ACNS0332, Efficacy of Carboplatin administered Concomitantly with Radiation and Isotretinoin as a Prop-Apoptotic Agent in Other Than Average Risk Medulloblastoma/PNET Patients.

Age greater than or equal to 3 and less than 22 years at the time of diagnosis. Newly diagnosed, previously untreated: (1) M0 Medulloblastoma with >1.5 cm2 residual; (2) M+ Medulloblastoma; (3) M0 or M+ Supratentorial PNET (including pineoblastoma). Patients with diffusely anaplastic medulloblastoma are eligible regardless of M-stage or residual tumor. A pre-operative MRI scan of the brain with and without contrast. Post-operative head MRI scan with and without contrast is required (preferably within 72 hours post-surgery). Spinal MRI imaging with and without gadolinium is required within 10 days of surgery if done preoperatively or within 28 days of surgery if done post-operatively. Lumbar CSF cytology examination must be obtained pre-operatively or within 31 days following surgery. Normal performance status and life expectancy > 8 weeks. No previous chemotherapy or radiation therapy. Patients taking Accutane (Isotretinoin) for acne must discontinue drug use with this indication prior to enrollment. Corticosteroids should not be used during chemotherapy administration as an antiemetic because of their effect on the blood-brain barrier. Isotretinoin is contraindicated in patients with parabens allergy as the capsule is preserved with the agent and patients with soybean allergy since Isotretinoin is suspended in soybean oil. Concurrent use with tetracyclines should be avoided due to reports of cases of pseudotumor cerebri with concurrent use. Clinically significant drug interactions have been reported when using vincristine with strong CYP450 3A4 inhibitors and inducers. Selected strong inhibitors of cytochrome P450 3A4 include azole antifungals, such as fluconazole, voriconazole, itraconazole, ketoconazole, and strong inducers include drugs such as rifampin, phenytoin, phenobarbitol, carbamazepine, and St. John[Single Quote]s wort. The use of these drugs should be avoided with vincristine. The clinical outcome and significance of CYP450 interactions with cyclophosphamide are less clear. CYP450 3A4 stimulators or inhibitors should be avoided or used with great caution. Aprepitant also interacts with CYP3A4 and should be used with caution with etoposide or vincristine chemotherapy. CISplatin should be used with caution with nephrotoxic drug. Aminoglycoside should be avoided or used with caution during or shortly after cisplatin administration and concomitant use with amphotericin B should probably also be avoided. Patients receiving CISplatin and other potentially ototoxic drugs such as aminoglycoside or loop diuretics concomitantly should be closely monitored for signs of ototoxicity. In patients receiving cisplatin and phenytoin or fosphenytoin, serum concentrations of phenytoin may decrease. Carbamazepine concentration may also decrease with concomitant use. Plasma levels of anticonvulsant agents should be monitored and doses adjusted during therapy with CISplatin. No other experimental therapy is permitted while on study. Adequate renal, liver and bone marrow function. All patients and/or their parents or legal guardians must sign a written informed consent. All institutional, FDA, and NCI requirements for human studies must be met. Spanish and Vietnamese speaking subjects are eligible to participate in this study using the Spanish and Vietnamese short form consent.