randomisation
Highly symptomatic patients (e.g., declining ECOG performance status; rapidly worsening symptoms; rapid progression of disease; progression of tumor at critical anatomical sites [e.g., spinal cord compression] requiring urgent alternative medical intervention) are not eligible
Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI); spinal cord compression will be defined as 360 degree circumferential obliteration of T2 cerebrospinal fluid signal around the spinal cord; treatment should be completed for spinal cord compression
Patients with untreated spinal cord compression; patients with spinal cord compression may be enrolled if stable after completing surgery (may enroll 14 days after surgery) or radiation (may enroll 14 days after treatment) and must be off corticosteroids for at least 14 days prior to the start of study treatment
Planned treatment site(s) associated with spinal cord compression or canal compromise requiring decompression
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; treated brain metastases are allowed as long as they are stable for at least 28 days post-treatment
Symptomatic brain metastases, leptomeningeal carcinomatosis, or spinal cord compression (treated metastatic brain, leptomeningeal carcinomatosis, or spinal cord compression are allowed); Note: Patients must be off steroids used for brain metastases, leptomeningeal carcinomatosis, or spinal cord compression
Participants with uncontrolled tumor-related pain\r\n* Symptomatic lesions amenable to palliative radiotherapy (e.g., bone metastases or metastases causing nerve impingement) should be treated prior to enrollment\r\n* Asymptomatic metastatic lesions whose further growth would likely cause functional deficits or intractable pain (e.g., epidural metastases that are not currently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrollment
Evidence of untreated or progressive brain metastases, spinal cord compression, or carcinomatous meningitis
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease (Note: Patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered over the 14 days prior to study treatment)
Symptomatic or impending spinal cord compression or cauda equina syndrome.
Uncontrolled tumor-related pain\r\n* Subjects requiring pain medication must be on a stable regimen at study entry\r\n* Symptomatic lesions amenable to palliative radiotherapy (e.g., bone metastases or metastases causing nerve impingement) should be treated prior to enrollment\r\n* Asymptomatic metastatic lesions whose further growth would likely cause functional deficits or intractable pain (e.g., epidural metastasis that is not currently associated with spinal cord compression) should be considered for loco-regional therapy if appropriate prior to enrollment
Leptomeningeal carcinomatosis or cord compression
Symptomatic or untreated brain metastases, leptomeningeal disease, or spinal cord compression
Have known or suspected brain metastases or spinal cord compression, unless the condition has been asymptomatic, has been treated with surgery and/or radiation, and has been stable without requiring escalating corticosteroids nor anti-convulsant medications for at least 4 weeks prior to the first dose of study medication
Brain metastases or spinal cord compression, unless treatment was completed at least 4 weeks before study entry, and stable without steroid treatment for at least 4 weeks
Patients that require urgent therapy due to tumor mass effects or spinal cord compression
Prognostic Index for Spinal Metastases (PRISM) group 1-3
Spinal cord compression or brain metastases unless asymptomatic, stable and not requiring steroids for at least 4 weeks prior to start of study treatment
In the dose-finding portion of the study, participants with known or suspected parenchymal brain, spinal cord, leptomeningeal disease prior to study enrollment will be excluded; in the dose-expansion portion of the study, known or suspected parenchymal brain or spinal cord disease, and/or suspected or symptomatic leptomeningeal disease prior to study enrollment will be excluded; asymptomatic leptomeningeal disease only will be allowed in the dose-expansion cohort
Has tumor primarily localized to the brainstem or spinal cord
Spinal anesthesia
Has a spinal cord compression unless asymptomatic, radiographically stable over the last 4 weeks, and not requiring steroids for at least 4 weeks before the start of study treatment
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; if these were treated and clinically stable for 4 weeks, patient can be considered for the trial
Patients with symptomatic metastatic prostate cancer such as moderate to severe pain, impaired organ function, or spinal cord compression will be excluded from this study unless these issues have been taken care of
Brain metastases or spinal cord compression unless asymptomatic, treated and stable off steroids and anti-convulsants for at least 3 months
No history of tumors involving spinal cord or heart
Patients with symptomatic metastatic prostate cancer such as moderate to severe pain, impaired organ function or spinal cord compression will be excluded from this study unless these issues have been taken care of
Have symptomatic or uncontrolled brain metastases, spinal cord compression, or leptomeningeal disease requiring concurrent treatment.
Active seizure disorder or evidence of untreated or progressive brain metastases, spinal cord compression, or carcinomatous meningitis\r\n* Subjects with brain metastases are eligible if they have been treated and there is no CT or magnetic resonance imaging (MRI) evidence for at least 4 weeks after central nervous system (CNS) metastasis treatment is complete
Known brain metastases or spinal cord compression
Quantification of the degree of epidural spinal cord compression as grade 1C, 2, or 3 by magnetic resonance imaging (MRI), with and without contrast sequences; axial T2 sequence is encouraged but not required
Motor strength >= 4 out of 5 in extremity or extremities affected by the level of the spinal cord compression
Frank cord compression or cord compression from bone components or configuration and acute neurological deficits (defined as motor strength < 4/5 in extremity or extremities affected by the level of the spinal cord compression)
Has symptomatic or untreated leptomeningeal, brain metastases, or spinal cord compression.
Untreated symptomatic spinal cord compressions
Patients with evidence of tumor in the brainstem, cerebellum, or spinal cord, or with evidence of leptomeningeal disease
PHASE I: Tumor localized primarily to the posterior fossa or spinal cord
Patients that require urgent therapy due to tumor mass effects or spinal cord compression
Spinal cord compression (unless treated with the patient attaining good pain control and stable or recovered neurologic function), carcinomatous meningitis, or leptomeningeal disease
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression (patients with controlled central nervous system [CNS] disease, i.e. asymptomatic and currently receiving concurrent intrathecal chemotherapy, are eligible upon discussion with the principal investigator)
Symptomatic or untreated CNS metastases or spinal cord compression. Brain metastasis must be stable with verification by imaging .
Has imminent or established spinal cord compression based on clinical findings and/or MRI
Brain metastases and/or spinal cord compression untreated with surgery and/or radiotherapy, and without clinical imaging evidence of stable disease for 14 days or longer; Subjects requiring steroids within 4 weeks prior to start of study treatment will be excluded;
Cord compression at 2 non-contiguous sites in the spine
Brain metastases or spinal cord compression unless the patient's condition is stable and off steroids for at least 14 days prior to the start of study treatment. Patients with suspected or known brain metastases at screening should have an MRI (preferred)/CT, preferably with IV contrast to access baseline disease status.
Imminent or established spinal cord compression based on clinical and/or imaging; in subjects with untreated imminent or established spinal cord compression, treatment with standard of care as clinically indicated should be completed at least 4 weeks before enrollment
Are symptomatic or have uncontrolled brain metastases, leptomeningeal disease, or spinal cord compression not definitively treated with surgery or radiation (brain metastases that are stable and asymptomatic, either treated or untreated, will be allowed)
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Brain metastases or spinal cord compression unless asymptomatic, treated and stable off steroids and anti-convulsants for at least 30 days
Brain metastases or spinal cord compression that requires treatment, unless the treatment ended at least 4 weeks before starting protocol therapy and the condition has been stable without steroid treatment for at least 10 days
PHASE II STUDY COHORT 1 OVARIAN CANCER ELIGIBILITY CRITERIA (MEDI+O, MEDI+C AND MEDI+O+C):\r\nPatients with evidence of CNS metastasis, spinal cord compression, or leptomeningeal disease within one year prior to enrollment will be excluded from this clinical trial; patients with a remote history of brain metastases may be considered if they received sterilizing therapy to the CNS (resection or radiation) and have been CNS progression free for the 1-year period; baseline imaging to rule out brain metastases is not required for screening, but should be performed prior to study enrollment if clinically indicated; patients with spinal cord compression may be considered if the condition is medically managed and currently asymptomatic
PHASE II STUDY COHORT 5 TRIPLE NEGATIVE BREAST CANCER ELIGIBILITY CRITERIA (MEDI+O ONLY):\r\nPatients with evidence of CNS metastasis, spinal cord compression, or leptomeningeal disease within six months prior to enrollment will be excluded from this clinical trial; patients with a remote history of brain metastases may be considered if they received sterilizing therapy to the CNS (resection or radiation) and have been CNS progression free for the six months period; baseline imaging to rule out brain metastases is not required for screening, but should be performed prior to study enrollment if clinically indicated; patients with spinal cord compression may be considered if the condition is medically managed and currently asymptomatic
PHASE II STUDY METASTATIC CASTRATE-RESISTANT PROSTATE CANCER COHORT 4 ELIGIBILITY CRITERIA (MEDI+O ONLY):\r\nPatients with evidence of CNS metastasis, spinal cord compression, or leptomeningeal disease within 1 year prior to enrollment will be excluded from this clinical trial; patients with a remote history of brain metastases may be considered if they received sterilizing therapy to the CNS (resection or radiation) and have been CNS progression-free for the 1-year period; baseline imaging to rule out brain metastases is not required for screening, but should be performed prior to study enrollment if clinically indicated; patients with spinal cord compression may be considered if the condition is medically managed and currently asymptomatic
Prior radiation > 20 Gy to any critical normal organ (e.g., lung, liver, spinal cord, both kidneys) within 1 year of the treatment date
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease; patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered for at least 28 days
Patients with uncontrolled seizure disorder, spinal cord compression or carcinomatous meningitis
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI); treatment should be completed for spinal cord compression
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Patients must have demonstrated progression of disease on MRI or computed tomography (CT) assessment of the spinal cord/cauda within the previous radiation field\r\n* Progression may consist of an increase in maximal dimension of the tumor by >= 20%, compromise of the spinal cord/cauda equina and/or exiting spinal nerves (assessed clinically or radiographically), or both
Patients with intradural or intramedullary lesions, or lesions with < 2 mm distance from tumor to spinal cord
Unable to undergo either a myelogram or MRI of spinal cord/cauda equina and/or exiting spinal nerves
Tumor within 1 cm of the spinal cord
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Evidence of disease in sites or extent that, in the opinion of the investigator, would put the patient at risk from therapy with testosterone (e.g. femoral metastases with concern over fracture risk, spinal metastases with concern over spinal cord compression, lymph node disease with concern for ureteral obstruction)
Metastatic deposits near a great vessel or spinal cord
Subjects with spinal cord compression
Exposure to any prior chemotherapy or steroid use within 14 days of study-related drug therapy; (steroid use is allowed if necessary to treat spinal cord compression)
T4 tumor with direct invasion of esophagus, spinal cord, major blood vessel, or heart
Patients with primarily infra-tentorial or spinal cord tumor are not eligible
Have symptomatic leptomeningeal carcinomatosis or spinal cord compression. Patients with asymptomatic leptomeningeal disease and no evidence of spinal cord compression are allowed.
Spinal cord compression unless asymptomatic and not requiring steroids for at least 4 weeks before the start of study treatment. - Presently has a second malignancy other than SCCHN, or history of treatment for invasive cancer other than SCCHN in the past 3 years. Exceptions are
Symptomatic or untreated leptomeningeal disease, brain metastasis, or spinal cord compression
Patient with epidural, spinal nerve, and/or cord compression on MRI may be included
Untreated or active primary brain tumor, central nervous system (CNS) metastases, or spinal cord compression
Spinal cord compression or brain metastases
Patients with untreated brain metastases, spinal cord compression, or leptomeningeal carcinomatosis are excluded from this clinical trial; patients with brain metastases or spinal cord compression previously treated with radiation and/or surgery are allowed if local treatment was > 30 days ago, most recent MRI demonstrates stability or decrease in size of all lesions, and the patient has no current neurologic symptoms related to the metastases and treatment and no requirement for corticosteroids related to the prior treatment
Spinal cord compression, symptomatic and unstable brain metastases except for those patients who have completed definitive therapy, and have had a stable neurological status for at least 2 weeks after completion of definitive therapy. 20.Refractory nausea and vomiting, chronic gastrointestinal diseases, inability to swallow the formulated product or previous significant bowel resection that would preclude adequate absorption of osimertinib
History of brain metastases, uncontrolled spinal cord compression, carcinomatous meningitis, or new evidence of brain or leptomeningeal disease.
Known or suspected brain metastasis or active leptomeningeal disease or spinal cord compression
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated but without evidence that disease has been clinically stable for >/=2 weeks prior to Day 1 of Cycle 1
Evidence of spinal cord compression or CNS complication unless controlled by appropriate therapy.
Clinical spinal cord compression syndromes (unless patient has undergone treatment, for example, surgery or radiation therapy, and neurological findings are ? Grade 1 and patient is off corticosteroids for spinal cord edema or on a stable regimen of < 10 mg/day prednisone equivalent
Patients with primary tumor location of brainstem or spinal cord
Patients with symptomatic uncontrolled brain metastases; a scan to confirm the absence of brain metastases is not required; the patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to treatment; patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days
Evidence of disease that, in the opinion of the investigator, would put the patient at risk from testosterone therapy (e.g. femoral metastases with concern over fracture risk, spinal metastases with concern over spinal cord compression, lymph node disease with concern for ureteral obstruction)
Active or untreated brain metastases or spinal cord compression
Symptomatic or untreated spinal cord compression
Spinal cord compression or impending spinal cord compression
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI); treatment should be completed for spinal cord compression
Patients with symptomatic uncontrolled brain metastases. A scan to confirm the absence of brain metastases is not required. The patient can receive a stable dose of corticosteroids before and during the study as long as these were started at least 4 weeks prior to treatment. Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days.
Patients with symptomatic metastatic prostate cancer experiencing moderate to severe pain, impaired organ function or spinal cord compression will be excluded from this study unless these issues have been addressed
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Subjects with symptomatic or impending cord compression unless appropriately treated beforehand and clinically stable and asymptomatic.
Symptomatic brain or spinal cord metastases (patients must be stable for > 1 month post radiotherapy or surgery).
Tumors primarily localized in the infratentorial compartment or spinal cord – tumors with limited infratentorial compartment or spinal cord involvement are eligible
Patients must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to Step 2 re-registration; patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment and prior to re-registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to re-registration
Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression
Patients must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to Step 2 Re-registration; patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment prior to re-registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to re-registration
Patients must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to step 2 re-registration; patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: (1) metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment and prior to re-registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to re-registration
Patients that require urgent therapy due to tumor mass effects or spinal cord compression
Symptomatic or untreated spinal cord compression
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Patients with symptomatic or untreated leptomeningeal or brain metastasis or spinal cord compression
Pathologic long-bone fractures, imminent pathologic long-bone fracture (cortical erosion on radiography > 50%) or spinal cord compression
Patient must not have known symptomatic leptomeningeal or brain metastases or spinal cord compression
Concurrent radiation, with or without steroids, or steroids alone for emergency conditions secondary to lymphoma (i.e. cord compression, etc.) will be permitted
The entire tumor volume must be included in a treatment field that limits the total spinal cord dose to 54 Gy (prior plus planned dose)
Cord blood transplant
Current symptomatic cord compression requiring surgery or radiation therapy
Patients must have symptomatic multiple myeloma without advanced organ damage (such as multiple fractures or advanced bone disease causing immobilization, renal failure, spinal cord compression, or organ compromise due to soft tissue plasmacytoma); if immediate therapy with radiation and high-dose steroids (e.g., for spinal cord compression) or if triple therapy is clearly advisable from the start, the patient is not eligible for this trial
History of central nervous system (CNS) lymphoma, leptomeningeal disease or spinal cord compression.
DISEASE RELATED CRITERIA: Patients must not have known brain metastases, leptomeningeal carcinomatosis or spinal cord compression unless: (1) metastases have been locally treated (including stereotactic body radiation therapy [SBRT], whole brain radiotherapy [WBRT], and surgical resection) and have remained clinically controlled and asymptomatic for at least 14 days following treatment and prior to registration, AND (2) patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to registration
Have known untreated brain metastases, uncontrolled spinal cord compression, or leptomeningeal disease.
Subject has symptomatic brain metastases, spinal cord compression, or intractable back pain due to compression of destructive mass.
Complicated bone metastases including clinical or radiological evidence of spinal cord compression or impending pathological fracture
Presence of, or history of, central nervous system (CNS) lymphoma, leptomeningeal disease or spinal cord compression.
Patients with known leptomeningeal or brain metastases or spinal cord compression should be excluded from this clinical trial
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease. Patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered for at least 28 days.
Patients must have a CT or MRI scan of the brain to evaluate for central nervous system (CNS) disease within 42 days prior to RE-TREATMENT registration; patient must not have leptomeningeal disease, spinal cord compression or brain metastases unless: metastases have been locally treated and have remained clinically controlled and asymptomatic for at least 14 days following treatment and prior to RE-TREATMENT registration, AND patient has no residual neurological dysfunction and has been off corticosteroids for at least 24 hours prior to RE-TREATMENT registration
History of or known active seizure disorder, brain metastases, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease.
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for greater than (>) 2 weeks prior to randomization
First day of dosing with tesevatinib is less than 4 weeks from the last radiotherapy of the brain or spinal cord/cauda equina
No history of tumors involving spinal cord or heart
No tumors involving spinal cord or heart
Have current spinal cord compression (symptomatic or asymptomatic and detected by radiographic imaging). Patients with leptomeningeal disease and without cord compression are allowed.
Index tumor causing clinical or radiographic evidence of spinal cord or cauda equina compression/effacement
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease. Patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered for at least 28 days.
Patients may have received prior radiotherapy for symptomatic localized bone lesions or impending spinal cord compression only; radiotherapy must be completed at least 14 days prior to registration and all toxicities must have resolved to =< grade 1
Spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for >= 2 weeks prior to screening
Spinal cord compression not definitively treated or not clinically stable
Spinal cord compression or brain metastases unless asymptomatic, stable and not requiring steroids for at least 6 weeks prior to start of study treatment
have previously documented brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression
Has documented brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
Untreated symptomatic spinal cord compressions
Patients with primary spinal cord tumors are eligible. Patients with multi-focal disease within the cerebrum are eligible.
Any concurrent chemotherapy, biologic, or hormonal therapy for cancer Treatment; 2. History of leptomeningeal carcinomatosis; 3. Active or prior documented autoimmune or inflammatory disorders; 4. Brain metastases or spinal cord compression unless asymptomatic or treated and stable off steroids and anti-convulsants for at least 14 days prior to study treatment start; 5. QT interval corrected for heart rate using Fridericia's formula (QTcF) ?470 ms; 6. Known allergy or hypersensitivity to IP or any IP excipient
Have documented brain metastases, leptomeningeal disease or uncontrolled spinal cord compression.
Brain metastases, spinal cord compression, carcinomatous meningitis, or leptomeningeal disease.
Has history of brain metastasis, spinal cord compression (unless treated, asymptomatic, and stable on most recent imaging and enrolling in expansion cohort), or lymphoma involving the central nervous system (CNS)
Subject has experienced acute pathologic fracture or spinal cord compression within 28 days prior to first dose of study therapy
Participant has brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression.
Presence of tumor cells in the brain or spinal cord that have not been treated
Evidence of diffuse subependymal disease or tumor in the brainstem, cerebellum, spinal cord, or CSF.
Spinal cord compression or impending spinal cord compression
Untreated spinal cord compression
Brain metastases or spinal cord compression.
Spinal cord compression, leptomeningeal carcinomatosis or active symptomatic brain metastases
Known spinal cord compression or brain or liver metastasis
Unstable brain metastases or spinal cord compression
The participant has documented brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
Patients with known brain metastases or spinal cord compression should be excluded from this clinical trial
Imminent or established spinal cord compression based on clinical and/or imaging; in patients with untreated imminent or established spinal cord compression, treatment with standard of care as clinically indicated should be completed at least 4 weeks before enrollment
Patients with evidence of tumor in the brainstem, cerebellum, or spinal cord, radiological evidence of multifocal disease, or leptomeningeal disease
Following breast cancer disease conditions are not eligible:\r\n* Single bone lesion\r\n* Two or more visceral metastasis\r\n* Single visceral lesion < 2 cm without any laboratory changes or clinical symptoms due to the metastatic lesion is permitted\r\n* Presence of brain metastases\r\n* Imminent spinal cord compression based on clinical findings and/or MRI\r\n* Impending fracture, spinal cord compression, and/or potentially unstable compression fracture of vertebral body with possibility of cord compression\r\n* Life expectancy severely limited by concomitant illness (less than 12 months)\r\n* Concurrent external beam radiation therapy to non-target lesion is permitted
Brain metastases or spinal cord compression unless asymptomatic, treated and stable (not requiring steroids)
Has tumor localized primarily to the brainstem or spinal cord
Has tumor primarily localized to the brainstem or spinal cord
Patients with history of brain metastases, spinal cord compression, or a history of leptomeningeal carcinomatosis;
Spinal cord compression, symptomatic and unstable brain metastases, except for those patients who have completed definitive therapy, are not on steroids, have a stable neurologic status for at least 2 weeks after completion of the definitive therapy and steroids.
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; treated brain metastases must have been stable for at least 1 month
Patients who have symptomatic, uncontrolled spinal cord compression and/or brain metastases; a scan to confirm absence of brain metastasis is not required; patients can receive a stable dose of corticosteroids (except those prohibited per protocol) before/during study if these were started at least 28 days prior to entry
Patients with history of brain metastases, spinal cord compression, or leptomeningeal carcinomatosis
Current or imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI); treatment should be completed for spinal cord compression
Untreated brain metastasis or history of leptomeningeal disease or spinal cord compression.
The generated planning target volume 1 (PTV1) must be > 5 mm from the spinal cord or brain
The generated PTV1 is located within 5 mm of spinal cord or brain
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression
Active seizure disorder or evidence of brain metastases, spinal cord compression, or carcinomatous meningitis
Current leptomeningeal metastases or spinal cord compression due to disease.
Untreated symptomatic spinal cord compressions
History of, or current metastases in the brain, meninges, or untreated spinal cord compression
Have current spinal cord compression.
History of, or current known metastases in the brain or untreated spinal cord compression
Brain metastases or spinal cord compression or unless asymptomatic, treated and stable (not requiring steroids).
History of or known brain metastases, spinal cord compression, or carcinomatous meningitis
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI). Subjects with history of spinal cord compression should have completely recovered
Symptomatic brain or spinal cord metastases (patients must be stable for > 3 months post radiotherapy or surgery) for subjects with mesothelioma, NSCLC, uveal melanoma excludes subjects with HCC or glioma).
Unstable brain metastases or spinal cord compression that requires treatment, unless the treatment ended at least 4 weeks before starting treatment and the condition has been stable without steroid treatment for at least 10 days
Have active cancer in the brain or spinal cord
Subject has clinical signs suggestive of high or imminent risks for pathological fracture, spinal cord compression and/or cauda equina syndrome.
Spinal cord compression or brain metastases unless asymptomatic, treated and stable and not requiring steroids for at least 4 weeks prior to start of study treatment.
Active seizure disorder or evidence of brain metastases, spinal cord compression, or carcinomatous meningitis
Presence of symptomatic or untreated leptomeningeal or spinal cord compression. Subjects who have been previously treated for these conditions and have stable CNS disease (documented by consecutive imaging studies) for >60 days, are asymptomatic and currently not taking corticosteroids, or have been on a stable dose of corticosteroids for at least 30 days prior to enrollment, are permitted
Patients with spinal cord compression unless considered to have received definitive treatment for this and evidence of clinically stable disease for 28 days.
Histologically confirmed, previously untreated CD30+ classical HL; (participants receiving limited emergent radiation therapy [RT] or steroid therapy - maximum of 7 days - because of cardiopulmonary decompensation or spinal cord compression will be eligible for protocol enrollment)
Uncontrolled brain or spinal cord metastases
Patient with >= 1 asymptomatic spinal metastases of the thoracic spine OR >= 1 asymptomatic spinal metastases of the lumbar spine may be included; patients with spinal metastases to multiple vertebral levels may be included at the discretion of the investigator; however, only one vertebral level will be treated
Tumor to be treated should not directly about the spinal cord, and should have at least 5mm separation from the spinal cord; for patients with tumors closer than 5mm, inclusion is permissible at the discretion of the treating radiation oncologist such that dosimetric review demonstrates that the total dose to spinal cord is within tolerable range of < 10 Gy to 10% partial volume or max point dose 18 Gy
Any patient with symptoms of pain, compression fracture, neurologic deficit attributable to spinal metastases will not be included
History of brain metastases, spinal cord compression, or carcinomatous meningitis
Symptomatic or untreated leptomeningeal, CNS or brain metastases or spinal cord compression at the time of transition to this study.
Subjects with symptomatic brain metastases, spinal cord compression, or intractable back pain due to a compressive or destructive mass
Evidence of ongoing spinal cord compression or leptomeningeal carcinomatosis
E 07. History of brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis or new evidence of brain or leptomeningeal disease.
Patients with untreated spinal cord metastases or metastases close to vital organs (as determined by the principal investigator) are excluded
Must be no clinical or radiographic evidence of spinal cord compression
Prior spinal cord maximum dose at level of vertebral disease must be =< 50 Gy
Patients with stable CNS primary tumor, brain metastases, or treated spinal cord compression are eligible if neurological symptoms and steroid use (if applicable) have been stable for 7 days prior to the first dose of LOXO-195
Untreated spinal cord compression.
Patients must have symptomatic multiple myeloma without advanced organ damage (such as multiple fractures or advanced bone disease causing immobilization, renal failure, spinal cord compression, or organ compromise due to soft tissue plasmacytoma); if immediate therapy with radiation and high-dose steroids (e.g., for cord compression) or with bortezomib-based therapy (e.g., for renal failure) is required, the patient is not eligible for this trial
Brain metastases or spinal cord compression, unless treated at least 4 weeks before first dose and stable without steroid treatment for 10 days
Prior recipient of cord blood
Symptomatic or untreated leptomeningeal disease or brain metastases or spinal cord compression
Active central nervous system primary or secondary malignancies, active seizure disorder, spinal cord compression, or carcinomatous meningitis.
Spinal cord compression within 6 months
Spinal cord compression or canal compromise requiring decompression,
Leptomeningeal metastases or spinal cord compression due to disease.
Have symptomatic or uncontrolled brain metastases, spinal cord compression, or leptomeningeal disease requiring concurrent treatment
Brain metastases, or spinal cord compression. Individuals with brain metastases are allowed if they have been treated with irradiation or surgery, are clinically stable without steroid treatment. Individuals with documented leptomeningeal disease are not eligible.
Symptomatic leptomeningeal, brain metastases, or spinal cord compression.
Patients with brain metastases or spinal cord compression unless they completed radiation therapy >= 4 weeks prior to the first dose of ponatinib and are stable without steroids or anti-convulsant therapy for >= 10 days
Index tumor(s) causing clinical or radiographic evidence of spinal cord or cauda equine compression/effacement
History of or known spinal cord compression or carcinomatous meningitis
History of or known brain metastases, spinal cord compression, or carcinomatous meningitis, or evidence of brain or leptomeningeal disease on screening computed tomography (CT) scan or MRI
Patients may not have symptomatic, uncontrolled spinal cord compression and/or brain metastases; a scan to confirm absence of brain metastasis is not required; patients can receive a stable dose of corticosteroids before/ during study if these were started at least 28 days prior to entry
Patients with evidence of other tumor masses in the spinal cord will be eligible unless there is evidence of spinal cord block radiographically or clinically
History of spinal cord compression or brain metastases, unless asymptomatic, treated, stable, and not requiring treatment with steroids for at least 4 weeks before the planned administration of the first dose of study drug. Any history of leptomeningeal metastases.
Untreated or inadequately treated spinal cord compression
Brain metastases or spinal cord compression, unless treatment was completed at least 4 weeks before study entry, and stable without steroid treatment for at least 4 weeks
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression.
Known leptomeningeal involvement, brain metastases or spinal cord compression.
History of brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease.
Anatomical considerations:\r\n* If the patient has >= 4 sites; only the 3 most painful sites of disease will be treated; or, in the absence of pain, the 3 levels at greatest risk of impending collapse, based on extent of involvement, presence of posterior element involvement, or biomechanical risk based on location (mid-thoracic area, thoraco-lumbar junction, lumbosacral junction)\r\n* Spinal cord compression with or without peridural spread\r\n* Neurologic compromise due to spinal cord compression
Spinal cord compression or brain metastases unless asymptomatic and not requiring steroids for at least 4 weeks
CNS primary malignancies, active seizure disorder or spinal cord compression, or carcinomatous meningitis.
History of brain metastases, uncontrolled spinal cord compression, or carcinomatous meningitis or new evidence of brain or leptomeningeal disease
History of leptomeningeal disease or spinal cord compression secondary to metastasis.
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; treated brain metastases must have been stable for at least 1 month
Subjects with leptomeningeal or brain metastases or spinal cord compression.
Symptomatic or untreated brain metastases or spinal cord compression or any of these conditions requiring chronic steroids to control symptoms.
Brain metastasis or spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated central nervous system (CNS) metastases or spinal cord compression without evidence of clinically stable disease for >/=4 days. Note: Patients with treated CNS metastases who are asymptomatic and on a stable dose of corticosteroids for >/= 14 days prior to randomization are eligible.
PART II: Participants must be without evidence of active spinal cord compression
Patients presenting with untreated cord compression, visceral metastases or those in need of immediate treatment are not eligible (patients with prior treatment and stability will be eligible)
Subjects with CNS symptoms should undergo a CT scan or MRI of the brain to exclude new or progressive brain metastases. Spinal cord metastasis is acceptable. However, subjects with spinal cord compression should be excluded.
Prior chemotherapy or radiotherapy (other than limited, emergent radiotherapy for treatment of eg. spinal cord compromise or threatened airway)
Spinal cord compression or brain metastases unless asymptomatic, treated and stable (not requiring steroids).
History of or known presence of brain or spinal cord metastases
Participant has spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for >=2 weeks prior to screening Treatment-Specific Exclusion Criteria:
Brain metastases or spinal cord compression not definitively treated with surgery and/or radiation, or previously treated central nervous system (CNS) metastases or spinal cord compression without evidence of stable disease for >/= 14 days
Diagnosis of primary brain tumor; untreated brain metastasis or history of leptomeningeal disease or spinal cord compression;
Untreated brain metastasis or history of leptomeningeal disease or spinal cord compression;
Known brain or spinal cord metastases unless adequately treated (surgery or radiotherapy) with no evidence of progression and neurologically stable off anticonvulsants and steroids.
Has brain metastases, uncontrolled spinal cord compression, or leptomeningeal disease
Untreated or symptomatic brain metastasis, leptomeningeal disease or spinal cord compression. Subjects who are on a stable dose of corticosteroids for more than 1 month or off corticosteroids for 2 weeks can be enrolled with approval of medical monitor. Subjects are not permitted to receive enzyme-inducing anti-epileptic drugs.
Conditions related to tumor, which require emergency treatment (airway compression, spinal cord compression) since enrollment would delay initiation of such therapy
Symptomatic or untreated leptomeningeal or brain metastases or spinal cord compression; patients with treated central nervous system (CNS) metastasis, no longer requiring steroid therapy are potentially eligible; patients with primary glioblastoma multiforme not requiring steroid therapy will be eligible
Patients with a current, untreated spinal cord compression
Imminent spinal cord compression based on clinical findings and/or magnetic resonance imaging (MRI); treatment should be completed for spinal cord compression
Symptomatic or impending spinal cord compression or cauda equine syndrome
Symptomatic or impending spinal cord compression or cauda equina syndrome.
Spinal cord or cauda equine compression/effacement in vertebral metastases with neurological symptoms other than just pain for the lesion that is planned for treatment
Patents with cord compression
Patients with epidural compression are eligible provided that there is a >= 3 mm gap between the spinal cord and the edge of the epidural lesion
Frank spinal cord compression or displacement or epidural compression within 3 mm of the spinal cord
Presence of spinal cord injury including any form of paraplegia or quadriplegia
History of cerebrovascular accident or spinal cord injury since the mechanism of acupuncture may be associated with central nervous system activity
Previous brain metastases, leptomeningeal disease, or uncontrolled spinal cord compression.
Peripheral neuropathy caused by tumor infiltration or compression of spinal nerves or surgical trauma
History of cerebrovascular accident or spinal cord injury since the mechanism of acupuncture may be associated with central nervous system activity
Index tumor causing clinical or radiographic evidence of spinal cord or cauda equina compression/effacement
Any spinal pathology which can prevent safe administration of epidural/ spinal anesthesia
Eminent or established cord compression as assessed by medical record review
Spinal cord compression not definitively treated with surgery and/or radiation, or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for > 2 weeks prior to randomization
Spinal cord compression.
Primary brainstem or spinal cord tumor
History of leptomeningeal disease or spinal cord compression
Spinal cord compression is excluded unless the patient demonstrates good pain control attained through therapy and there is stabilization or recovery of neurological function for two weeks prior to study entry
History of spinal cord compression
Spinal cord compression not definitively treated with surgery and/or radiation or previously diagnosed and treated spinal cord compression without evidence that disease has been clinically stable for >= 2 weeks prior to enrollment
Known or suspected brain metastasis or active leptomeningeal disease or spinal cord compression
Spinal cord compression.
Brain metastases (even if treated and/or stable), spinal cord compression, carcinomatous meningitis, or leptomeningeal disease.
History of brain involvement with cancer, spinal cord compression, or carcinomatous meningitis, or new evidence of brain or leptomeningeal disease. Patients with radiated or resected lesions are permitted, provided the lesions are fully treated and inactive, patients are asymptomatic, and no steroids have been administered for brain edema for at least 28 days