Individualized Treatment Plan in Children and Young Adults With Relapsed Medulloblastoma

Inclusion Criteria:

1. Participants must have recurrent medulloblastoma.

2. Participants must have surgically accessable disease.

3. Prior Therapy:

4. The participant must have recurrent medulloblastoma following at least oneprior therapy for initial diagnosis or previous recurrence- surgery followed byhigh dose chemotherapy with stem cell rescue or multi-modality therapy ofsurgery, radiation and chemotherapy - prior to study registration.

5. Participants must have fully recovered from the acute toxic effects of allprior chemotherapy, immunotherapy, or radiotherapy prior to entering thisstudy.

• Myelosuppressive chemotherapy: Participants must have received their lastdose of known myelosuppressive anti-cancer chemotherapy at least 3 weeksprior to study registration (6 weeks prior if nitrosourea).
• Biologic agent: Participant must have recovered from any toxicitypotentially related to the agent and received their last dose of thebiologic agent no less than 7 days prior to study registration.
• For agents that have known adverse events occurring beyond 7 days afteradministration, this period must be extended to beyond the time duringwhich adverse events are known to occur. The duration of this intervalshould be discussed with the study chair.
• For biologic agents that have a prolonged half-life, the appropriateinterval since last treatment should be discussed with the Study Chairprior to registration.
• Monoclonal antibody treatment: At least three half-lives must have elapsedprior to registration. Such participants should be discussed with thestudy chair prior to registration. For bevacizumab, participants must havereceived last dose > 32 days prior to study registration.
• Bone Marrow Transplant: Participant must be >= 6 months since allogeneicbone marrow transplant prior to registration and >=3 months sinceautologous bone marrow/stem cell prior to registration.

4. Participant must be a candidate for surgical resection or biopsy. Minimum tissuerequirements for study are defined in Section 9.1.

5. Radiation - Participants must have:

6. Had their last fraction of local irradiation to primary tumor >= 12 weeks priorto registration; investigators are reminded to review potentially eligiblecases to avoid confusion with pseudo-progression.

7. Had their last fraction of craniospinal irradiation or total body irradiation >= 12 weeks prior to registration

8. At least 14 days after local palliative radiation (small-port)

9. Age >=12 months to <= 39 years of age.

10. Karnofsky >= 50 for participants > 16 years of age and Lansky >= 50 for participants <= 16 years of age. Participants who are unable to walk because of paralysis, butwho are up in a wheelchair, will be considered ambulatory for the purpose ofassessing the performance score.

11. Corticosteroids: Subjects who are receiving dexamethasone or equivalent must be on astable or decreasing dose for at least 1 week prior to registration.

12. Organ Function Requirements (within 7 days prior to study registration)

13. Adequate Bone Marrow Function Defined as:

• Peripheral absolute neutrophil count (ANC) >= 1000/mm3
• Platelet count >= 100,000/mm3 (transfusion independent, defined as notreceiving platelet transfusions for at least 7 days prior to enrollment).

2. Adequate Renal Function Defined as:

• Creatinine clearance or radioisotope GFR >= 70 milliliter/minute (mL/min) /1.73 m2 or
• A serum creatinine based on age/sex as follows:Age / Maximum Serum Creatinine (mg/dL) Male / Maximum Serum Creatinine (mg/dL)Female.
• 1 to < 2 years / 0.6 / 0.6.
• 2 to < 6 years / 0.8 / 0.8.
• 6 to < 10 years / 1 / 1.
• 10 to < 13 years / 1.2 / 1.2.
• 13 to < 16 years / 1.5 / 1.4.
• >= 16 years / 1.7 / 1.4.
• The threshold creatinine values in this table were derived from theSchwartz formula for estimating Glomerular filtration rate (GFR)utilizing child length and stature data published by the Center forDisease Control (CDC) (Schwartz GJ and Gauthier B 1985).

3. Adequate Liver Function Defined as:

• Bilirubin (sum of conjugated and unconjugated) <= 1.5 x upper limit ofnormal (ULN) for age.
• Serum glutamic-pyruvic transaminase (SGPT) / alanine aminotransferase (ALT) <= 110 U/L.
• Serum albumin >= 2 g/dL.

10. The effects of the agents used in this study on the developing human fetus areunknown. For this reason, women of child-bearing potential and men must agree to useadequate contraception (hormonal or barrier method of birth control; abstinence)prior to study entry, for the duration of study participation and 4 months aftercompletion of therapy administration. Should a woman become pregnant or suspect sheis pregnant while she or her partner is participating in this study, she shouldinform her treating physician immediately.

11. Adequate neurologic function defined as participants with seizure disorder may beenrolled if seizures are well controlled. Participants on non-enzyme inducinganticonvulsants may be excluded pending interaction(s) with study drug.

12. A legal parent/guardian or participant must be able to understand, and willing tosign, a written informed consent and assent document, as appropriate.

Exclusion Criteria:

1. Participants who have had chemotherapy or radiotherapy within 3 weeks (6 weeks fornitrosoureas or mitomycin C) prior to entering the study or those who have notrecovered from adverse events due to agents administered more than 4 weeks earlier.

2. Participants who are receiving any other investigational agents.

3. Participants must be at least 7 days since the completion of therapy with a biologicor small molecule agent. For any agent with known adverse events that can occurbeyond 7 days after administration, the period prior to enrollment must be beyondthe time during which adverse events are known to occur. Such participants shouldalso be discussed with study chairs.

4. Participants who are currently taking any anti-cancer direct therapy. Steroids arenot considered anti-cancer therapy.

5. Uncontrolled intercurrent illness including, but not limited to, ongoing or activeinfection.

6. Women of childbearing potential must not be pregnant or breast-feeding. A negativeserum or urine pregnancy test is required prior to start of therapy.

Important note: The eligibility criteria listed above are interpreted literally and cannot be waived.